Check with your automobile insurance policy, if you have one. While the policy might be written on that sedan parked in an airport parking lot miles away from your current vacation spot, the policy should cover your liability as a driver no matter where you roam.
Call your credit card company to see if it offers any coverage that would make rental car insurance unnecessary. Even if you don't have auto insurance, with the right credit card, you still might be able to forgo the rental policy.
Consider buying a non-owned auto liability insurance policy rather than rental car insurance if you rent often and don't have your own auto policy. This policy covers whether you're driving a rented car or a friend's vehicle and makes the most sense for drivers who don't have their own cars.
Get a rental car insurance policy on your rental if you don't have auto insurance, a credit card that would cover damage to a car rental--and don't want to get a non-owner auto liability insurance policy. This option makes the most sense for foreigners who will be in the country briefly rather than repeat times in a year.