United States – Health Service

What is the standard of healthcare in the United States?

The US is home to some of the most technologically advanced hospitals and specialist medical centres anywhere in the world. In major cities — among them New York, Boston, Chicago, Houston, and Los Angeles — internationally regarded teaching hospitals and specialist clinics deliver cutting-edge diagnostics, complex surgical interventions, and active clinical research programmes. For those who have comprehensive insurance and reside near well-resourced facilities, the level of care on offer is genuinely exceptional.

That said, quality and accessibility are far from uniform across the country. The number of primary care providers relative to the population is noticeably lower in rural communities than in cities, and patients in remote areas may face considerable distances and expense simply to reach basic care — with access to subspecialty services even more constrained. This stands in stark contrast to systems such as the UK’s NHS or Canada’s publicly funded model, where a guaranteed standard of care is available regardless of where a person lives. The market-driven character of US healthcare means that geography plays a decisive role in what patients can realistically expect.

Since 2005, close to 200 rural hospitals have closed or discontinued inpatient services, eliminating local access to emergency care, maternity units, chemotherapy, and other essential services, and between 400 and 700 additional rural hospitals are presently considered at risk of closure. When nearby facilities disappear, people delay seeking care, travel long distances, or simply go without treatment altogether.

For expats planning to settle in the US, where you choose to live will directly shape the quality and availability of healthcare open to you. Choosing a major metropolitan area typically means proximity to world-class facilities, whereas moving to a rural region demands careful advance planning. For authoritative assessments of US healthcare quality, consult the WHO United States country profile and the U.S. Department of Health and Human Services (HHS).

How is healthcare funded, and is private health insurance necessary?

The US healthcare system is best characterised as a mixed model that relies predominantly on private insurance and direct out-of-pocket payments, distinguishing it sharply from the tax-funded Beveridge-style systems of the UK and Scandinavia, or the social insurance frameworks common across much of continental Europe. There is no universal healthcare programme; instead, care is delivered through a combination of private providers, employer-sponsored insurance plans, and government schemes for defined eligible groups — principally Medicare for older adults and Medicaid for lower-income residents.

Private health insurance represents the single largest source of healthcare financing in the country, accounting for $1.6 trillion and 31% of total national healthcare expenditure in 2024. Total health spending reached $5.3 trillion, or $15,474 per person, in the same year. Numbers on this scale make it clear that insurance is not simply advisable — it is a practical necessity for anyone residing in the US.

Government health insurance programmes — Medicare, Medicaid, and the Children’s Health Insurance Programme (CHIP) — are administered by the Centers for Medicare & Medicaid Services (CMS) and funded primarily through taxation. Medicare is the largest public payer, covering individuals aged 65 and over irrespective of income or medical history, as well as people under 65 with permanent disabilities or end-stage renal disease. Medicaid supports individuals living below the poverty line or who otherwise cannot afford healthcare, with funding shared between the federal government and each state.

The overwhelming majority of expats are not eligible for Medicare or Medicaid, which are reserved for US citizens or permanent residents under particular criteria relating to age, income, or disability. Green card holders may qualify once residency requirements have been satisfied. Those on temporary visas, tourists, and most newly arrived foreign nationals have no entitlement to subsidised public healthcare.

Lawfully present immigrants can purchase coverage through the ACA Health Insurance Marketplace and may be eligible for premium tax credits depending on their income level. However, the eligibility rules for non-citizens are subject to change — readers should verify their current entitlements directly with HealthCare.gov or the HHS.

US law does not compel most expatriates to hold health insurance. Nevertheless, the cost of medical care is so formidable that being uninsured exposes you to the very real risk of catastrophic financial loss. From a practical standpoint, comprehensive health coverage must be treated as essential from the moment you arrive.

How do I register with a doctor or access primary care?

In many countries, patients are formally enrolled with a single GP or family doctor through a public network. The US works differently: you select a primary care physician (PCP) from the list of providers approved under your insurance plan’s network. Your insurer supplies a directory of in-network doctors in your area, and you arrange an appointment directly with the practice of your choice.

There is no centralised national registration process comparable to signing up with an NHS GP or designating a médecin traitant in France. The practical steps instead involve confirming which physicians are covered by your specific plan, contacting the practice to be accepted as a new patient, and completing intake paperwork that generally asks for your insurance details, identification, and medical history. First-time appointments at a new practice can take longer to secure than follow-up visits for established patients.

Even for people who already have a regular source of primary care, the average waiting time for a family medicine appointment stands at 20.6 days — a delay that can push people toward more expensive alternatives such as emergency rooms. Arranging a PCP immediately on arrival, rather than waiting until illness strikes, is strongly recommended.

