Health insurance for the United States — area of cover, exclusions and what no public system means
Every other destination sets a rule you must satisfy. The United States sets none — and is the one country insurers price as a separate world. Two words on your schedule decide whether you are insured at all when you land.
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Not ready to book? Read what area of cover means
What makes the USA different
No floor, and a tier named after leaving it out.
Three facts, and the third is the one that costs people money. There is no national system to fall into, your area of cover is the real decision, and the difference between the two tiers is not small.
There is no national system to fall into
Every other destination on this site has a public scheme you eventually join. The United States does not. Cover is employer-based, bought on an exchange, or bought privately — and there is no floor underneath any of it.
Your area of cover is the decision
International policies are sold in two shapes: worldwide, and worldwide *excluding* the United States. That second tier exists because American treatment costs enough to reprice the whole policy. No other country has a product tier named after leaving it out.
And the difference is not a rounding error
Adding the United States to an area of cover raises the premium substantially — sources put it anywhere from ⚑ half again to ⚑ several times over. Which is why people quietly buy the cheaper tier, forget they did, and find out at the worst possible moment.
Which is why this page asks you to do something almost nobody does: find your policy schedule, and read the two words next to "area of cover" before you read anything about benefits.
Arrival, dated
No system to join. Real deadlines anyway.
The American surprise is not that nothing is automatic — it is that the windows are real and short. ⚑ marks figures pending confirmation against HealthCare.gov's own material.
Before you land
Read your existing schedule's area of cover (the two words this page exists for). If it says excluding USA, you are choosing between upgrading it, an international plan that includes the US, or entering the American domestic market on arrival.
⚑ Your first 60 days · the window nobody frames as a deadline
Moving to the US counts as a qualifying life event, which opens a special enrollment period on the ACA marketplace — ⚑ sixty days from arrival, for lawfully present immigrants (work and student visas included; tourists excluded). Miss it and the marketplace closes until the annual window.
Employer onboarding
If a job brought you, the employer plan is usually the answer — typically the employer pays ⚑ the larger share of the premium. The questions worth asking in the offer stage: who is on it, what deductible, and which network your actual address falls inside.
Every autumn · open enrollment
The marketplace reopens annually. If you arrived uncovered and missed the sixty days, this is when the domestic door reopens — and until then an international plan including the US is often the only clean bridge.
If you leave again
US domestic cover ends at the border in spirit and usually in letter. The returning-home version of this page is the /usa/ journal material — going home is a relocation too, and mid-year re-entry has its own timing rules.
What that means in practice
Read the schedule, not the brochure.
Area of cover is one line on a document most people have never opened. It is not in the marketing, it is not in the summary of benefits, and it is the single most consequential thing on the policy if the United States is anywhere in your life.
The reason it goes wrong is entirely ordinary. Someone bought cover years ago for a life that did not include America, took the cheaper of two tiers because that is what a sensible person does, and their life changed afterwards. Nobody hid anything.
It is also binary. You are either in the tier that covers the United States or you are not, and a hospital does not offer partial credit for having meant well. That is unusual — most insurance failures are about limits and exclusions at the margin, and this one is about a boundary on a map.
So the check is short and worth doing today rather than before a trip: find the schedule, find the area of cover, and know which of the two you hold. If it says excluding, you now have a decision. If it does not, you have one less thing to worry about than you did this morning.
| What happens | Employer plan | ACA marketplace | International plan |
|---|---|---|---|
| Who can get it | Employer plan: employees (+family, often) | Marketplace: ⚑ lawfully present residents | International plan: anyone, from anywhere |
| When you can start | At hire / annual window | ⚑ 60 days from arrival, else annual window | Any time |
| Premium logic | Employer pays ⚑ most, you the rest | Income-linked subsidies possible | Age and cover level |
| Network reality | The plan's network, not your choice | Varies by state and tier | Often broader, check US networks |
| When the job ends | Ends (COBRA bridges, expensively) | Unaffected | Unaffected |
| When you leave the US | Ends | Ends | Follows you |
Behaviours, not scores. Most internationally mobile lives end up combining two of the three columns, which is precisely what a review is for.
Who this page is for
Four situations, four different checks.
The posted employee
The employer plan is probably right — but read who is on it and what the deductible actually is. American "covered" routinely includes four-figure deductibles that would be scandalous anywhere else on this site.
The self-employed arrival
You are the sixty-day person. Lawfully present, no employer plan waiting — the special enrollment window is your one clean entry to the domestic market before autumn.
The part-year snowbird
Tourist status is excluded from the marketplace, so the question is entirely about your international policy's area of cover and its per-trip limits. This is the persona the excluding-USA tier hurts most.
