Moving to the USA? Understand the U.S. Healthcare System
Planning to move to the U.S.? Understand the American healthcare system, insurance types, costs, and tips for expats in this complete beginner’s guide.
If you are planning to move to the United States, one of the most important (and often confusing) things to understand is the U.S. healthcare system. See more about moving to the USA here: https://www.eb5brics.com/usa-investor-visa Unlike many countries that offer universal healthcare, the United States operates a largely privatized, insurance-based system. Healthcare in the U.S. is advanced, but it can also be extremely expensive without proper coverage. This guide gives a comprehensive overview of how the U.S. healthcare system works, who pays for what, the types of insurance available, how much it can cost, and how to prepare before moving.
Key Characteristics of the U.S. Healthcare System
- No Universal Free Healthcare
The U.S. does not have a national healthcare system that covers everyone. Instead, people receive healthcare services from a combination of private insurance companies, employer-sponsored plans, and government-funded programs for specific groups.
- Insurance is Necessary
Health insurance is the primary way most people pay for medical services. Without insurance, medical bills can be financially devastating.
- Mixed Public and Private Structure
The healthcare system includes:
- Private Insurance (commercial insurance companies)
- Employer-Sponsored Insurance
- Public Programs like Medicare (for seniors) and Medicaid (for low-income individuals)
Why Healthcare is So Expensive in the U.S.
There are several reasons why healthcare costs are significantly higher in the United States compared to many other countries:
- High cost of medical technology, equipment, and pharmaceuticals
- Administrative costs related to billing and insurance
- Physician wages and hospital charges
- Lack of price regulation
- Lawsuits and malpractice insurance
Types of Health Insurance
If you are moving to the U.S., you will likely need to purchase one of the following types of health insurance:
- Employer-Sponsored Health Insurance
Employers often provide health insurance benefits to full-time employees. This is the most common form of coverage. Employers usually pay a large portion of the monthly premium, and employees pay the rest through payroll deductions.
Pros:
- Generally cheaper than buying your own plan
- Often includes dental and vision
Cons:
- Tied to your job
- Limited choice of plan types in some companies
- Individual or Marketplace Insurance
If you’re self-employed, working part-time, or not yet working, you can purchase insurance through the Health Insurance Marketplace (under the Affordable Care Act, also called “Obamacare”).
Plans are categorized by tier:
- Bronze (lowest monthly premium, highest out-of-pocket costs)
- Silver
- Gold
- Platinum (highest premium, lowest out-of-pocket)
Depending on your income, you may qualify for a subsidy that reduces the monthly premium.
- Medicaid
Medicaid is a public health insurance program for people with very low income or specific disabilities. Eligibility and benefits vary by state. Some states have expanded Medicaid under the Affordable Care Act.
- Medicare
Medicare is for people aged 65 and older, or for certain disabled individuals. It is not available to newcomers unless they have been legal residents for at least five years and meet other requirements.
- Short-Term or Temporary Insurance
Non-immigrants, students, or those in their first months of stay might use short-term plans. These plans cover emergencies but often exclude pre-existing conditions, routine care, maternity, etc.
Terms You Must Understand
The U.S. healthcare system uses several financial terms you need to know:
| Term | Meaning |
| Premium | Monthly amount you pay for the insurance plan |
| Deductible | Amount you must pay out-of-pocket before insurance starts covering |
| Copay | Fixed fee you pay per visit (e.g., $25 for doctor visit) |
| Co-insurance | Percentage of cost you pay after deductible (e.g. 20%) |
| Out-of-Pocket Maximum | Maximum amount you will pay in a year – after that the insurer pays 100% |
How a Typical Visit Works
- Make an Appointment: Most visits to doctors or specialists need an appointment.
- Show Insurance Card: At the clinic or hospital, you show your insurance information.
- Pay Copay: You often pay a small amount upfront.
- Billing: The clinic sends a bill to your insurance company for the remaining cost.
- Possible Balance Bill: If some services are not fully covered, you will receive a bill later.
Primary Care vs Specialists
- Primary Care Physician (PCP): Your regular doctor for general health issues.
- Specialists: For example, cardiologists, dermatologists, etc. In many insurance plans, you need a referral from your PCP to visit a specialist.