Primary care visits are not free at the point of use. Most plans require a co-payment per visit — commonly $20–$50 as of 2024, though this differs significantly across plans — and additional costs may apply before your annual deductible has been reached. Federally Qualified Health Centers (FQHCs) offer sliding-scale fee primary care to uninsured or low-income patients regardless of immigration status, serving more than 27 million people each year and helping to ease pressure on emergency departments while improving management of chronic conditions. Locate your nearest FQHC through the HRSA Health Center Finder.

How do I set up primary care as a new arrival in the US?

1. Obtain health insurance — Through your employer’s benefits package, the ACA Marketplace at HealthCare.gov, or a private international insurer before or immediately upon arrival.
2. Review your plan’s provider directory — Log in to your insurer’s portal or call the member services number to identify in-network primary care physicians near your home address.
3. Contact the practice — Call or use the practice’s online booking system to register as a new patient and schedule an initial appointment.
4. Prepare your documents — Bring your insurance card, a government-issued photo ID (passport is fine), and any relevant medical records or vaccination history from your home country.
5. Complete intake forms — New patients complete a health history questionnaire and authorise the practice to bill your insurer directly.
6. Pay any co-payment — Confirm the co-payment amount before your visit; pay at the time of the appointment unless your plan covers the visit at no cost.
7. Establish a relationship — Your PCP will become the gateway for referrals to specialists and for managing ongoing or chronic conditions.

What services do hospitals provide, and what should patients expect?

Hospitals in the US — particularly those located in larger cities — provide an exceptionally wide spectrum of services, ranging from routine surgical procedures and maternity care through to advanced oncology, cardiac surgery, neurology, and organ transplantation. Academic medical centres attached to major universities, such as the Mayo Clinic, Johns Hopkins, and Massachusetts General Hospital, enjoy international reputations for specialist treatment and medical research. Private hospitals typically offer modern infrastructure, private rooms, and a relatively smooth admission experience for patients with adequate insurance coverage.

Public hospitals and safety-net institutions serve uninsured and low-income patients and are legally obligated under the federal Emergency Medical Treatment and Labor Act (EMTALA) to carry out a medical screening and provide stabilising care irrespective of a patient’s ability to pay. It is important to note, however, that stabilisation is legally distinct from comprehensive treatment, and uninsured patients — including foreign nationals — can still face substantial bills even following emergency care. Carrying your insurance card and your insurer’s contact number at all times is advisable.

One aspect of hospitalisation in the US that often surprises arrivals from other parts of the world is the role of family members. In the US, nursing staff take full responsibility for all clinical and personal care during an inpatient stay. Family and friends are welcomed as visitors and sources of emotional support, but they are neither expected nor required to provide hands-on nursing care. This differs considerably from the norm in many parts of Asia, Latin America, the Middle East, and parts of Southern Europe, where family participation in bedside care is both common and expected.

The gap in experience between well-resourced private hospitals and busy urban public emergency departments can be considerable. Private facilities generally offer superior amenities, faster access to specialists, and shorter waits for elective procedures. At the same time, patients without access to primary care or subspecialists often rely on emergency departments for everyday healthcare needs — as of 2024, 16% of rural adults compared to 13% of urban adults reported using emergency departments in this way.

How does follow-up and aftercare work?

Once discharged from hospital, ongoing care in the US is typically coordinated through your primary care physician and any specialists who were involved in your treatment. Before you leave the hospital, the care team will normally arrange follow-up appointments and issue referrals for outpatient physiotherapy, rehabilitation, wound care, or other services. Nevertheless, the onus for ensuring continuity of care falls largely on the patient — or on a family member supporting them — to act on those referrals and confirm that each subsequent service is covered under their insurance plan.

Rehabilitation services — including inpatient rehabilitation facilities, skilled nursing facilities (SNFs), and home health agencies — are widely available in urban areas and are generally covered by insurance, subject to criteria around medical necessity and individual plan limitations. The duration of coverage for these services varies considerably; many private insurance policies place caps on the number of permitted therapy sessions or the total length of post-acute care.

For expats without robust insurance, aftercare can become a serious financial burden. Out-of-pocket expenses for physiotherapy, specialist consultations, and post-discharge prescriptions can accumulate quickly. Community health centres and telehealth services offer more affordable alternatives for lower-acuity follow-up requirements. Telemedicine has emerged as a particularly valuable tool for broadening access to care: virtual consultations, remote patient monitoring, and mobile health applications have all contributed to better patient engagement and more effective management of chronic conditions.

