The United States operates a highly complex and largely private healthcare system, distinct from many other developed nations. It is not a universal healthcare system; instead, access to care is primarily tied to health insurance coverage, which can be obtained through employers, government programs (with strict eligibility), or purchased privately. The system is characterized by high costs, advanced medical technology, and a mix of high-quality specialized care alongside significant disparities in access and outcomes. Expats moving to the U.S. must prioritize securing comprehensive health insurance immediately upon arrival, as out-of-pocket expenses for medical services can be extraordinarily high without it.

The primary public healthcare programs in the U.S. are Medicare and Medicaid. Medicare is generally for individuals aged 65 or older, or younger people with certain disabilities, who have contributed to the system through taxes for a specified period. Medicaid provides health coverage to low-income individuals and families.

Access for Foreigners: Access to these public programs for foreigners and expats is highly restricted and has become even more so due to recent legislative changes.

• Medicare: As of July 4, 2025, new applications for Medicare are limited to U.S. citizens, Lawful Permanent Residents (LPRs or green card holders), certain Cuban and Haitian entrants, or Compact of Free Association (COFA) migrants. Immigrants with humanitarian protections (e.g., refugees, asylees) who do not fall into these categories will not be able to apply. Those already enrolled but not meeting these new criteria may be removed from Medicare by January 2027. Medicare generally does not cover healthcare services received outside the United States.
• Medicaid: Beginning October 1, 2026, federal Medicaid/CHIP funding for lawfully present non-citizens will be largely limited to LPRs, Cuban/Haitian entrants, and COFA migrants. Many other lawfully present immigrants, including asylees, refugees, and survivors of domestic violence and trafficking, will lose eligibility for federally funded full-benefit Medicaid. Most green card holders must also observe a five-year waiting period before becoming eligible for federal Medicaid. Some states may offer state-funded coverage for certain immigrant groups, but this varies significantly.
• Emergency Medicaid: Under the Emergency Medical Treatment and Labor Act (EMTALA), emergency departments must provide stabilizing care regardless of citizenship status. Emergency Medicaid may reimburse hospitals for care provided to low-income immigrants who would otherwise qualify for Medicaid, but this federal matching payment will also see limitations starting October 2026.

Given these stringent rules and upcoming changes, most expats should not rely on public healthcare programs for their primary medical needs.

Private healthcare is the cornerstone of the U.S. system, offering a wide array of services through private hospitals, clinics, and specialists. The quality of private care is generally very high, with access to advanced medical technology, specialized treatments, and often shorter waiting times compared to some public systems globally. However, this comes at a significant cost.

Many private hospital networks operate across the country, and the choice of provider often depends on your insurance plan's network. Popular types of private insurance plans include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). PPOs typically offer more flexibility in choosing providers without a referral but often come with higher premiums.

Typical Consultation and Procedure Costs (without insurance):

• Primary Care Visit: A standard visit can range from $40 to $300, with an average of $171 in major U.S. cities in 2026. Some sources indicate a range of $200-$400 for basic consultations in 2026.
• Urgent Care Visit: For non-life-threatening issues, urgent care centers are an alternative to emergency rooms. Costs typically range from $150 to $600, depending on the complexity of treatment.
• Specialist Consultation: Initial specialist visits can cost between $300 and $800, with cardiologists, dermatologists, and orthopedic surgeons often at the higher end.
• Hospital Stays and Procedures: These costs can quickly escalate into thousands or tens of thousands of dollars, making comprehensive insurance essential.

Accessing healthcare in the U.S. as a foreigner or expat is primarily determined by your immigration status and health insurance coverage.

For Tourists: Tourists are generally expected to have travel insurance that covers medical emergencies. Without insurance, they will be responsible for 100% of all medical costs, which can be astronomical. Emergency care will be provided, but the bills will follow.

For Residents and Workers: If you are a resident or working in the U.S., securing health insurance is paramount.

