United States – Health Insurance

Is health insurance mandatory for expats in the United States?

Anyone intending to spend six months or more living in the US as a non-citizen should treat health insurance as a fundamental priority. Federal law stops short of mandating coverage for expats, but a number of individual states enforce their own tax penalties on residents who go without it. Your precise obligations will therefore depend largely on which state you call home.

Since 1 January 2019, the federal government no longer imposes a financial penalty — previously known as the individual shared responsibility payment — on people who fail to maintain minimum essential health coverage. That said, states retain the authority to establish their own requirements, so it is always worth investigating the rules that apply specifically where you will be residing.

Certain visa categories introduce their own compulsory insurance requirements that exist independently of federal law. J-1 visa holders, for instance, must maintain valid health insurance throughout their entire study or exchange programme. Any policy must satisfy standards set by the US Department of State, and failing to secure appropriate coverage can jeopardise both your visa and your right to remain in the country.

J-1 insurance must provide a minimum of $100,000 in coverage per accident or illness — with a deductible not exceeding $500 — along with $25,000 for the repatriation of remains and $50,000 for medical evacuation to your home country.

Regardless of whether insurance is formally required under your visa category, the financial exposure of being uninsured in the US is substantial. Routine medical appointments, diagnostic tests, and emergency treatments can all generate bills running into thousands of dollars, making adequate coverage a sound investment for any expat on a work, study, or dependent visa.

How does the public health system in the United States work?

The United States stands apart from most developed nations in that it lacks a universal healthcare system open to all residents. Healthcare is delivered through a combination of private providers, employer-sponsored plans, and government programmes that serve defined groups — most notably Medicare for older adults and Medicaid for those on lower incomes.

This model differs fundamentally from systems like the UK’s National Health Service or Australia’s Medicare, both of which extend coverage to all residents irrespective of employment or financial circumstances. In the US, individuals must proactively arrange their own coverage; there is no national health service an expat can simply sign up to upon arrival.

Federal-level public healthcare support is available for particular groups including military veterans, people aged 65 and over, and individuals living with disabilities. Medicaid reaches additional populations — children, pregnant women, and low-income adults — but the specific eligibility criteria and services provided differ considerably from state to state.

Non-citizen eligibility for federal healthcare programmes is shaped by both the programme in question and the individual’s immigration status. Federal law contains a range of restrictions that prevent certain categories of non-citizens from accessing these programmes.

Foreign visitors are ineligible for both Medicare and Medicaid, and most “lawfully present immigrants” must satisfy a five-year residency requirement before qualifying for these programmes. It is also worth noting that the US has no reciprocal healthcare agreements with other nations, meaning that any public health entitlement you hold in your country of origin will not carry over to the US.

The Affordable Care Act (ACA), passed in 2010, significantly broadened access to health insurance and created a government-operated marketplace where individuals can compare and purchase private plans. This marketplace — commonly referred to as “Obamacare” — allows lawfully present immigrants to shop for regulated coverage, with income-based subsidies available to those who qualify.

Non-citizens who lack health insurance may find themselves relying on the healthcare safety net, including federally qualified health centres that are obligated to treat patients regardless of their ability to pay. In 2023, over 15,500 such delivery sites across the United States collectively served more than 31 million patients.

How do expats register for public health coverage in the United States?

The path to obtaining coverage will depend on your immigration status and income level. Most expats will secure insurance through an employer, the ACA Marketplace, Medicaid (where eligible), or a private international plan. The steps below describe how to obtain coverage through the ACA Marketplace, which is typically the most accessible route for lawfully present immigrants who do not receive insurance through their employer.

1. Confirm your eligibility. Lawfully present immigrants are eligible for health coverage through the Health Insurance Marketplace, a service operated by the federal government that helps people shop for and enrol in health insurance. Review your immigration status against the eligibility criteria listed at HealthCare.gov to determine whether you qualify.
2. Gather your documents. Before applying, collect the relevant documentation: this may include your green card, employment authorisation document, and foreign passport. You should also have your Social Security Number (if applicable) and income details to hand.
3. Visit HealthCare.gov or your state’s marketplace. If your employer does not offer qualifying coverage that meets ACA standards, you will need to buy insurance through the marketplace during the open enrolment window. The marketplace is an online platform enabling you to compare plans from approved providers and select the level of coverage that suits your needs. You register through the marketplace for your state of residence.
4. Enrol during the open enrolment window. The open enrolment window runs for three months — from 1 November through 31 January. Once this period closes, you can only adjust or obtain coverage if you experience a qualifying life event such as marriage, divorce, the birth of a child, or the death of a family member.
5. Check for subsidies. If the cost of coverage is a concern, you may be entitled to the Premium Tax Credit, which helps bring down monthly premiums. This credit is calculated based on your income and household size, and can either be applied directly to your premium payments or claimed as a refundable credit on your tax return.
6. Apply for Medicaid or CHIP (if eligible). Applications for Medicaid and CHIP can be submitted at any point during the year through your state’s Medicaid or CHIP agency. Contact the relevant agency directly to obtain eligibility information and guidance on the application process.
7. Call for help if needed. If you would prefer to speak with an advisor, the toll-free Marketplace helpline is available at 1-800-318-2596. Support is offered in a variety of languages.

