Understanding American Healthcare and How to Access It
The US healthcare system can be confusing to new arrivals in the country, and learning how to navigate it can seem like a daunting task. However, if you are planning to live or travel to America, it’s important to understand how the system works and how to access medical care when you need it.
This is especially true since the United States does not offer universal healthcare to citizens or visitors. The U.S. also has the most expensive healthcare system in the world. As a result, paying for medical care can be very expensive if you do not have adequate health insurance to cover the costs.
Find out how to access healthcare in the United States, where to go if you have an emergency, and what you can do to keep your costs down as an expat or visitor.
The US healthcare system can be confusing to new arrivals in the country, and learning how to navigate it can seem like a daunting task. However, if you are planning to live or travel to America, it’s important to understand how the system works and how to access medical care when you need it.
This is especially true since the United States does not offer universal healthcare to citizens or visitors. The U.S. also has the most expensive healthcare system in the world. As a result, paying for medical care can be very expensive if you do not have adequate health insurance to cover the costs.
Find out how to access healthcare in the United States, where to go if you have an emergency, and what you can do to keep your costs down as an expat or visitor.
An Overview of Healthcare in the United States
Healthcare in the U.S. is provided by a mixture of public, private, and university-run hospitals, medical practices, and institutions. While there is no universal system, a major piece of healthcare legislation passed in 2010 called the Affordable Care Act (ACA), also known as Obamacare. This created greater access to health insurance for most Americans and a government healthcare portal for finding coverage.
The United States offers excellent healthcare services to those who can afford it. For this reason, between 100,000 and 200,000 international patients enter the country each year to receive treatment. However, this high-quality care comes with a hefty price tag, as U.S. healthcare costs are higher per capita than those in any other developed nation.
However, despite spending more on healthcare per person, outcomes are worse. According to the 2023 U.S. News and World Report ranking of well-developed public health systems, the United States was placed at number 23, below countries like Italy, Singapore, and South Korea.
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Healthcare Funding and Expenditure
The U.S. spends a higher percentage of its GDP on healthcare compared to all other wealthy, industrialized countries – about twice as much per capita, on average.
Healthcare facilities in the United States are primarily privately owned and funded by a mixture of public programs, private insurance, and out-of-pocket payments. As a result, most citizens cover their healthcare costs through a combination of health insurance and personal funds.
The Pros of the U.S. Healthcare System
The U.S. healthcare system has several benefits that make it stand out in medical care and innovation. Although it can be complicated and expensive, those who can use it enjoy many advantages, such as:
- Choice of Care: If you have health insurance, you can choose your primary care doctor, as long as they are in your insurer’s network. This allows you to select a doctor that fits your specific needs.
- Focus on Prevention: Americans have good access to screenings for diseases like breast and colorectal cancer. Early detection helps in identifying and treating health issues before they become serious.
- High-Level Care: The U.S. has world-renowned healthcare facilities such as the Mayo Clinic and the Cleveland Clinic, which are known for their excellent care and advanced treatments.
- State-of-the-Art Treatment: The country is also home to some of the best hospitals in the world for specialized care, such as cancer, heart issues, and brain surgery. These facilities use the latest technology for treating severe conditions.
- Wide Range of Facilities: Major cities offer a wide range of healthcare options, including public and private hospitals, surgery centers, urgent care clinics, and specialty clinics. This ensures that patients can find the care they need.
- Telehealth Infrastructure: The growth of telehealth services means that patients can now see doctors remotely. This makes it easier to get medical advice and care without having to travel.
The Cons of the U.S. Healthcare System
On the flip side, there are several disadvantages to the U.S. healthcare system, such as:
High Costs: Depending on the injury or illness, treatment can range from several thousand to hundreds of thousands of dollars. In 2021, 58% of American debts that went into collection were medical bills.
