Yes, foreign visitors definitely need car insurance if they get behind the wheel in the US.
The vast majority of states in the US require you to be insured anytime you're driving a car. Even in the few that don't drivers are still financially responsible for any damage resulting from an accident they cause.
What happens if I'm driving without insurance and I get in an accident as a foreign visitor to the US?
There are two serious consequences. First, you may end up owing tens of thousands of dollars for other people's medical care and damage to their car if you are responsible for causing the crash. Second, you may end up charged with a crime.
Don't put yourself in a bad spot.
Driving without insurance may leave you stuck with other people's medical bills.
Healthcare in the US is infamously expensive. Imagine a crash where you hit another car from the rear. The passengers inside are taken to the hospital by ambulance, which is a paid service in the US. There are likely to be charges for X-rays or other diagnostic tests plus emergency room fees and doctors' bills.
Even if nobody is seriously injured, these costs could total $10,000 or more per passenger. And if anyone is admitted to the hospital, the costs could easily be ten times as much.
If the passengers have health insurance, their insurance company will usually pay for their treatment first, then go after any insurance the driver has for repayment. And if there's no car insurance, the health insurance company can sue the driver directly. If the injured passengers don't have insurance, the hospital will be the party chasing for payment.
Driving uninsured is a crime in most states
In almost every state, insurance is required to drive a car. If you are caught driving without insurance, either because you get pulled over for speeding or another traffic violation, or after an accident, you will likely face civil or criminal penalties.
These vary by state and based on the situation, but driving without insurance in the US can result in fines of thousands of dollars or even jail time.
None of this is anything you want to complicate your stay in the US. Being insured is the better option.
For more information on car insurance for visitors to the United States read our articles on how to buy car insurance as an expat and how to save money on car insurance if you don't have a US driving license.