Always verify current eligibility rules and income thresholds with HealthCare.gov or your state’s health authority, as these rules are subject to change. Notably, provisions in the 2025 tax and budget law will eliminate eligibility for federally funded health coverage for many groups of lawfully present immigrants. Under the new law, eligibility for Medicaid, CHIP, subsidised Marketplace coverage, and Medicare will be limited to lawful permanent residents (green card holders), certain Cuban or Haitian entrants, and citizens of Compact of Free Association countries residing in the US. Check the official sources for the latest position.

What costs are involved in the public health system in the United States?

In contrast to single-payer models — such as the provincial health plans in Canada, where government taxes fund the bulk of medical costs — the US system requires individuals to shoulder premiums, deductibles, copayments, and coinsurance. For those accustomed to more straightforward state-funded healthcare, this multi-layered cost structure can take some adjustment.

Coinsurance refers to the proportion of a covered healthcare expense that you are required to pay personally once you have met your deductible. A copayment, or copay, is a set amount you contribute each time you receive a particular covered service.

For eligible immigrants accessing Medicare, the programme’s Part B component carries a monthly premium of $185 in 2025. Late enrolment carries a permanent penalty of 10% per 12-month period during which you were eligible but chose not to enrol. Always verify the current premium figure at Medicare.gov, as it is reviewed and adjusted each year.

If you hold “qualified non-citizen” status, you may be entitled to free or reduced-cost Medicaid and CHIP coverage, provided you meet your state’s income and residency criteria and have held your qualifying immigration status for at least five years. This waiting period does not apply to refugees, asylees, or lawful permanent residents who previously held refugee or asylee status.

Premiums for ACA Marketplace plans vary considerably based on the plan tier you select (Bronze, Silver, Gold, or Platinum), your age, your state of residence, and your income. Income-linked Premium Tax Credits can substantially reduce monthly costs for those who qualify. For current plan pricing and subsidy thresholds, consult HealthCare.gov, where figures are refreshed annually.

For expats purchasing private international plans that incorporate US coverage, annual premiums for individual policies in the United States averaged $15,296 according to Pacific Prime’s 2024 Cost of International Health Insurance Report — a figure that underscores just how costly US-inclusive coverage is relative to plans designed for other parts of the world.

What does public health cover in the United States include and exclude?

For those who do qualify for public programmes, the breadth of coverage depends on which programme applies. Medicare and Medicaid operate under distinct benefit frameworks, and ACA Marketplace coverage is delivered through regulated private insurers rather than being provided by the government itself.

Medicare offers free or low-cost health insurance to adults aged 65 and over, as well as to people living with disabilities or serious illnesses. It covers inpatient hospital care (Part A), outpatient visits and physician services (Part B), and — through private insurers — prescription medications (Part D). Standard Medicare does not extend to dental care, vision, or long-term care services.

Medicaid is a jointly funded federal and state programme providing free or low-cost coverage to qualifying low-income individuals, families, children, pregnant women, older adults, and people with disabilities. The range of services varies by state but typically encompasses doctor visits, hospital treatment, maternity care, and mental health services.

Emergency Medicaid may cover the treatment of a medical emergency for individuals who satisfy all applicable eligibility criteria — such as income and state residency — but who do not hold a qualifying immigration status. This provision functions as a safety net rather than a replacement for comprehensive coverage.

ACA Marketplace plans — private plans regulated under federal law — are required to cover ten categories of “essential health benefits.” These include emergency services, hospital stays, maternity and newborn care, mental health and substance use disorder treatment, prescription drugs, laboratory services, and preventive care. Dental and vision coverage for adults is generally available as an optional add-on rather than a standard inclusion, so it is important to examine plan details carefully.

Individual states may adopt more inclusive approaches to coverage. California, for example, permits all residents to enrol in Medi-Cal — its Medicaid programme — regardless of immigration status. As of April 2025, 14 states and the District of Columbia offer comprehensive state-funded coverage to children irrespective of their immigration background.

