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Unlike many European, and other nations, the USA is a private insurance-driven health care system.

Health care services are available to the uninsured on a “pay as you go” type of arrangement. Costs vary by state, as does the cost of insurance plans.

Insurance plans have a variety of offerings and coverage, ranging from basic doctor visits to every health care interaction, prescription coverage, dental and vision services. Insurance plans all have a “deductible” and will involve “co-pay.” The deductible, just like vehicle insurance, is the amount you have to pay “out of pocket” before the insurance company will start to reimburse health care expenses. The co-pay is the amount you will need to pay to the health care provider at each interaction; for example, you may be required to pay your family doctor $25 per person per visit. It is worth noting that not all treatments or procedures are covered by health insurance, so it is important to check your policy before undergoing any “experimental” treatment or non-standard procedures.

Most people in the USA receive health insurance through their employers, but employment is no longer a guarantee of health insurance coverage. In recent times, as the US moves to a more service-based economy, health insurance coverage through an employee has become less accessible.

In addition, health insurance premiums have risen significantly over recent years and many small employers cannot afford to offer health benefits. Companies that do offer health insurance often require employees to contribute a larger share toward their coverage. As a result, an increasing number of Americans have opted not to take advantage of job-based health insurance because they cannot afford it.

For certain low-income families and individuals who can not afford health insurance, government programs like Medicaid and Medicare are available. Medicaid is a means-tested program designed for families and individuals who meet certain criteria; each state has its own set of criteria, and just because one is considered “poor” does not mean one will be eligible for Medicaid. Medicare provides health insurance to people aged 65 and older.

Nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007. The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 62 percent in 2007. This is the lowest level of employment-based insurance coverage in more than a decade. However, the large majority of the uninsured (80 percent) are native or naturalized citizens.

For those purchasing health insurance on their own, instead of through an employer, there are a number of health insurance companies to choose from, including Allstate, Blue Cross and Blue Shield, Fortis, and Kaiser Permanente, just to name a few. Expats may want to consider purchasing international health insurance from a company like BUPA. International health insurance premiums tend to be cheaper than most local insurance companies (although be aware that the US has the most expensive medical care in the world, so premiums are adjusted for this). International health insurance is particularly useful if you will be spending a long time away from your home country or if you will be traveling to many different countries, as the coverage follows you wherever you go. For expats who will be spending a short amount of time in the US, general travel insurance should cover most medical needs.

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Expat Focus would like to acknowledge the kind help given by Kirstie Wilson of British Business Connection in compiling this guide.

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