What are the rules on medical treatment for foreign visitors and new arrivals?

The United States has not entered into reciprocal public healthcare arrangements with other nations of the kind that allow EU citizens to access subsidised care across member states through the European Health Insurance Card (EHIC). No bilateral agreement exists that entitles foreign nationals to free or reduced-cost treatment simply by presenting documentation from their home country.

Under EMTALA, every individual who presents at a hospital emergency department must receive a medical screening examination and any treatment necessary to stabilise their condition, regardless of nationality, immigration status, or capacity to pay. This legal protection is, however, confined to emergency stabilisation — it does not extend to elective, ongoing, or non-emergency care. Once stabilised, hospitals will pursue payment and can issue very large bills to uninsured patients from overseas.

Short-term visitors to the US — whether on tourist, business, or student visas — have no entitlement to public healthcare and should arrange comprehensive travel or visitor health insurance before departing their home country. Certain visa categories, such as the J-1 exchange visitor visa, actually mandate proof of health insurance as a condition of entry. Requirements differ by visa type; confirm the terms applicable to your specific visa with the U.S. Department of State.

For those who have recently taken up residence in the US, eligibility for Medicaid or ACA Marketplace coverage depends on your immigration status and, in certain cases, a mandatory waiting period. The category of “lawfully present” encompasses immigrants holding qualified non-citizen status, individuals with humanitarian protections such as Temporary Protected Status, and refugees and asylees, among others. The rules governing immigrant eligibility in this area are subject to ongoing legislative and policy change; always confirm your current position directly with HealthCare.gov or your state’s Medicaid office.

What are the most important health insurance options for expats?

Selecting appropriate health insurance is arguably the most consequential financial decision an expat faces when moving to the US. The principal options are: employer-sponsored group health insurance, ACA Marketplace plans, and international or expatriate health insurance products. Each differs in terms of eligibility requirements, premium costs, scope of coverage, and the structure of its provider network.

Employer-sponsored health insurance is the most common route for expats who arrive on a work visa. Larger US employers in particular typically include group health plans as part of their benefits packages, with the employer covering a meaningful share of the premium — making this the most cost-effective option when it is available. Before accepting a plan, review its annual deductible, out-of-pocket maximum, and the geographic reach of the approved provider network.

ACA Marketplace plans are open to lawfully present immigrants who lack access to affordable employer-based coverage. Open Enrolment runs from 1 November to 15 January each year — during this window you can enrol in a new plan, renew your existing cover, or adjust your arrangements. Enrolling by 15 December secures coverage effective from 1 January. Premium tax credits may help offset costs depending on your income. Visit HealthCare.gov for up-to-date figures and eligibility tools.

International or expatriate health insurance offers the greatest flexibility, particularly for those on non-immigrant visas who are unable to access government programmes. Providers including Cigna Global, Allianz Care, and IMG offer internationally portable health plans that incorporate US coverage. According to Pacific Prime’s 2024 Cost of International Health Insurance Report, individual international plans covering the United States averaged $15,296 per year — the highest of any country in the survey. Premiums vary according to age, level of coverage, deductible, and whether the plan includes the US.

When comparing plans, pay close attention to: the breadth and quality of in-network providers in your locality; the annual out-of-pocket maximum (the ceiling on your total personal expenditure in a given year); coverage provisions for pre-existing conditions; and the prescription drug formulary. For information on regulatory oversight and consumer rights, contact your state’s Department of Insurance — a full directory is accessible through the National Association of Insurance Commissioners (NAIC). Always confirm current premium levels and coverage terms directly with insurers, as these figures are revised annually.

Are there particular health risks or considerations for people moving to the US?

The United States spans an enormous geographic area with highly varied climates, so health considerations differ markedly from one region to another. For most arrivals from other high-income countries, vaccination needs align with standard adult immunisation schedules — review your own vaccination records against the CDC’s recommended schedule at CDC.gov. Certain visa categories require an immigration medical examination including documented proof of vaccination, carried out by a designated civil surgeon.

Tick-borne illnesses — most notably Lyme disease in the Northeast and Upper Midwest — are an important consideration for those living near wooded or grassy environments. West Nile virus, spread by mosquitoes, circulates across much of the country during the warmer months. Parts of the Southwest carry a risk of Valley Fever (coccidioidomycosis), a fungal respiratory infection. Consulting a travel medicine specialist or your GP before relocating is advisable, and the CDC Traveler’s Health pages provide region-specific guidance.

Air quality is a significant concern in certain urban environments — particularly Los Angeles and California’s Central Valley — and during wildfire season, which increasingly affects large areas of the Western US. Those with asthma or other respiratory conditions should investigate local air quality data through AirNow.gov before settling on a location.