Hidden Coverage Gaps: Patients need to check if their hospitals and doctors are part of their insurance network to avoid higher bills. If you use an out-of-network provider, your insurer may not cover the full cost, leaving you responsible for the difference.
Limited Care in Rural Areas: In smaller communities, care options are more limited, and many rural hospitals are closing. This means some patients have to travel long distances to receive proper care.
High Maternal Mortality: This is an ongoing problem, especially for Black women. Contributing factors include untreated chronic illnesses, insufficient prenatal care, and a higher rate of C-sections compared to other countries.
Inconsistent Women’s Healthcare: In 2022, the U.S. Supreme Court ruled that states could make their own decisions about whether abortion would be legal. Since then, some areas have not followed standard medical guidelines for managing pregnancy complications.
Who Can Access US Healthcare?
Having health insurance is not mandatory at the federal level in the US, and you do not need it to access healthcare in the country. However, it’s a good idea to get insured to avoid a large medical bill if you get sick or injured. What’s more, some states may impose a tax penalty if you don’t have coverage.
If you're working in the U.S., your employer may provide you with health insurance. You can also access "Marketplace" coverage through Healthcare.gov, which meets the ACA's minimum standards. These plans are available to citizens and "lawfully present" immigrants.
Undocumented immigrants are usually not able to join Medicaid programs in most states. However, California allows anyone to enroll in Medi-Cal (the state’s Medicaid program) regardless of their immigration status.
Even if you're eligible for a U.S. plan, be aware that sometimes insurance coverage is limited to a certain state or geographic area. If you plan to travel around the U.S., or if you want to visit other countries while using the United States as a home base, consider an international insurance plan with more extensive coverage.
Does the United States Have Universal Healthcare?
No, the United States is one of the few wealthy industrialized nations left without a universal healthcare system. However, the government does offer healthcare to specific groups. For instance, the Veterans Health Administration provides medical services to veterans and seniors over the age of 65, and some younger disabled individuals, are eligible for Medicare.
Medicaid is a government-funded health program that serves many children, pregnant women, low-income individuals, and those with disabilities. Eligibility for Medicaid varies by state.
If you do not qualify for Medicaid, you will need private insurance or will have to pay for medical care yourself. Although health insurance is not legally required, about 90% of Americans have some form of coverage. If employer-provided insurance is not an option, you can buy your own coverage.
Different health insurance plans offer different benefits. Large companies that directly cover their employees' healthcare costs are not required to meet the standards set by the Affordable Care Act (ACA), also known as "Obamacare." However, plans that do comply with ACA guidelines must cover the following:
- Doctor visits
- Preventive care (such as vaccines)
- Lab tests
- Birth control
- Prescriptions (though the medications covered can vary by plan)
- Pregnancy and childbirth
- Mental health services
- Inpatient and outpatient hospital care
- Physical therapy
- Dental care for those under 18
Notably, adults usually need separate insurance to cover vision and dental care.
Can Expats Access Public Healthcare in the US?
Non-citizens generally cannot access Medicare or Medicaid except under certain conditions. Most people who qualify as “lawfully present immigrants” have to wait five years before being eligible, though there are exceptions.
However, most expats in the U.S. with any kind of legal status are qualified to use the Marketplace, which is the health insurance portal provided at healthcare.gov.
Can Visitors Access Public Healthcare in the US?
Since the U.S. does not have a public healthcare system, visitors cannot access it. However, hospital emergency rooms are required to stabilize patients regardless of whether they have insurance or not.
Still, it’s a good idea to buy travel insurance that includes medical coverage when visiting the United States. This will help expedite your care, and make it possible for you to receive care beyond the minimum without receiving a hefty bill afterward.
How to Access US Healthcare as an Expat or Visitor
Accessing healthcare in the United States essentially involves having health insurance. Americans often receive health, dental, and vision insurance through their employer, and you probably can too, if you’re moving to the US to work.
