Yes, travel insurance is close to essential for a trip to Maewo, a remote island in Vanuatu's Penama province known locally for its many waterfalls and streams. Maewo sits well outside the country's main population center, and the honest core of the insurance question here is evacuation logistics rather than any dramatic danger on the ground.
Local medical facilities on Maewo are limited to what a small island community can support, and anything beyond minor care typically means transfer first to Port Vila, Vanuatu's capital and its main hospital hub, with onward evacuation to Australia or New Zealand reserved for the most complex cases. Confirm your policy explicitly covers inter-island medical evacuation and international repatriation, since a policy that only reimburses local clinic visits misses the part that actually matters on an island this remote.
Getting to and from Maewo typically means a small domestic flight or boat connection from Port Vila, and that link is genuinely vulnerable to weather. Cyclone season across the South Pacific runs roughly November through April, and storms during this window can suspend inter-island transport for days, which matters for trip-delay cover as much as medical protection. Communications across the island are limited outside the main settlements, so contacting an insurer's assistance line in a genuine emergency can itself take time, which is worth factoring into how quickly outside help can realistically arrive.
Keep any clinic paperwork, boat or charter documentation, and receipts for emergency transport if you need to file a claim, since documentation is scarce and easy to lose track of in a place this remote. Check whether your existing health cover extends abroad and specifically to Vanuatu before relying on it, since most home plans were never designed for a destination this remote. Many policies also require notification before major expenses like evacuation are incurred, so check the claims process in your policy wording well before you travel rather than after something happens.