The United States operates without a universal public healthcare system. Rather than providing care to all residents through a centrally funded model, it relies on a predominantly private, insurance-based structure in which your ability to see a doctor is largely determined by the coverage you carry. Expats relocating to the US need to secure health insurance before they arrive — whether through a job offer, the ACA Marketplace, or an international private plan — because medical expenses paid entirely out of pocket can reach staggering amounts.
| Item | Details |
|---|---|
| Healthcare model | Primarily private, insurance-based; limited public programmes (Medicare, Medicaid) with strict eligibility rules |
| Public eligibility for expats | Most newly arrived expats do not qualify for Medicare or Medicaid; lawful permanent residents may qualify for Medicaid after a 5-year waiting period (as of 2025) |
| Average international health insurance cost (USA) | Approx. $15,296 per year for an individual international plan including USA coverage (as of 2024) |
| ACA Marketplace open enrolment | 1 November – 15 January each year; coverage starts 1 January if enrolled by 15 December |
| Employer-sponsored insurance | The most common route for working expats; premiums shared between employer and employee |
| Official health information source | HealthCare.gov (federal ACA Marketplace) and CMS.gov (Centers for Medicare & Medicaid Services) |
How the US healthcare system works and what it means for expats
Where countries such as the United Kingdom and Canada provide healthcare through publicly funded systems that residents access without purchasing separate insurance, the US takes a fundamentally different approach. The American system blends private insurance, government programmes, and direct out-of-pocket payments, with the vast majority of hospitals and medical practices operating as private entities. There is no equivalent of the NHS or a single-payer national model.
At the federal level, publicly funded healthcare is reserved for defined groups: military veterans, people aged 65 and over, and individuals with qualifying disabilities. The two main programmes are Medicare, which serves those aged 65 and above, and Medicaid, a means-tested programme for low-income individuals and families. Medicaid covers categories including children, pregnant women, and low-income adults, but both the eligibility criteria and the scope of benefits differ from state to state. Enrolment is never automatic — applicants must submit applications and demonstrate their citizenship or lawful immigration status.
Immigrants seeking to enrol in Medicaid or the Children’s Health Insurance Program (CHIP) are generally required to complete a five-year waiting period after obtaining qualified noncitizen status. However, individual states retain the authority to waive this period for children and pregnant people. As of January 2025, 38 states have waived the waiting period for lawfully present immigrant children, while 32 states have done so for lawfully present pregnant immigrants.
Lawfully present immigrants become eligible to buy into Medicare upon turning 65, provided they have maintained legal US residency for at least five continuous years. Those aged 65 or older who have paid payroll taxes for ten years may qualify for Medicare without paying a Part A premium. Undocumented immigrants are ineligible for both Medicaid and Medicare and cannot receive financial assistance to purchase coverage through ACA marketplaces.
The Affordable Care Act (ACA), signed into law in 2010, broadened health insurance access and created a federally operated marketplace through which individuals can purchase plans. The ACA landscape is, however, evolving rapidly for immigrants. More than one million lawfully present immigrants stand to lose access to affordable marketplace coverage, Medicaid, or Medicare from 2026 onwards, as a consequence of H.R. 1 and an associated federal rule. Expats are strongly encouraged to monitor eligibility requirements closely through HealthCare.gov’s immigrant coverage pages and the Centers for Medicare & Medicaid Services (CMS).
How to find and register with a doctor in the United States
The US has no equivalent of the postcode-based GP registration systems common across much of Europe, where patients are assigned to a local practice. Instead, access to a primary care physician (PCP) — which may be a family medicine doctor, internist, or general practitioner — is shaped by the health insurance plan you hold. Insured individuals are expected to select a primary care provider from within their insurer’s approved network of providers.
