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How can expats get health insurance in the US?
Evidence tier: A1 Evidence type: Auto-discovered official publication Source: Wise Blog Official publication date: 2026-07-15 Captured: 2026-07-17T13:20:11.213Z
Moving to the US comes with a long list of admin tasks, and health insurance is usually one that causes a lot of confusion. You probably have many questions about expat health insurance and how it works.
Do you need insurance before you land? Will your employer cover you? What happens if you get sick before any policy kicks in? And why does everyone keep warning you about high medical bills?
The US doesn't have a universal public system, so coverage is something you arrange for yourself, usually through your job or a private plan.
Here's everything you need to know about how US health insurance works, the main routes expats use to get coverage, and what you can expect to pay.
We'll also introduce Wise — your international money transfer alternative. Use Wise to send stress-free transfers to over 140 countries - all at the standard mid-market exchange rate.
How does US health insurance work?
American healthcare runs on private networks.
Insurance companies negotiate discounted prices with hospitals, clinics, labs, and doctors, and that group of providers becomes the plan's network.
When you visit someone inside the network, your insurer pays the negotiated rate, and you pay a small share. When you visit someone outside of it, you pay much more, and sometimes even the entire bill.
In other words, your health insurance decides both how much of your medical costs get covered and which doctors you're allowed to see at that price.
Premium
Your premium is the fixed amount you pay every month to keep your insurance active, even if you don't see a doctor.
If you're on an employer plan, your share of the premium is usually deducted straight from your paycheck, and your employer covers the rest. If you buy your own plan, you pay the full premium yourself.
Deductible
The deductible is the amount you pay out of pocket each year before your insurer starts paying its share.
For example, on a plan with a 2,000 USD deductible, you cover the first 2,000 USD of your medical costs yourself. After that, the insurer picks up most of the bill.
Plans with low monthly premiums usually come with high deductibles, and the reverse is also true.
Copay and coinsurance
These are the two ways you split costs with your insurer once the deductible is met.
A copay is a flat fee for a specific service, like 30 USD for a visit to your family doctor. Coinsurance is a percentage, so on an 80/20 plan, your insurer pays 80% of the bill, and you pay the remaining 20%.
Most plans also have an out-of-pocket maximum. Once your spending in a calendar year hits that ceiling, your insurer covers 100% of eligible costs for the rest of the year.
PPO
A Preferred Provider Organization gives you more freedom. You can see any doctor or specialist you like without asking permission first, and you get some coverage even outside the network.
However, you'll pay a higher monthly premium for this flexibility.
HMO
A Health Maintenance Organization is more restrictive but cheaper.
You pick a primary care physician who becomes your first point of contact, and you need a referral from them before you can see a specialist. If you go outside the network, you generally pay the full cost yourself, except in emergencies.
How to pick a plan
Start by working backwards from how you expect to use healthcare over the next year.
Someone young and healthy, who rarely visits a doctor, will do better on a plan with a low premium and a high deductible, since they'll pay less every month and are unlikely to hit the deductible anyway.
At the same time, someone managing a chronic condition, expecting a baby, or taking regular prescriptions will usually save money on a higher premium plan with a lower deductible, because their costs are predictable and ongoing.
Once you've decided roughly where you sit, check whether the doctors and hospitals near your new address are in the plan's network and whether any medication you take regularly appears on the plan's formulary, which is the list of drugs it covers.
You'll also want to know whether dental and vision are included, since they're often sold as separate policies in the US.
The 4 main paths to health insurance for expats in the USA
Here's how the main options for US health insurance for expats compare:
<table><tbody><tr><td><strong>Option</strong></td><td><strong>Best for</strong></td><td><strong>Typical cost</strong></td><td><strong>Coverage abroad</strong></td><td><strong>When you can enroll</strong></td></tr><tr><td>Employer-sponsored</td><td>Anyone moving on a work visa with a US employer</td><td>Lowest, since your employer pays most of the premium</td><td>Rarely, or emergencies only</td><td>On your start date or during open enrollment</td></tr><tr><td>ACA Marketplace</td><td>Self-employed expats, students, spouses, and anyone without a job offer</td><td>Moderate</td><td>No</td><td>Within <strong>60 days</strong> of moving, or during open enrollment¹</td></tr><tr><td>International Private Medical Insurance (IPMI)</td><td>Expats splitting time between countries</td><td>Highest</td><td>Yes, usually worldwide</td><td>Any time</td></tr><tr><td>Short-term travel insurance</td><td>Filling a gap of a few weeks or months in the US</td><td>Low, but limited</td><td>Sometimes</td><td>Any time</td></tr></tbody></table>Let's take a closer look at how each of these options works.
