In the US insurance is usually covered by your credit card, or your personnel car insurance. You can get additional insurance through the rental company, but I never have. I have used that option in other country's. Totaled a rental in Ireland, and was glad to have it. Have to say that the experience in Ireland was amazing, everyone involved was so kind and helpful, the police, the medics, and hospital staff, and even the people I pulled out in front of, who had just purchased the car they were driving. Totally my fault, the left/right side of the road thing, and being used to looking one way first, and then the other when pulling out. The police helped us find a place to stay, and the hospital apologized for having to charge us $40 after my wife got a total workup, including x-rays and a prescription for pain medication. The other couple in the crash waited with my son and I until my wife was pronounced to be ok. That kind of thing just doesn't happen here in the US. Sorry for going on. Mike