Your employer will usually pay for part of this coverage, but employees almost always have to pay insurance premiums and deductibles. This coverage usually extends to an employee's family members, including children up to the age of 26. However, as you might expect, adding family members increases the premium and deductible.
Another option for obtaining private health insurance is via Healthcare.gov. The government helps those with lower incomes pay for this coverage. Some of these plans may include adult dental coverage, but if it doesn’t, you can find separate dental plans at Healthcare.gov.
For visitors to the U.S., accessing healthcare is generally limited to emergencies, where you can visit a hospital’s emergency room.
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How to Access Emergency Treatment as an Expat or Visitor
In the U.S., all hospital emergency rooms are required to treat anyone who comes in. However, unless you are in a life-or-death situation, it’s usually better to visit an urgent care clinic.
You can read more about what to do in an emergency and how to access hospital treatment in our article on Hospitals in the United States.
General and Preventive Care for Expats in the US
Many adults in the U.S. have a primary care provider or general practitioner who handles preventive care, such as health screenings and treats mild illnesses. Parents usually register their children with a pediatrician so they have a regular doctor to see for both preventive care and illness.
With some insurance plans, you might have to visit your primary care provider before seeing a specialist, while other plans allow patients to go directly to a specialist for care. As always, make sure that the physicians you visit are in-network, as this means they have an agreement with your health insurer to accept their payment rates. Otherwise, you will need to pay higher costs for your care.
Notably, you can make appointments to see dentists and eye doctors without needing a referral. These providers may operate independently or as part of a larger practice or. Remember to check that they are in-network for your dental or vision insurance to avoid paying extra costs.
Pharmacies and Medication in America
In the United States, pharmacies are the go-to places for both over-the-counter and prescription medications. These may be independent small businesses or part of regional or national chains, such as Walgreens and CVS. Pharmacies might be standalone or located within clinics, grocery stores, or hospitals.
Prescription medications generally take from a few minutes to several hours to be filled. While most people prefer to visit a pharmacy in person, prescriptions can also be filled and delivered by mail.
You can also purchase over-the-counter medicines in big box stores and from online retailers. If you are shopping for common medications, it’s worth checking if the store or pharmacy has a less expensive generic equivalent.
The Food and Drug Administration (FDA) advises bringing no more than a 90-day supply and having a doctor’s note in English to explain the need for the medication.
If you bring prescription or over-the-counter medications from your home country to the United States, make sure to keep them in their original labeled container. The Food and Drug Administration (FDA) recommends you bring no more than a 90-day supply of any medicine. You should also have a doctor’s note in English explaining why you need the medication.
Recommended and Mandatory Vaccinations
You can get vaccinations at pharmacies, doctor's offices, or clinics in the U.S. Health insurance often covers these vaccines. There are currently no mandatory vaccines required for travel to the United States.
Although the U.S. does not mandate vaccinations for entry into the country, foreign governments generally recommend that routine immunizations be up to date before traveling. These include vaccines for hepatitis A, hepatitis B, tetanus, diphtheria, measles, mumps, rubella, pertussis, polio, rotavirus, chickenpox, shingles, pneumonia, meningitis, seasonal influenza, and COVID-19. You should consult your doctor for personal guidance before you go.
If you are emigrating to the U.S. and seeking permanent residency, it is mandatory to have vaccines for mumps, measles, rubella, polio, tetanus and diphtheria, pertussis, Haemophilus influenzae type B, hepatitis A and B, rotavirus, meningococcal disease, varicella, pneumococcal disease, seasonal influenza, and COVID-19.
How Much Does Healthcare Cost in the US?
Healthcare in the U.S. is notoriously expensive, and there is no universal public program. Without insurance, even the most basic treatments can be extremely costly. You can read more about this in our article on How Much Does Healthcare Cost in the U.S.?
Out-of-Pocket Costs
Without health insurance, medical care costs stack up quickly. But even with health insurance, you will still have to pay some out-of-pocket costs, as follows:
Copayments: For most doctor or hospital visits, you will pay a copayment. This is a fixed amount, usually ranging from around $10 to $150, which you pay for a service that is covered by your insurance.
