Healthcare in the USA

Healthcare in the US is a contentious issue. The US invests more than 17 percent of its GDP in healthcare, amounting to trillions of dollars a year. Despite this, the country has significantly poorer healthcare outcomes compared to its economic peers, including lower life expectancy and higher mortality rates.

The US is the world’s only developed country without universal healthcare, and medical services in the US are some of the most expensive in the world. More than half of the population receives private health insurance from their employers, while about one-third rely on government-funded programmes such as Medicare and Medicaid. Around 10 percent pay for their own private insurance, and about 8 percent of the country is uninsured.

Hospitals are required by law to provide emergency medical services to anyone, including the uninsured, although patients can nevertheless expect to receive a hefty bill afterwards. Outside of an emergency, hospitals can refuse to treat a patient who is unable to present a means of payment. Federally qualified health centres and community health clinics, by contrast, provide care regardless of ability to pay.

Private health insurance in the USA

The USA doesn’t have a federal health insurance requirement, although California, Massachusetts, New Jersey, Rhode Island and Washington, DC, require residents to have coverage or face penalties. It’s wise to secure the best health insurance policy you can afford or negotiate coverage into your employment contract. Without appropriate health insurance, you run the risk of paying colossal bills or receiving no medical attention outside of emergencies.

Keep all receipts from medical treatment to submit insurance claims.

Most expats get health insurance through their employer, which typically covers a significant portion of premiums. If your employer doesn’t offer coverage, or if you’re self-employed, you can purchase insurance through the Health Insurance Marketplace during open enrollment periods, usually November through January.

When evaluating plans, pay attention to:

• deductibles (what you pay before insurance kicks in)
• copays (your portion of each visit)
• network restrictions (which doctors and hospitals you can use)
• and out-of-pocket maximums (the most you’ll pay in a year).

HMO plans typically have lower premiums but require referrals to see specialists, while PPO plans offer more flexibility at a higher cost.

Government health insurance in the USA

Medicare

Medicare is a tax-funded initiative for those aged 65 and older who have paid Social Security taxes. In limited cases, including disability, kidney failure and ALS, some residents under 65 are also covered under Medicare.

There are four coverage components to Medicare. The original Medicare consists of Parts A and B. Part D can be added at an extra cost. Part C provides an alternative way of getting Medicare benefits.

• Part A: Provides coverage for inpatient hospital care, nursing and hospice
• Part B: Provides coverage for outpatient physician services, preventive care and medical equipment
• Part C: Also known as Medicare Advantage, Part C allows patients to select private insurance plans as an alternative to Original Medicare. These plans cover everything in Parts A and B, and often include Part D prescription drug coverage. Unlike traditional Medicare, these plans have out-of-pocket payment limits.
• Part D: Provides coverage for prescription drugs

Most expats on temporary work visas cannot access Medicare, as eligibility requires paying into the Social Security system for at least 10 years. Lawfully present non-citizens may qualify if they’ve worked and paid Medicare taxes long enough or are married to someone who has. Green card holders must typically wait five years and have sufficient work history to qualify.

Medicaid

Medicaid is funded by state and federal resources and provides healthcare for eligible patients with low income, such as pregnant women, elderly adults and people with disabilities living in poverty, as well as their children. It is managed at the state level, and each state determines its own eligibility requirements within the federal guidelines.

Most expats on temporary visas are not eligible for Medicaid. Even lawful permanent residents (green card holders) typically must wait five years after obtaining qualified immigration status before enrolling, although there are exceptions for children and pregnant women in some states.

Children’s Health Insurance Plan (CHIP)

Families who earn too much to qualify for Medicaid may be eligible for low-cost treatment for their children under CHIP, also funded by federal and state resources. Again, eligibility rules vary from state to state. In about half of the states, pregnant women are also eligible for CHIP coverage. Some states charge a monthly premium for CHIP coverage. By law, total out-of-pocket costs may not exceed 5 percent of the family’s annual income.

Eligibility for expat children depends on their immigration status and state policies. Lawfully present immigrant children may qualify in some states without a waiting period; others require a five-year residency period.

Useful links

• Medicare
• Medicaid
• HealthCare.gov

Healthcare in the USA

The majority of hospitals in the US are privately owned, typically run by non-profit associations or investor boards.

The standard of medical facilities in the US is high. With adequate insurance, you’ll have access to some of the best medical technology. Doctors are highly trained, and many of the best specialists can be found in the US.

The advantages of private healthcare in America include short waiting times for operations and specialists as well as competing medical services.

Finding a primary care physician is your first step. Check your insurance company’s provider directory to see which doctors are in-network, as out-of-network care costs significantly more. You can also ask colleagues for recommendations or use your insurer’s online tool to compare doctors. Once you select a PCP, you’ll typically need their referral to see specialists if you have an HMO plan.

Pharmacies in the USA

Pharmacies can easily be found in US cities. They are located in drug stores, grocery stores and large department stores, and are often attached to hospitals and medical clinics.

Almost all prescription medications can be found at a pharmacy in the US. Medication costs in the US are significantly higher than in most countries. Keep all receipts to claim costs from your insurance provider.

If you’re bringing medication from another country, you must have a valid prescription to prove it’s for personal use. US Customs generally allows up to a 90-day supply in original packaging, although some medications are prohibited regardless of prescription. Medications that don’t meet requirements will be confiscated at customs.

Useful links

• FDA: Drug Safety and Availability

Pre-travel restrictions and vaccinations for the USA

If you’re planning to settle in the US for an extended period, you’ll need to undergo a medical exam and show proof that your immunisations are up to date. If requirements aren’t met, you’ll receive the necessary vaccinations during the medical exam. The Centers for Disease Control and Prevention (CDC) has an up-to-date list of required vaccinations for immigration.

As of March 2025, COVID-19 vaccination is no longer required for immigration medical examinations, but the other standard vaccinations are still mandatory.

Ongoing vaccinations in the USA

Once settled in the USA, annual flu shots are recommended for everyone over six months old, typically available from September through March. Many employers and pharmacies offer free flu vaccinations.

If you have children, be aware that all US states require certain vaccinations for school attendance, although specific requirements and exemption policies vary by state. Standard school-required vaccines include MMR, polio, tetanus, and varicella. Some states also require meningococcal and HPV vaccines for older children.

Useful links

• Centers for Disease Control and Prevention (CDC)
• USCIS

Emergency services in the USA

Emergency medical services in the US are regulated by individual state governments and, by law, must be provided to anyone in need.

In the case of a medical emergency, dial 911. The operator will then dispatch an ambulance to the location of the emergency. Paramedics in the US are highly trained and can provide an excellent level of care at the scene of an accident. If the situation is not immediately life-threatening, you can also make your way to the nearest hospital emergency department. For urgent non-emergency issues, consider an urgent care clinic.

Emergency department or urgent care?

Emergency departments are staffed 24/7 with physicians and nurses trained in administering emergency care, while urgent care clinics are ideal for urgent but non-emergency situations. They are typically staffed with physicians, physician assistants or nurse practitioners. Urgent care providers can do basic lab and imaging tests, such as X-rays, and provide diagnoses and offer treatment plans. Urgent care clinics have set hours and an established list of conditions that can be treated. As a result, Urgent care clinics are generally less expensive and have shorter wait times than emergency departments.

Be aware that both ambulance transport and emergency care will result in bills, which can be substantial even with insurance. Your insurer may provide a list of preferred hospitals for emergencies. Keep your insurance card accessible at all times, as you’ll need to provide coverage information when receiving emergency treatment.

Useful links

• 911.gov