Health insurance in the USA for expats.
The United States has no national system to join and no insurance rule to satisfy. Your cover comes from an employer, the ACA marketplace or an international plan, and two words on its schedule decide whether the US is covered at all.
In brief
What health insurance do expats need in the United States?
There is no national system to join, so cover comes from one of three places:
- An employer plan: the employer typically pays the larger share of the premium.
- The ACA marketplace, open to lawfully present residents, work and student visas included. Arrival opens a sixty-day enrollment window; miss it and you wait for open enrollment.
- An international plan whose area of cover includes the USA. “Worldwide excluding USA” is a standard tier: check your schedule.
Why US health insurance is different for expats.
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 — no insurer publishes by how much, and the public guesses run from a third more to several times over — which tells you they are guesses. What is not in doubt is the underlying cost: the United States spends about $14,900 per person a year on health, against an OECD average near $6,000. 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.
Arriving in the US: the sixty-day enrollment window.
The American surprise is not that nothing is automatic — it is that the windows are real and short.
| When | What it involves |
|---|---|
| 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 daysthe 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, and at many Exchanges sixty days before it too (45 CFR 155.420(c)). It is open to lawfully present US residents, work and student visas included; visitors and ESTA travellers are not residents, so it is closed to them. One trap worth knowing: the moving SEP normally demands cover in the preceding sixty days, but 155.420(a)(5) exempts anyone who was living abroad — so arriving from another country clears a bar a domestic mover would not. 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 — about 80% of the premium for single cover and 72% for family in 2025, on the federal MEPS-IC survey, though no law requires it. The questions worth asking in the offer stage: who is on it, what deductible, and which network your actual address falls inside. |
| Every autumnopen 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. |
Does your policy cover the USA? Read the schedule.
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 US 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 (~80% single, ~72% family, 2025), 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.
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.
Not the most expensive country. A different category.
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.
Cheaper: Hong Kong (SAR) and Singapore.
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.
Three standard profiles
- At 24 · Indian national, born 2001
- $12,773
- At 35 · British national, born 1990
- $18,765
- At 50 · American national, born 1975
- $22,368
- Average across seven international insurers
- $17,969
Of 50 countries1st.
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 excluding USA — 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
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. We work through the questions that matter in your situation: underwriting, renewal, exclusions and treatment geography. If you already hold cover, we read its wording and personal endorsements. We identify what is clear and what still needs the insurer's written confirmation.
Your Private Client Report
One working day later, your Private Client Report arrives — around twelve pages setting out what we found, the alternatives considered, available cost information, and the reasons for our recommendation. Any missing documents or insurer answers are identified as open questions. 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 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 expert
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 and protection expert
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
Virginie Josten
IPMI expert
Came to insurance from luxury and consulting, where the clients were demanding and the work was international. Then a Swiss insurer’s international desk — cross-border employees, expats and retirees abroad. Legal training and a master’s from Paris Dauphine. English and French.
Book with Virginie
Davide Nezel
IPMI expert
FINMA-certified independent insurance intermediary, who began in financial advice at Swiss Life. He works with globally mobile households, and coordinates with the insurer when a medical need actually arises — which is where a policy is finally tested. German, French and English.
Book with Davide
Chantal Leprêtre
Client Advisor
Client advisor for international private medical insurance at SIP Medical Family Office, the partner through which international cover is placed. She works from London, in English and French.
Book with ChantalHealth insurance in the USA: your questions.
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 international health insurance with 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.
Where these facts come from.
Every figure on this page rests on the sources below — federal regulation, HealthCare.gov, the federal MEPS-IC survey and the insurers' own regulated policy documents. The premium differential for including the US is deliberately never quoted. We went looking for it at primary level: no regulator, actuarial body or insurer publishes a loading, and every public figure traces back to marketing copy with no source behind it. A number we cannot stand behind is worse than the mechanism plainly stated.
- 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
Reading on this country.
- Facts checked 2026-08-10Group medical insurance for US assignmentsMost international health policies are written 'worldwide excluding USA', so a US transfer leaves the assignee covered everywhere except where they live.
- Facts checked 2026-08-10Worldwide excluding USA: what the exclusion means for nomadsMost 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.
- Facts checked 2026-08-01The American returning home: re-entering US insuranceMoving back to the US opens a 60-day Special Enrollment Period on the ACA marketplace. Miss that window and the market stays shut until open enrollment.
- Facts checked 2026-08-01Reading your schedule: the five-minute area-of-cover checkOne line on your policy schedule decides whether you are insured in America. Most people have never read it. Here is how, and what each wording means.
Ready 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 review