Mental health support is available via private therapists, community mental health centres, and telehealth platforms. As of September 2024, 61.85% of Mental Health Professional Shortage Areas were situated in rural parts of the country, meaning those settling outside major cities should look into mental health service availability before committing to a location. Expats coping with the stress of relocation, cultural adjustment, or social isolation may find that employer-provided Employee Assistance Programmes (EAPs) offer a helpful initial resource. Before relocating, consult your own national travel health advisory service — such as the UK’s NaTHNaC Travel Health Pro, Germany’s Auswärtiges Amt, or an equivalent body — for the most current guidance.

Frequently asked questions about healthcare in the United States

Can expats use the US public healthcare system?

The vast majority of expats are not eligible for Medicare or Medicaid, both of which are reserved for US citizens, permanent residents who meet specific criteria, or certain qualifying immigrant categories. Lawfully present immigrants may be able to purchase ACA Marketplace plans and could qualify for premium subsidies based on their income and immigration status. Because eligibility rules are revised regularly, you should confirm your individual situation directly with HealthCare.gov or your state’s Medicaid office rather than assuming entitlement.

How do I find a doctor who speaks my language?

Large hospitals and medical centres in major cities routinely employ multilingual staff or maintain professional interpretation services. US federal law requires any healthcare provider receiving federal funding to ensure meaningful access for patients with limited English proficiency. When browsing your insurer’s provider directory, you can typically filter results by languages spoken at the practice. Community organisations and consular offices in your area may also be able to suggest doctors who work in your language.

What happens in a medical emergency?

Dial 911 for any life-threatening emergency. Under the federal EMTALA statute, every hospital emergency department is legally required to carry out a medical screening and provide stabilising care regardless of your insurance status, nationality, or financial means. You will nonetheless receive a bill afterwards if you are uninsured or receiving care outside your network — emergency hospital charges in the US can easily reach tens of thousands of dollars. Keep your insurance card and your insurer’s emergency contact number with you at all times.

How do prescriptions work in the United States?

The great majority of medications require a prescription issued by a licensed US physician — pharmacies in the US generally do not honour prescriptions written abroad. Once you have established care with a US-based primary care physician, they can write prescriptions as needed. Drug costs vary considerably depending on your insurance plan and whether a medication is generic or branded. Generic versions are substantially more affordable than their branded counterparts. Services such as GoodRx can, in certain circumstances, reduce out-of-pocket prescription costs even for patients who carry insurance.

Will my pre-existing condition be covered?

Under the Affordable Care Act (ACA), insurance plans sold through the Marketplace or offered by most employers are prohibited from denying coverage or imposing higher premiums on the basis of a pre-existing condition. This is a significant protection relative to many private insurance markets around the world. However, short-term health plans and certain products that do not comply with ACA requirements are exempt from this rule and may exclude pre-existing conditions from their coverage. Confirm the position with the insurer before you commit to any plan. As of 2025, ACA protections for pre-existing conditions remain in effect — consult the CMS website for updates on any legislative developments.

How much should I budget for health insurance in the US?

Costs vary considerably depending on the type of plan, your age, and your location. As a general benchmark, individual international health insurance plans that include US coverage averaged approximately $15,296 per year as of 2024, according to Pacific Prime’s Cost of International Health Insurance Report. Employer-sponsored plans are usually more affordable because the employer subsidises a portion of the premium. ACA Marketplace plans differ by income level, age, and the state in which you reside. In addition to premiums, plan for deductibles — often $1,000–$5,000 or more per year as of 2024 — as well as co-payments and annual out-of-pocket maximums. Always obtain current figures directly from insurers and through HealthCare.gov.

Is dental care included in standard US health insurance?

Dental treatment is not typically bundled into standard medical health insurance in the United States. Covering routine check-ups, fillings, and most dental procedures requires a separate dental insurance policy. While some ACA plans incorporate paediatric dental coverage as an essential benefit, dental cover for adults is almost always a distinct product. Factor the cost of dental insurance into your overall healthcare budget in addition to your medical plan when calculating expenses.

Does the US have reciprocal healthcare agreements with other countries?

The United States has not entered into bilateral agreements that grant foreign nationals access to subsidised or free healthcare — there is no US equivalent of arrangements such as the European Health Insurance Card. Regardless of nationality, all foreign nationals living in or visiting the US should hold comprehensive private health insurance. Verify the current position through your own country’s Ministry of Foreign Affairs or national health authority, as the landscape of international agreements can shift over time.