• Employer-Sponsored Insurance: Many employers offer health insurance as part of their benefits package. This is a common way for expats to obtain coverage and is often the most affordable option, as employers typically subsidize a significant portion of the premiums.
• Affordable Care Act (ACA) Marketplace: If employer-sponsored insurance is not available, individuals can purchase plans through the ACA Marketplace (healthcare.gov). Eligibility generally requires living in the U.S. and being a U.S. citizen or lawfully present immigrant. However, significant changes are impacting eligibility for financial assistance:
  • Beginning January 1, 2026, lawfully present immigrants with incomes below the federal poverty level who are ineligible for Medicaid due to immigration status will no longer receive financial assistance for ACA Marketplace coverage.
  • By January 1, 2027, only Lawful Permanent Residents (LPRs), Cuban/Haitian entrants, and COFA migrants will be eligible for subsidized Marketplace coverage.
• International Health Insurance: Many expats opt for international health insurance plans, especially if they anticipate frequent travel or desire coverage that extends beyond the U.S. These plans can be tailored to specific needs and often provide comprehensive global coverage.

Registration Steps and Documentation: There isn't a single 'registration' process for healthcare like in countries with universal systems. Instead, you register with an insurance provider, and then with individual doctors or hospitals within your plan's network. Required documentation typically includes your visa, passport, proof of residency, and insurance details. For public programs like Medicare or Medicaid, extensive documentation of immigration status and income is required, and eligibility is, as noted, severely restricted for many foreigners.

Reciprocal Health Agreements: The U.S. does not have reciprocal health agreements with other countries that would provide free or subsidized healthcare for foreign citizens.

Expats in the U.S. have several options for health insurance, each with varying costs and coverage levels. Choosing the right plan is crucial due to the high cost of care.

1. Employer-Provided Plans: This is the most common and often most cost-effective option for working expats. Employers typically contribute to premiums, reducing the employee's out-of-pocket cost. These plans vary widely in terms of deductibles, co-pays, and network restrictions (HMO, PPO, EPO, POS). In 2025, the average annual premium for family employer-sponsored coverage was $26,993, with covered workers contributing an average of 26% ($6,850) for family coverage.
2. Affordable Care Act (ACA) Marketplace Plans: Individuals who do not receive employer-sponsored insurance can purchase plans through state or federal marketplaces. These plans are categorized into 'metal tiers' (Bronze, Silver, Gold, Platinum) indicating the level of cost-sharing.
   • Typical Monthly Premiums (2025): Average monthly premiums range from approximately $380 for Bronze plans to over $510 for Gold plans. Individual average premiums were around $440/month, and family averages were about $1,168/month in 2025.
   • Subsidies: Enhanced premium tax credits, which help reduce premium costs, have been extended through 2025. However, starting in 2026, lawfully present immigrants below the federal poverty level who are ineligible for Medicaid will lose access to these subsidies. By 2027, only LPRs, Cuban/Haitian entrants, and COFA migrants will be eligible for subsidized Marketplace coverage.
3. International Health Insurance: Designed specifically for expats, these plans offer comprehensive coverage both within the U.S. and globally. They are often more expensive but provide flexibility and peace of mind for those who travel frequently or plan to move between countries.
   • Typical Annual Premiums (2025): Individual plans can range from $500 to over $10,000 per year (averaging around $2,500 for mid-tier coverage), while family plans can range from $6,000 to over $25,000 per year.

It is crucial to compare plans carefully, considering premiums, deductibles, co-pays, out-of-pocket maximums, and network restrictions.

Healthcare costs in the United States are among the highest in the world, and understanding these expenses is vital for expats. The average annual healthcare cost for a person increased to $7,871 in 2025. Without insurance, individuals are responsible for the full cost of services, which can be financially devastating.