Employer-sponsored insurance
If you're moving to the US for a job, this is almost always the cheapest route. Your employer pays a large share of the monthly premium, and your portion comes out of your paycheck before tax.
You'll usually be given a choice of two or three plans, and coverage starts either on your first day or after a waiting period. You may be able to add your spouse and children, but it'll likely cost more, since employers subsidize family coverage less generously.
The ACA marketplace (Obamacare)
The Affordable Care Act marketplace at HealthCare.gov sells individual plans to anyone lawfully present in the US, which includes most visa holders and green card holders.
Plans are sorted into metal tiers, including Bronze, Silver, Gold, and Platinum.²
Enrollment opens once a year in the fall, but moving to the US counts as a qualifying life event, giving you a 60-day special enrollment period from your arrival date.¹
International Private Medical Insurance (IPMI)
IPMI is global coverage sold by insurers like Cigna Global, Allianz Care, and Bupa Global. One policy works across borders, so you're covered in the US and in your home country.
This suits people who move between countries for work or keep a doctor back home.
Policies tend to have generous limits, direct billing with major hospitals, and English-speaking support lines, but the catch is the price. It can be really high.
American treatment costs a lot more than treatment in other countries, so adding US coverage to a global plan can raise your premium by a hefty amount.
Short-term travel medical insurance
These policies cover accidents and sudden illness for a set period, usually somewhere between a few days and a year.
If you have a gap in your health insurance coverage, such as the weeks between arriving in the US and your employer coverage kicking in, or the wait for a marketplace plan to become active, getting one of these plans can be a good option.
They're inexpensive and quick to buy, often within minutes online. However, expect the coverage to be limited to mostly emergencies.
What does health insurance in the USA cost?
It depends on your age and how you get covered.
If you're on a plan through your job, you'll pay around 114 USD a month for yourself, because your employer covers most of the cost. If you buy your own plan on the ACA marketplace, expect to pay around 497 USD a month before any tax credits.³
Your age and your plan tier are the biggest factors influencing the cost of your health insurance. For example, a 30-year-old pays about 618 USD a month for a PPO plan, but a 60-year-old pays a whopping 1,478 USD a month on average.³
What’s the best way to send money internationally?
Banks are certainly one option for sending money internationally, as are services like PayPal. But the problem with banks is they can often be slow, expensive and inconvenient. Luckily, there’s a better alternative out there.
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Steps to secure your coverage before and after you arrive
Coverage gaps can get expensive for expats in the US, so you want to minimize them as much as possible.
Before you fly
Confirm the date your employer coverage begins, since many US companies impose a waiting period after your start date. If there's a gap, buy a short-term travel medical policy to bridge it.
If you're moving to the US without a job offer, price out marketplace plans in the state you're moving to.
On arrival
Gather the documents you'll need to enroll in anything. That typically means:
- Your passport
- Visa documentation or I-94 record
- Social Security number (once you receive it)
- Proof of your US address (a lease agreement or a utility bill)
Having a US bank account can also help, since most insurers set up premiums as an automatic monthly debit.
Within 60 days
If you're not covered by an employer, apply through the ACA Marketplace.
Moving to the US counts as a qualifying life event, which opens a special enrollment period lasting 60 days from your arrival date.¹
Working out the US health system is something close to a rite of passage for every expat. But eventually, it becomes more familiar and easier to navigate.
That said, try to secure coverage early if you can. Spending even just a few days or a couple of weeks in the US without health insurance is a big financial risk, since the medical costs are some of the highest in the world.
While you're sorting it out, keep an eye on how you're moving money across borders.
Health insurance premiums and the general expenses of an international move add up, both in transfer fees and currency exchange rate markups.
To minimize these costs, use Wise.
<table><thead><tr><th><a href="https://wise.com/us/send-money/">Send money internationally with Wise</a> to 140+ countries and 40+ currencies – all at the fair <a href="https://wise.com/us/mid-market-rate">mid-market exchange rate</a> with low, transparent fees.</th></tr></thead><tbody></tbody></table>Sources
- HealthCare.Gov - Special enrollment opportunities
- HealthCare.Gov - How to pick a health insurance plan
- Investopedia - How Much Does Health Insurance Cost?
*Please see terms of use and product availability for your region or visit Wise fees and pricing for the most up to date pricing and fee information.
This publication is provided for general information purposes and does not constitute legal, tax or other professional advice from Wise Payments Limited or its subsidiaries and its affiliates, and it is not intended as a substitute for obtaining advice from a financial advisor or any other professional.
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