The returning American
Going home is a relocation. Your international policy may not follow you, and mid-year re-entry has its own timing rules — treat it with the same hour you would give any other country on this site.
An independent benchmark
Not the most expensive country. A different category.
- $12,773At 24Indian national, born 2001
- $18,765At 35British national, born 1990
- $22,368At 50American national, born 1975
Cheaper: Hong Kong (SAR) and Singapore.
The United States tops all fifty at about $17,970 a year on average — 2.9 times Morocco at the foot of the table, and just over twice Switzerland. The 50-year-old persona's figure, roughly $22,370, is the single highest number anywhere in the index. Note what is being priced: every other country is quoted on worldwide cover excluding the USA, while the American row includes it. That inclusion is most of the gap, and it is also the reason a policy bought elsewhere so often stops working the moment someone takes a job in Boston.
One thing the index is not, and its authors say so twice: it does not compare the seven insurers against one another. Where two of them price the same country differently, that reflects different benefits, cover areas and networks — not one being better value. And none of these figures is a quote. They are averages for three people who do not exist, and what you would actually pay turns on your age, your health, your family and where you want to be treated.
Source: SIP Health Cost Index 2025, SIP Medical Family Office. Data as at August 2025, published 1 December 2025. Figures rounded to the dollar. Comparisons and any tax-adjusted figures in the text above are our own arithmetic on SIP's published numbers, not SIP findings.
All fifty countries, and what the ranking hidesIn the USA specifically
Three ways this goes wrong, and all three are avoidable.
A worldwide policy that is not worldwide
The most common failure we see anywhere, and it belongs here. Somebody holds excellent international cover, moves to or through the United States, and discovers their schedule says <em>excluding USA</em> — two words chosen years ago to save money on a policy for a life that has since changed. Read your area of cover before you read anything else.
A short trip is not a short exposure
A fortnight in the United States on a policy that excludes it is not a small risk taken for a small time. One admission can exceed what most people insure their house for. The exposure is not proportional to the length of the visit, and this is the one place where that is true.
Going home is a move too
Americans returning after years abroad often treat it as the end of the insurance question rather than the start of a new one. An international policy may not follow you home; the domestic market you left has changed; and returning mid-year has its own timing rules. It is a relocation, and it deserves the same hour as any other.
Any of these sound like your situation? See how a review works
How a review works
What a first review actually looks like.
Arranging international cover for the first time, or checking what you already hold — the process is the same, in this order.
The demand intake
Right after you book, we email you a short intake form. Where you are, where you're going, who's coming with you, anything you already hold. It takes a few minutes, and it means the 45 minutes start prepared — with your situation, not with paperwork.
We study your situation
Not products first. Your life first. We look at the country you're moving to and what it legally requires, the country after that if there is one, who depends on you, and where the real exposure sits. We don't quote anything at this stage.
The consultation
45 minutes, by video, in English. Every question you bring gets an answer. We compare the international insurers on how each of them behaves in your situation — underwriting, renewal, exclusions, and what happens on the day a claim is filed. If there is already a policy in force, we go through it clause by clause. Nothing is pitched at the end of it.
Your Private Client Report
One working day later, your Private Client Report arrives — around twelve pages setting out what we found, what we weighed it against, what each option costs, and why we would choose one over the others. What to arrange, what to keep, and where you are paying for something that isn't doing any work. Sometimes the report says: keep what you have. It is yours either way.
45 minutes. By video, wherever you are. Free. Nothing has to change afterwards.
The Cleveland Clinic charges $1,690 for a written second opinion. Ours comes with the review, and there is no fee for it.
The team
The people who'll actually review your situation.
Specialists by topic, not a rota. You'll know who you're speaking to before you book, and you'll speak to the same person again next year.
Robert Kolar
Health insurance
Twenty-plus years spent on the distance between what a health policy promises and what it pays when a claim actually lands. German and English. He has been the foreigner working out somebody else's health system from the outside, which is its own kind of qualification.
Book with Robert
Nicole Bohne
Life · Protection · Planning
Spent her career inside Basler Versicherung and Zurich Insurance before crossing to this side of the table. Nicole reads a life-cover decision against the whole household — who depends on whom, what already exists, and whether the answer is a policy at all.
Book with Nicole
Hans Steiner
Pension · Tax · Cross-border
Financial Planner IAF, Federal Diploma of Higher Education. German, English and French. Hans takes the cases where a move collides with a pension, with two tax systems, or with both at once.
Book with HansUSA questions
What people actually ask us about the United States.
Can I buy US health insurance as a foreigner?