Typical Out-of-Pocket Costs (without insurance):

• GP Visits: A primary care visit can cost between $40 and $400, with an average of $171 in major cities. This typically covers the consultation but not additional tests or procedures.
• Specialist Consultations: Expect to pay between $300 and $800 for an initial specialist visit.
• Urgent Care Visits: For non-emergency situations, urgent care centers are a more affordable alternative to emergency rooms, with costs typically ranging from $150 to $600.
• Hospital Stays: A single hospital stay, even for a minor issue, can quickly accumulate bills in the thousands of dollars. Major surgeries or extended stays can reach tens or hundreds of thousands.
• Prescriptions: Prescription drug costs are a significant driver of overall healthcare expenses, with pharmacy costs rising by 9.7% in 2025. The cost of medications varies widely, and some high-cost drugs can be very expensive without insurance or with high deductibles.
• Dental and Vision Care: These are often not covered by standard health insurance plans and typically require separate dental and vision insurance or out-of-pocket payment. Routine dental check-ups can cost $100-$300, while more complex procedures are significantly higher. Eye exams can range from $50-$200, plus the cost of glasses or contacts.

It is important to note that these figures are averages, and actual costs can vary significantly based on location, provider, and the complexity of the medical issue. Always inquire about pricing upfront if paying out-of-pocket.

In the United States, the universal emergency telephone number for all emergencies, including medical, fire, and police, is 911. This number should be used for life-threatening situations, serious injuries, or any immediate danger.

What to Expect When Calling 911:

1. A dispatcher will answer and ask for your location and the type of emergency.
2. Be prepared to provide details about the situation and the phone number you are calling from.
3. Stay on the line until the dispatcher tells you to hang up, as they may provide instructions or ask further questions.
4. Emergency Medical Services (EMS) personnel, including Emergency Medical Technicians (EMTs) and Paramedics, are trained and licensed to provide prehospital emergency medical care.

Treatment for Foreigners: Emergency departments in the U.S. are legally required to provide stabilizing treatment for patients with urgent medical conditions, regardless of their ability to pay or immigration status, under the Emergency Medical Treatment and Labor Act (EMTALA). However, this does not mean the treatment is free. Foreigners, like uninsured citizens, will receive a bill for emergency services, which can be very expensive. Ambulance services also incur separate charges.

Ambulance Availability: Ambulances are widely available across the U.S. and are dispatched through the 911 system. Access to an emergency department (ED) is generally good, with 71% of the U.S. population having access to an ED within 30 minutes, and 98% within 60 minutes.

For non-emergency medical advice or situations, avoid calling 911. Many cities offer a 311 non-emergency municipal services number, and a national Poison Control hotline is available at 1-800-222-1222.

The U.S. healthcare system presents a mixed picture regarding quality. While it is renowned for its cutting-edge medical research, advanced technology, and highly specialized treatments, its overall performance in international rankings is often lower than other wealthy nations. In 2025, the United States ranked 38th in global healthcare quality.

Strengths:

• Technology and Innovation: The U.S. excels in medical innovation, research, and the availability of advanced diagnostic and treatment technologies.
• Specialized Care: For complex or rare conditions, U.S. specialists and medical centers are often world-class.
• Treatment Outcomes: The U.S. performs similarly to or better than peer nations in some specific treatment outcomes, such as mortality rates within 30 days of acute hospital treatment for certain conditions like ischemic strokes.

Weaknesses:

• Overall Health Outcomes: Despite spending nearly twice as much per capita on healthcare as comparable wealthy nations (an estimated $14,885 per person in 2024), the U.S. has a lower life expectancy and worse long-term health outcomes. Americans live shorter lives and have more avoidable deaths compared to many peer countries.
• Access and Affordability: High costs and the lack of universal coverage create significant barriers to access for many, contributing to poorer outcomes. The U.S. has the highest rate of preventable and treatable deaths for all ages among a group of high-income countries.
• Maternal Mortality: The U.S. has the highest rate of pregnancy-related deaths (18.6 deaths per 100,000 live births in 2023) compared to similar countries (5.1 deaths per 100,000 live births).
• Primary Care and General Practitioners: The U.S. performs worse than peer nations in health system capacity, such as the rate of general practitioners.
• Waiting Times: Average wait times for a primary care visit are around 31 days, and even longer for specialty treatments, which can impact timely access to care.

In comparison to neighboring countries like Canada (which has a universal public system), the U.S. offers more immediate access to specialized care and advanced procedures for those with comprehensive private insurance, but at a significantly higher cost and with greater administrative complexity. The overall system is often criticized for its inefficiency and inequities despite its high spending.