Your starting point should be your insurance plan’s directory of in-network doctors. Consulting a provider who falls outside your network can result in dramatically higher costs or a complete absence of coverage. Hospitals, clinics, individual physicians, and even pharmacies participate in various networks, and a searchable list is typically available through your insurer’s online customer portal. Every insurer offers a “Find a Doctor” or equivalent search function for this purpose.
Once you have identified a suitable PCP, scheduling your inaugural appointment is relatively straightforward. You will need to book in advance, and waiting times for that first visit vary from a matter of hours to several weeks depending on the urgency of your needs. Unlike some national systems, there are no geographic catchment boundaries dictating which provider you may use — you are free to choose any in-network doctor regardless of location.
When attending your first appointment, expect to bring a valid photo ID, your insurance card, and your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) if one has been issued to you. Most practices ask new patients to complete a health history questionnaire. There is no central registration database in the US; your patient relationship is established directly with the individual clinic or practice you choose.
Students arriving on a student visa have the option to purchase health insurance through their college or university. Eligibility may depend on being enrolled in a minimum number of credit hours. Contacting your institution’s health centre is the best way to understand what options are available to you.
For those without insurance, community health resources offer an important alternative. Federally Qualified Health Centers (FQHCs) provide primary care on a sliding-scale fee structure, meaning charges are adjusted according to your income regardless of insurance status. The HRSA Health Center Finder can help you identify the nearest facility.
The process of registering with a primary care doctor can be broken down into the following steps:
- Obtain health insurance: Secure coverage through your employer, the ACA Marketplace at HealthCare.gov, or a private international health plan before seeking care.
- Access your insurer’s provider directory: Log in to your insurer’s website or app and search for in-network primary care physicians near your home address.
- Confirm acceptance of new patients: Call the practice directly to confirm they are taking new patients and that they accept your specific insurance plan.
- Book a new patient appointment: Schedule an appointment, noting that first visits can sometimes take several weeks to arrange for non-urgent needs.
- Gather your documents: Bring your insurance card, photo ID, any existing medical records or a GP summary from your home country, and a list of current medications.
- Complete new patient paperwork: Arrive early to fill out health history forms, consent documents, and insurance information at the clinic.
- Establish your care relationship: At your first appointment, discuss your medical history, existing conditions, and any ongoing prescriptions with your new doctor.
How to pay for a doctor’s appointment in the United States
Funding for private healthcare in the US flows primarily through insurance premiums paid by employers and individuals, with patients also contributing through various forms of cost-sharing at the point of care. This contrasts sharply with social insurance frameworks — such as those in Germany or France — where mandatory payroll contributions fund a broadly universal system. In the US, you pay a recurring monthly premium to maintain your plan, and then contribute further each time you receive medical attention.
A visit to the doctor typically involves several distinct layers of cost. A deductible is the total amount you must personally cover before your insurer begins sharing the expense. Once your deductible has been met, you may still owe co-payments — fixed charges for specific services or prescriptions. A typical co-payment for a primary care appointment ranges from $20 to $50, though this varies considerably depending on your plan; always consult your plan documents for the precise figures applicable to your coverage.
Out-of-pocket expenditure in the US is shaped by several factors: high deductibles, coinsurance requirements, unexpected charges from out-of-network providers, and services that fall entirely outside your plan’s coverage. These financial exposures represent a marked structural difference from most European healthcare models, where patient cost-sharing is generally more predictable and capped at relatively modest levels. Total US health expenditure reached approximately $14,900 per person (PPP-adjusted) in 2024, equating to 17.6% of GDP.
If you are employed in the US, your employer will often contribute a share of your monthly premium as part of your overall compensation. Expats may be able to purchase their own insurance independently, negotiate an employer contribution toward a private plan, or in some cases join their employer’s group benefits scheme directly. For current details on ACA plan costs and available premium tax credits, visit HealthCare.gov’s cost information page.