If you are lawfully present — work visas, student visas, green cards — the ACA marketplace is open to you, and arriving counts as a qualifying life event that opens a ⚑ sixty-day special enrollment window. Tourists and ESTA visitors are excluded, which is why their answer lives entirely in the area-of-cover question above.
What happens if I miss the sixty-day window?
The marketplace closes to you until the annual open-enrollment period in the autumn. The clean bridge in between is an international plan whose area of cover includes the US — expensive, but a known cost against an unbounded one. This is the single most avoidable American insurance mistake, because the window is real and nobody frames it as a deadline.
How do employer plans work for arriving employees?
Typically the employer pays the larger share of the premium and you pay the rest per pay-cheque — and the plan is chosen for you. The three things to read in the offer stage: who is covered (you or the family), the deductible you would pay before cover bites, and whether the network includes hospitals near where you will actually live. Negotiating cover into an offer is normal in America; not asking is the mistake.
Why does my international policy exclude the United States?
Because American treatment costs enough that insurers price it as a separate world. "Worldwide excluding USA" is a standard tier, and it is usually the default quote — not because anyone hid it, but because it is cheaper and most buyers never plan to be treated there. Check which tier you actually hold; it is on the schedule, not in the brochure.
How much more does US cover cost?
Substantially, and the honest answer is that the range quoted publicly is wide enough that we will not repeat a multiplier here. What matters more is that the question is binary rather than gradual: you are either in the tier that covers the United States or you are not, and there is no partial credit at a hospital.
I am only visiting the US briefly. Do I need to change anything?
Possibly, and it is cheap to find out. Some policies allow short visits within an excluding-USA area, some do not, and the limit is written in days rather than in spirit. A single admission can run past what most people insure their house for, so this is the rare case where a five-minute check is worth doing before every trip.
Is there a public system I will eventually qualify for?
Not in the way the rest of this site means it. There is no national scheme you join by residing long enough. Cover comes from an employer, from an exchange, or from your own pocket, and none of it happens automatically. If you are used to a country where time solves this, that assumption is the thing to unlearn first.
I am American and moving back after years abroad. What changes?
More than people expect. Your international policy may not follow you home, the domestic market has moved on since you left, and re-entering mid-year has its own timing rules. Treat going home as a relocation rather than as the end of one — it is the version of this conversation people most often skip.
How much does international health insurance cost in the United States?
Comparable international private medical insurance in the United States costs about $17,969 a year on average, which ranks the United States 1st of the 50 countries in the SIP Health Cost Index 2025 (data as at August 2025). That is an average across 7 international insurers and three standard profiles — a 24-year-old, a 35-year-old and a 50-year-old — so it describes what the country costs rather than what you would pay. Your own premium depends on your age, your health history, whether you are insuring a family, your deductible, and whether you need cover in the United States.
Sources & verification
Where these facts come from.
Everything marked ⚑ rests on the sources below pending confirmation against HealthCare.gov and named policy wordings. The premium differential for including the US is deliberately never quoted — published figures disagree too widely to hand a reader a number to budget against.
- HealthCare.gov — special enrollment periods — PRIMARY — verified 2026-08-01: moving is a qualifying life event; usually 60 days after the event to enrol; miss it and you wait for open enrollment
- Feather — health insurance in the USA for expats — secondary, consulted 2026-08-01
- Wise — can foreigners buy health insurance in the USA — secondary, consulted 2026-08-01
- GlobalMedPlan — worldwide cover with or without the US — secondary, consulted 2026-07-30
From the journal
Reading on this country.
facts checked 2026-08-10
Sending staff to the United States: worldwide excluding USA
Most international health policies are written 'worldwide excluding USA', so a US transfer leaves the assignee covered everywhere except where they now live.
Read it
facts checked 2026-08-10
Worldwide excluding USA: what the exclusion means for nomads
Most nomad policies are sold worldwide excluding USA. The United States ranks 1st of 50 for cover cost, and a visitor joins no national scheme on arrival.
Read it
facts checked 2026-08-01
The American returning home: re-entering US insurance
Moving back to the US opens a 60-day Special Enrollment Period on the ACA marketplace. Miss that window and the market stays shut until autumn open enrollment.
Read it
facts checked 2026-08-01
Reading your schedule: the five-minute area-of-cover check
One line on your policy schedule decides whether you are insured in America at all. Most people have never read it. Here is how, and what each wording means.
Read itReady for a calm conversation about cover?
A first review is free — 45 minutes, in English, wherever in the world you happen to be. We'll listen first. Then you'll hear exactly what we would arrange if the situation were ours. What you do with that is yours to decide.
Book a reviewOr write to hello@expatsavvy.com — we reply within the working day.