What are the advantages of international private health insurance for expats in the United States?

Given how restricted access to US public programmes is for the majority of expats, private health insurance is the central means of obtaining meaningful coverage. The benefits extend well beyond simply bridging a legal gap — in the US context, private plans deliver real and tangible advantages.

Depending on their visa status and intended length of stay, expats may choose between employer-provided plans, ACA Marketplace plans, or private international insurance. Plans designed specifically for internationally mobile individuals offer the greatest flexibility, particularly for those who travel between countries or who plan to stay in the US for a defined period before moving on.

Expat health insurance — also referred to as international health insurance — provides medical coverage for people residing outside their home country for extended periods. Unlike travel insurance, it encompasses routine care, hospitalisation, and ongoing medical needs, functioning much like a domestic health plan but with the added benefit of worldwide portability.

Private and international plans generally open the door to a wider network of specialists and hospitals and, in many cases, do not require a referral to see a specialist. The US healthcare system is home to some of the most advanced medical technology and expertise on the planet, especially in complex or specialised fields — a fact reflected by the 100,000 to 200,000 international patients who travel to the United States each year seeking treatments unavailable or less accessible in their home countries.

International plans with US coverage frequently bundle in medical evacuation, repatriation cover, and round-the-clock multilingual assistance — services absent from standard ACA domestic plans. Core coverage typically encompasses hospital admissions, emergency room visits, cancer treatment, and mental health services, with optional extras such as dental, vision, and maternity care available for an additional premium.

One effective way to reduce costs is to exclude US coverage from an international plan, which can bring premiums down by 20% to 40%. This may be a sensible choice if you expect to visit the US occasionally rather than reside there on a permanent basis.

How do international private health insurance plans work in the United States?

Providers such as Cigna Global, Allianz Care, and IMG all offer international health plans that include coverage within the United States. These policies are typically purchased online — either directly through the insurer or via an international insurance broker — and can often be activated before you set foot in the country.

When evaluating plans, the key variables to consider are:

• Inpatient vs outpatient cover: Inpatient cover for hospital stays is a standard feature of most plans. Outpatient cover — encompassing GP consultations, specialist visits, and diagnostic testing — typically costs more and is often sold as a separate add-on. Confirm precisely what is included in the core plan before committing.
• Network restrictions: Many US-based plans operate within a defined provider network under an HMO or PPO model. Using a provider outside your designated network can dramatically increase your out-of-pocket expenses, so understanding network boundaries is essential.
• Pre-existing conditions: Most international plans impose a waiting period or outright exclusion for pre-existing conditions. J-1 visa insurance plans, for instance, may set a waiting period for such conditions, provided the period is consistent with prevailing insurance industry standards.
• Geographic scope: Establish whether your plan covers you solely within the US or across a broader international territory. Some international plans extend protection across the US and more than 200 countries and territories worldwide.
• Direct billing: Certain international insurers settle medical bills directly with the treating provider, removing the need for you to pay upfront and seek reimbursement. Given the scale of US medical costs, this feature can be particularly valuable.

Premiums rise with age. A 30-year-old might pay around $1,500 per year for a plan that could cost a 60-year-old $5,000 or more (as of 2025). Adding optional benefits such as dental, vision, or maternity cover will push premiums higher still.

Some private and international insurers will accept applications without a Social Security Number, whereas government-subsidised plans generally require one. If you have just arrived and have not yet obtained a Social Security Number, a private international plan is likely to be your most immediately accessible option.

For those on work visas, employer-sponsored insurance remains the most common route to coverage. More than half of all people living in the US receive private health insurance through their employer. If your employer provides a plan, take the time to review it carefully — pay particular attention to deductibles, copayment structures, and whether the policy extends to your dependants.

What should expats watch out for with health insurance in the United States?

The US healthcare system presents a number of traps that frequently catch expats off guard. Familiarising yourself with the most common pitfalls before you arrive can spare you considerable expense, confusion, and frustration.