Lower-income individuals who qualify may be entitled to a Premium Tax Credit to help offset the cost of monthly premiums. This credit can either be applied directly to your insurer on your behalf or claimed as a refundable credit when you file your annual tax return. The credit amount is calculated based on your household income and family size. Eligibility rules are subject to change, so you should confirm your current status directly at HealthCare.gov.
Whether expats need private health insurance to see a doctor in the United States
For any expat living in the US, holding private health insurance is not merely advisable — it is a practical necessity. While most states do not legally compel expats to maintain coverage, operating without it exposes you to a healthcare system that can become inaccessible or financially devastating in moments of serious illness or injury. Uninsured individuals in the US who experience a major medical event routinely face bills that can lead to severe financial hardship or even bankruptcy.
International health insurance with comprehensive US coverage gives expats a pathway to some of the world’s leading private hospitals and medical facilities. These institutions are widely recognised for the quality of care they offer, but that quality comes at a price that is largely unmanageable without insurance.
The US consistently records the highest international health insurance premiums globally. According to Pacific Prime’s 2024 Cost of International Health Insurance Report, average annual individual premiums ranged from $3,900 in Poland to $15,296 in the United States. Expats who do not require US-specific coverage can achieve premium reductions of between 20% and 40% by excluding the US from their plan.
Unlike Germany, France, and Spain — which require proof of health coverage as a condition of obtaining a residency permit — the US does not mandate insurance documentation for most visa categories. Nevertheless, this legal distinction does nothing to reduce the real-world importance of holding adequate coverage given how costly US healthcare can be. Every individual has the right to purchase health insurance regardless of their immigration status. The ACA Marketplace open enrolment period runs from 1 November to 15 January each year, during which you can take out a new plan, renew an existing one, or modify your current coverage. Enrolling by 15 December means your coverage begins on 1 January; enrolments completed after that date result in a 1 February start.
It is equally important to note that ACA eligibility rules for non-citizens are in a state of significant flux. Starting in 2025, a series of federal policy changes introduced by the Trump Administration have materially affected coverage eligibility, access to public benefits, and healthcare protections for immigrant families. Expats should verify their eligibility directly with HealthCare.gov and, where immigration circumstances are complex, seek guidance from a qualified immigration attorney.
How to transfer your medical records to a doctor in the United States
No single national electronic health record system links all US healthcare providers. Patient records are maintained at the individual practice or hospital level, and the responsibility for bringing relevant medical history to a new provider rests with the patient. Before departing your home country, it is strongly advisable to request a thorough medical summary from your current GP or any specialists you see regularly.
Anyone travelling with pre-existing or complex medical conditions should ideally carry a doctor’s letter detailing their diagnoses, known allergies, blood type, and current medications — including generic drug names. Where the destination country’s primary medical language differs from English, a professionally translated version of this documentation is recommended. Because English is the working language of healthcare throughout the US, records originating from English-speaking countries will generally be usable without translation, while records in other languages should be translated before your first appointment.
When attending your initial US consultation, bring your translated medical summary, a complete medication list with generic names, documentation of any allergies, an up-to-date vaccination record, and reports or imaging from any significant recent investigations. Your new provider will build a fresh patient file in their own electronic health record (EHR) system — widely used platforms in the US include Epic, Cerner, and Athenahealth.
A growing range of mobile applications now allow individuals to store and access medical records, medication lists, electrocardiograms, and other health data directly from their devices, which can be particularly useful when attending urgent or unfamiliar appointments. The HealthIT.gov website maintained by the federal government provides guidance on patients’ rights to access their electronic health information. Under US law, you are entitled to request copies of your health records from any US provider, and they are obliged to furnish them — typically within thirty days of receiving your request.
Once you have established an ongoing relationship with a US primary care physician, they can request records from other US providers directly, provided you give written authorisation. If medical records from your home country are needed during an emergency situation, ensure that documentation of any overseas treatment — including medications — is shared promptly with the providers responsible for your care.