Coinsurance: Depending on your plan, your insurance may cover only a percentage of your medical costs, leaving you responsible for the remaining percentage.. In these cases, the portion you pay is called coinsurance. Be sure to review your plan details carefully to understand your financial responsibilities.
Deductible: Some plans require you to pay a certain amount out of pocket before your insurance begins to cover costs. For example, if a doctor's visit costs $200 and you have a $500 deductible, you’ll pay the full amount for the first two visits, then $100 for the third, and whatever the copay is for subsequent visits.
Prescriptions: Some health plans cover prescriptions, while others do not. Prescription medicines can be very expensive, but there are often cheaper non-brand-name alternatives available.
Payment and Subsidies
You’ll pay for most co-pays and prescriptions at the point of sale. If you receive specialist care or have a surgery or hospital stay, you’ll typically receive a bill.
The provider will send this bill to your insurance company to determine how much your plan will cover and how much you owe. Sometimes, you may need to pay the bill upfront and then submit the receipt to your insurance company for reimbursement.
If you are over 65 and meet certain criteria, you might qualify for Medicare. T If you have a certain immigration status, you may be eligible for Medicaid and CHIP (Children's Health Insurance Program)) benefits. These programs are not available to travelers, but if you are already living in the U.S., check healthcare.gov to see if you qualify.
Because so much of the U.S. healthcare system relies on insurance, it’s important to make sure you have coverage while traveling to or living in the country. As a visitor, you can’t access any government programs including the Marketplace, and as an expat, you might face waiting periods before benefits start.
Health Insurance for Expats and Visitors to the U.S.
Whether you are looking to relocate to the U.S. or enjoy a brief visit, it's essential to have appropriate health insurance in place before you leave. This is especially true for the United States, given the high cost of healthcare and the lack of public coverage.
Naturally, there are differences between what an expat and a visitor might need when choosing the right insurance policy. For tailored advice, explore our detailed guides on Health Insurance for Foreigners in the USA and Safety and Travel Insurance for the USA to find the best insurance plan to meet your specific needs and budget.
If you are unsure of which plan to get, you can also we are here to assist you and help you find select plans from the most trusted insurance providers worldwide. We can also provide you with free quotations so you can better assess your budget and wisely choose health insurance in the USA that will fit your situation.
If you're not sure which plan to choose, you can also talk to one of our licensed brokers for advice. We're here to help you pick from trusted insurance providers around the world. We also offer free quotes so you can plan your budget and find health insurance in the U.S. that fits your needs.
“Land of the Free” Doesn’t Mean Free Health Care
For expats and visitors to the United States, having adequate health insurance is the only way to ensure access to care without a very high price tag. Make sure you secure the right coverage you need before you travel or move to the country.
Wherever you are in the U.S., make sure you know the locations of the nearest urgent care clinic, as well as the closest hospital in case of an emergency. You might also want to check the hospitals’ ratings, but you will definitely want to make sure your particular plan covers you at the places you are most likely to receive care.
The U.S. is a vast and incredibly diverse country, with so much to see and experience. Whether you’re visiting for a week or settling down for the long haul, make sure you take care of your health and well-being so you can enjoy your stay!
Watch More
Envisage International and International Student Insurance (ISI) have created a 6-minute video that explains the U.S. healthcare system. It covers the challenges of navigating healthcare in the U.S. and offers tips for taking care of yourself.
Although the video was made with students in mind, the information is useful for any visitor or newcomer to the U.S. It includes advice on preparing for your stay, examples of medical costs, finding healthcare providers, and understanding key terms.
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Author: Sara Kettler is a content editor at International Citizens Insurance. She has lived and worked around the globe, spending time in England, Australia, France and Japan. In each new country she’s used local health insurance programs.