You have some options. The state of Texas has worked out a deal with most states for a "cheap" price (if I remember right, the number was between $200-$600 per rotation). I know some of my classmates who just didn't tell anyone and were never asked, and therefore never had to buy insurance. Finally, a few programs offer insurance at a reduced rate to rotators. If you can't get it, the private insurance is extremely expensive and labor intensive (in that you will have to do a lot of paperwork and phone calls to get it finalized). This is a problem, and The University of Texas system has opted to sit around and complain that the other programs are being unrealistic instead of trying to solve the problem. I had to explain this on nearly every interview I went on. Many other programs are becoming aware of the problem.