Language barriers and finding a doctor in the United States: what expats should know
English is the dominant language of medical practice throughout the United States. That said, the country’s exceptionally diverse population means that language support is more readily available than in many other destinations, particularly within major metropolitan areas. A substantial proportion of US physicians completed their medical training abroad, which considerably increases the chances of finding a provider who shares your native language — especially in cities home to large immigrant communities.
Foreign-born doctors make up a meaningful share of the US primary care workforce. In 2022, 70% of matched non-US international medical graduates secured positions in internal medicine, family medicine, or paediatrics. This internationally trained cohort enhances linguistic and cultural accessibility for expat patients, particularly in urban settings.
Federal law obliges healthcare providers who receive federal funding to make language assistance available. Under Title VI, hospitals and clinics that accept Medicare or Medicaid reimbursement must offer interpretation services to patients at no charge. You can arrange an interpreter when booking your appointment — by phone or in person — and the service must be provided without any cost to you.
In rural regions, the availability of in-person interpreters is often more limited, and identifying a physician who speaks a language other than English can be more difficult. Telephone and video interpretation services are commonly used in these settings as practical alternatives. Services such as Language Line are widely contracted by healthcare facilities and can provide real-time interpretation across hundreds of languages.
To locate doctors who consult in a specific language, search your insurer’s provider directory using the language filter, check with your country’s embassy or consulate for lists of recommended local providers, or draw on expat networks and online forums. Communities such as Expat Forum often feature city-specific recommendations shared by residents with first-hand experience. In some major cities, internationally oriented medical centres cater specifically to non-English-speaking patient populations.
Prescriptions and medication in the United States: essential information for expats
Prescription and over-the-counter medications are widely available across US pharmacies, as well as in many supermarkets and grocery stores, making it straightforward to obtain medicines once they have been prescribed. However, prescriptions written by doctors in other countries are not recognised in the US. Any ongoing medication you take will need to be re-prescribed by a licensed US physician, which underscores the importance of establishing care with a local doctor promptly upon arrival.
When making the transition, bring the original packaging of any medications you currently take from your home country. The packaging will display the generic (international nonproprietary) name of the drug, which your new US doctor will need in order to identify the correct domestic equivalent. Many medications sold under familiar brand names in other countries may be marketed under entirely different names in the US. Your physician will also need to assess whether the equivalent prescription is clinically appropriate for your situation under US treatment guidelines.
Prescription drug costs vary considerably in the US depending on whether a medication is generic or brand-name and whether it features on your insurer’s formulary — the approved list of covered drugs. Generic medications are generally far less expensive than their brand-name counterparts. Holding health insurance is therefore important not only for access but also for managing the cost of ongoing prescriptions. If you pay upfront, retaining all receipts and invoices allows you to submit a reimbursement claim to your insurer subsequently.
The US has no equivalent of Australia’s Pharmaceutical Benefits Scheme or the UK’s flat-rate NHS prescription charge — there is no universal government subsidy for medicines. Cost exposure from high deductibles, coinsurance, and uncovered drugs can be significant. Free comparison tools such as GoodRx allow patients to compare drug prices across local pharmacies and access discount coupons, which can meaningfully reduce out-of-pocket costs even for those who hold insurance.
For those eligible for Medicare — principally lawfully present residents aged 65 and above — Medicare Part D provides prescription drug coverage. From 2025, an annual out-of-pocket cap of $2,000 applies to prescription medications covered under Part D plans and Medicare Advantage prescription drug plans. All Part D-covered medications, including specialty drugs, are counted toward this cap. Because these thresholds are reviewed annually, check the most current figures directly at Medicare.gov.
If you are bringing a supply of medication with you when you first arrive in the US, keep all items in their original, clearly labelled containers and carry a letter from your prescribing physician that sets out each medication, the prescribed dosage, and the clinical reason for its use. Before travelling, consult the embassy of the destination country to confirm that your medications are permitted for import, as certain controlled substances may require additional documentation to enter legally.