How to Get Insurance If You’re a New Immigrant or Expat
Employer Sponsorship
If you are moving to the U.S. with a job offer, check if the employer provides insurance for you (and possibly your family).
Buy a Private Plan
You can compare plans on Healthcare.gov (for most states) or your state marketplace. You’ll need:
- Proof of legal status (Visa, Green Card, etc)
- U.S. address (some plans require residency)
International Expat Insurance
Some people choose international health insurance plans specifically designed for expats. Companies like Cigna Global, IMG, or Allianz offer expat health coverage that works globally including in the U.S. These plans can be expensive but provide coverage immediately.
Special Category: Students and J-1 Visa Holders
International students (F-1 visa) and exchange visitors (J-1 visa) are often required to buy student health insurance through their school or sponsor program. These plans are usually affordable compared to general adult plans.
Emergency Care vs Regular Care
Emergency Room (ER)
- For life-threatening emergencies
- Very expensive (often $1,500-$3,000 per visit)
- No appointment needed
- Insurance may or may not cover everything
Urgent Care Centers
- For minor emergencies
- Cheaper than ER
- Often used when immediate care is required outside regular hours
Prescription Medication
In the U.S., medication costs vary widely. You usually need a doctor’s prescription and a pharmacy to purchase medicines. Pharmacy prices are lower with insurance. Generic drugs are much cheaper than brand-name drugs.
Dental and Vision Care
Medical insurance does not include dental and vision coverage by default. Many people purchase separate dental and vision insurance plans. Some employer-sponsored plans include them as add-ons.
Telemedicine
Telemedicine (online doctor consultations) has become very popular, especially after COVID-19. Many insurance plans now include virtual visits which are cheaper and more convenient for minor health concerns.
The Role of the Affordable Care Act (ACA)
The ACA introduced:
- Health Insurance Marketplaces
- Subsidies based on income
- Ban on denying coverage due to pre-existing conditions
- Coverage for essential services (vaccines, maternity, etc.)
However, insurance is still not free and you must enroll during the Open Enrollment Period (usually November to mid-January) unless you qualify for a Special Enrollment Period (e.g., moving to the U.S., marriage, loss of other coverage).
Realistic Costs to Expect (Approximate)
- Employer plan: $0–$400/month per person (after employer contribution)
- Individual ACA plan: $300–$700/month per adult
- Deductible: $1,500–$6,000 per year
- Primary doctor visit: $100–$200 full price, $20–$30 with insurance
- ER visit: $1,500 and above
How to Prepare Before Moving
- Get All Medical Records
- Vaccination records
- Past prescriptions
- Important diagnoses
- Translated to English, if needed
- Understand Immigration Status
- Some health insurance requires SSN or legal presence
- Immigrants with green cards can apply for ACA plans
- Budget for Health Insurance
- Add insurance premiums as a fixed monthly living expense
- Temporary Coverage
- Consider travel or expat insurance for first few months
Healthcare for Children and Pregnant Women
- Children may qualify for state programs such as CHIP (Children’s Health Insurance Program) if parents’ income is below a threshold.
- Maternity care is covered under most ACA-compliant plans. However, pregnancy costs remain expensive without insurance.
Advantages of the U.S. Healthcare System
- High quality medical facilities
- Access to cutting-edge treatment, technology, and specialists
- Short wait times for surgeries compared to some public systems
- Choice of doctors and hospitals
- Personalized service if you can afford good insurance
Disadvantages
- Very costly without insurance
- Complex and paperwork-heavy
- Inequality in healthcare access
- Insurance bureaucracy and denial of claims in some cases
- Stress of choosing the right plan
Final Thoughts
The U.S. healthcare system offers some of the best medical care in the world – but it comes at a price. For anyone planning to live in the U.S., proper health insurance is not optional; it is a necessity. Understanding how insurance works, knowing what is covered, and choosing the right plan based on your health needs and budget will protect you from potentially overwhelming medical bills.
Before you move, research your insurance options, gather your medical records, and if possible, secure a plan that begins as soon as you arrive. Once you adapt to the system, you’ll find it manageable, especially if you maintain preventive care habits and keep documentation well organized.