• Assuming your home country’s insurance will cover you. The vast majority of foreign health insurance policies do not provide adequate protection for care received in the United States unless you hold a specific global policy. Never assume your domestic plan applies — contact your insurer directly before travelling to confirm your position.
• Confusing travel insurance with health insurance. Travel insurance is designed to handle emergencies during short trips, typically with the goal of stabilising you and getting you back home. Expat health insurance, by contrast, provides comprehensive and ongoing coverage for people living abroad — including routine check-ups, preventive services, and extended hospital treatment. Travel insurance is not an adequate substitute for long-term expat coverage.
• Missing the enrolment window. The ACA Marketplace open enrolment period runs from 1 November to 31 January each year. Outside this window, enrolment is only possible if you experience a qualifying life event — such as relocating to the US, getting married, or having a child. Arriving in the country mid-year may itself constitute a qualifying trigger; check the details at HealthCare.gov.
• Underestimating out-of-pocket costs. Even with insurance in place, US healthcare involves meaningful personal expenditure through deductibles, copayments, and coinsurance. Expats and foreign visitors without valid insurance who require medical attention will face the full cost of any treatment directly — and those costs can be steep. Even minor procedures at a hospital emergency department can amount to hundreds of dollars.
• Ignoring state-level insurance mandates. Although the federal penalty for lacking coverage was eliminated in 2019, several states continue to enforce their own individual mandates. California, Massachusetts, New Jersey, Rhode Island, and Vermont are among those that currently impose tax penalties for going uninsured. Make sure you understand what applies in your state of residence.
• Not understanding network rules. If your plan operates as an HMO (Health Maintenance Organisation), you will generally be required to use in-network providers or face significantly elevated costs. Receiving care — even emergency care — from an out-of-network provider can result in substantial additional charges. Always verify a provider’s network status before attending an appointment or facility.
• Forgetting the five-year Medicaid waiting period. In most cases, lawfully present immigrants must hold a qualifying immigration status for five full years before they are entitled to enrol in Medicaid or CHIP. This means Medicaid is unlikely to be available as immediate coverage when you first arrive in the US, and you should plan accordingly.
• Legislative changes affecting eligibility. Eligibility rules for immigrants seeking US healthcare coverage are evolving. From 1 November 2025, many lawfully present individuals will no longer qualify for the tax credits that reduce the cost of Marketplace health plans. Always confirm your current entitlements directly at HealthCare.gov or by consulting a licensed insurance adviser.

Frequently asked questions: health insurance for expats in the United States

Can I use my home country’s health insurance in the United States?

The US does not have reciprocal healthcare agreements with other countries, so any public or universal coverage from your home country does not apply while you are in the US. You will need a policy — either a US-based plan or an international plan with explicit US coverage — to be protected.

Do I need private health insurance if I have a work visa for the United States?

For expats in the US, you must arrange your own health insurance — whether through an employer, a government exchange, or a private provider. Without it, even a short hospital visit can cost thousands of dollars out of pocket. Most work visa holders access coverage through their employer or purchase a plan through the ACA Marketplace if they are lawfully present.

Am I eligible for Medicare or Medicaid as an expat?

Most expats are not eligible for Medicare or Medicaid, which are reserved for US citizens or permanent residents under specific conditions such as age, income, or disability. However, green card holders may qualify after meeting residency requirements. The five-year waiting period applies to most lawful permanent residents for Medicaid and CHIP.

What is the ACA Marketplace and can I use it as a non-citizen?

Lawfully present immigrants are eligible for health coverage through the Health Insurance Marketplace, a service operated by the federal government that helps people shop for and enrol in health insurance. Eligible immigration statuses include individuals with non-immigrant status such as H-1, H-2A, H-2B workers, student visa holders, and other visa categories. Undocumented individuals are not eligible to purchase Marketplace plans.

Is there a penalty for not having health insurance in the United States?

As of January 2019, the federal tax penalty is no longer applicable to US citizens and residents, including those living abroad. However, some states impose their own tax penalties if you don’t have health insurance. Check the rules in your specific state of residence, as these vary significantly.

What is a deductible, and why does it matter?

A deductible is the amount you pay out of pocket before your insurance plan begins to cover costs. In the US, deductibles can range from zero to several thousand dollars per year. Increasing your deductible — for example, moving from a $0 deductible to $1,000 or $2,500 — can cut premiums substantially. Choosing the right balance between premium and deductible depends on how frequently you expect to use healthcare services.

What should I do if I arrive in the US and am not yet covered by any insurance?

If you arrive outside the ACA open enrolment period and do not yet have employer-sponsored insurance, an international private health insurance plan is typically your fastest option, as these can be purchased directly and activated quickly. Individuals without insurance may rely on federally qualified health centres, which are required to provide care to individuals regardless of their ability to pay. However, this is a safety net and not a substitute for proper insurance coverage.

How much does private health insurance cost for expats in the United States?

In 2025, individual expat health insurance premiums range from about $500 per year for basic coverage to over $10,000 per year for comprehensive plans including US coverage. The average is around $2,500 per year for mid-tier coverage in moderate-cost regions. US-inclusive international plans are significantly more expensive than those without US coverage — a plan with US coverage can cost 50–100% more than one without — so the decision to include or exclude US cover is one of the most important choices you will make when selecting a policy.