Frequently Asked Questions
What should I do in a medical emergency in the United States?
If you face a genuine medical emergency, dial 911 or proceed immediately to the nearest hospital emergency room (ER). The Emergency Medical Treatment and Labor Act (EMTALA) requires all hospital emergency departments receiving Medicare funding to evaluate and stabilise any patient experiencing a medical emergency, irrespective of their insurance status or capacity to pay. A bill will follow regardless. Emergency room treatment in the US is extraordinarily expensive — charges can run to tens of thousands of dollars — which is why arranging health insurance before you arrive is so important.
Will a pre-existing condition be covered by US health insurance?
Under the Affordable Care Act, ACA Marketplace plans are prohibited from denying coverage or charging higher premiums on account of a pre-existing health condition. Coverage obtained through an ACA-compliant plan or an employer group plan should therefore include your existing conditions. Be aware, however, that short-term health plans and certain other non-ACA-compliant products may still exclude pre-existing conditions. Read all plan terms thoroughly and verify pre-existing condition protections before committing to any policy.
How long does it take to see a doctor for the first time in the US?
Wait times depend on the purpose of your visit. For routine or preventive care, a new patient appointment with a primary care physician can take two to four weeks or longer, particularly at busy practices in large cities. Urgent care centres provide a quicker alternative for non-emergency issues that still require timely attention, frequently offering walk-in or same-day appointments. Federal regulations oblige insurers to authorise urgent care within 72 hours and routine care within seven days.
What happens to my healthcare coverage if I change or lose my job?
Employer-sponsored health insurance is linked to your continued employment. If your employment ends for any reason, your workplace coverage will generally cease at the same time. You may be able to extend the same plan temporarily through COBRA (Consolidated Omnibus Budget Reconciliation Act), though under COBRA you assume the full cost of the premium yourself, which can be substantial. Alternatively, the loss of employer-sponsored coverage constitutes a qualifying life event, entitling you to enrol in an ACA Marketplace plan outside the standard open enrolment window. Full details are available at HealthCare.gov’s Special Enrolment page.
Can I use my home country’s health insurance or European Health Insurance Card (EHIC) in the US?
No. Neither foreign national health insurance plans nor cards such as the European Health Insurance Card (EHIC) carry any validity in the United States. The US has no reciprocal healthcare arrangements with other nations. You must obtain separate health insurance that is specifically designed to provide cover within the US. Some international health insurance products are structured to include US coverage, but you should verify this explicitly with your insurer before travelling.
Are there free or low-cost clinics if I cannot afford health insurance?
Regardless of your immigration status or financial situation, you have the right to access healthcare even without insurance. Federally Qualified Health Centers (FQHCs) deliver primary care services using a sliding-scale fee structure that adjusts charges to reflect your income level. Free clinics also operate throughout many communities across the country. To find a facility near you, use the HRSA Health Center Finder.
Do US visa applications require proof of health insurance?
The majority of US visa categories — including common non-immigrant visas such as the H-1B work visa, F-1 student visa, and B-1/B-2 visitor visa — do not formally stipulate proof of health insurance as a visa condition. Some universities, however, require enrolled students to carry health insurance as a term of their enrolment. Although insurance is not always a legal requirement, the financial exposure created by uninsured medical care in the US makes it strongly advisable in every case. Consult the US Department of State and your sponsoring institution for requirements that apply to your specific visa category.
How do I find a doctor who speaks my language in the US?
Begin with your insurer’s online provider directory, which typically includes a language filter allowing you to search for physicians who consult in your preferred language. Your nearest embassy or consulate may also hold a list of locally recommended healthcare providers. Online patient reviews are another useful resource, and given that a significant portion of US physicians received their training internationally, the chances of finding a provider who speaks your language are especially good in larger cities. Your hospital or clinic is also legally required to supply interpretation services at no cost to you whenever they are needed.