We answer some key questions about US healthcare and what you need to do to ensure you are covered.


January can be a super-miserable month, when every friend, colleague and neighbour seems to either be suffering from the awful cold “that’s going around” or they’re fighting fit and ploughing through those New Year’s Resolutions as though they actually enjoy a daily 5km run in incessant drizzle!

Obamacare, the Affordable Care Act (ACA) is only normally available to those expatriates with a Green Card

I’ve found myself in the former category, unfortunately, and it’s made me think about healthcare and how you are going to access it when you make the move to the US. At the time of writing it’s unclear what’s going to happen to the system when Donald Trump becomes President (tomorrow, heavens!), so in a bid to make the picture clearer, today we answer some questions about the current system, and run through possible outcomes.

How do expats currently get healthcare?

If you require treatment in the US, your first port of call will be the equivalent of a GP. You will need to register with your chosen doctor, and provide them with your medical history and insurance details. They will be able to supply you with prescriptions, and transfer you to any specialists. For emergency treatment, you’re advised to call ahead to the hospital to let them know you’re coming so that you can avoid long wait times. You will need to show them your insurance documents before any treatment can be administered. Once you’ve been seen to hospital, you will need to pay part of your bill before you can be discharged, and can expect to receive a bill for the remainder of the costs in the mail.


With adequate insurance, American health is as good as anywhere in the world


Why is insurance so important?

The standard of care that you receive in the USA is some of the very best in the world – but it has the price tag to match. That is perhaps why, despite being the world’s only superpower, US health outcomes such as longevity are only around mid-table on the OECD Better Life Index of major industrial nations. Interestingly, however, 88 percent of Americans report themselves as being very healthy, which is way above average – must be that American optimism shining through again!

Anyway, to ensure you aren’t hit with costly bills for any healthcare you require, you need to be fully insured from the minute you touch down in the USA. Bear in mind that even in the case of an emergency, you will be charged for an ambulance and all the care you receive.

If you’re relocating to the USA for work, always check whether your employer will be offering you and your family any kind of medical insurance package, and if so, what it covers. You may have to take out an additional private policy to guarantee you’re covered for all eventualities. For a family, paying over $10,000 per annum in health insurance is not unusual.

Will I be entitled to Obamacare?

Obamacare, the nickname for treatment provided under the Affordable Care Act (ACA), is only normally available to those expatriates with a Green Card. Trump has been vocal about planning to repeal ACA on “day one” of his administration. How he will do this remains to be seen, and since the election he has backtracked slightly, saying he might instead opt to amend the current act. Although it does look like things won’t stay as they are, it’s unclear how long a repeal, or any changes, are likely to take, especially as reversing the act will require a vote in Congress. In handover talks, Obama has allegedly outlined a list of healthcare policies he’d urge Trump to uphold. Whether Trump follows this advice remains to be seen, but the Republican leader of the Senate, Paul Ryan, is even more anti-Obamacare, so we may find President Trump actually defending your rights to health insurance! Assuming there is change, Congress’s last bash at repealing the act offered up a proposed transition period of two years.

Don’t make the mistake of assuming that ACA is the same as the NHS – it isn’t. You still have to pay health insurance of usually between $50 and $100 per month and go through an application process. Read more about applying and the costs involved by clicking here.

What does this mean for expats?

If you are only planning on spending extended holidays in your American property, you will need to take out an insurance policy that covers you for the specific period that you’re in town, for any treatment that you will require. Do be careful of any exclusions – Americans do not believe it is their responsibility to pay for your healthcare and a medical emergency could see you bankrupted or refused treatment if you are not covered.

If you are only planning on spending extended holidays in your American property, you will need to take out an insurance policy that covers you for the specific period that you’re in town, for any treatment that you will require

If you’re moving on a more permanent basis, will be living and earning in the US, and are considered a ‘resident’ for tax purposes, you will need to pay more careful consideration to the policy that you take out. As mentioned above, your employer may offer you some insurance cover. What policy you decide to take out will depend on your specific needs.

According to statistics from the Health and Human Services Department the number of people signing up to the ACA healthcare plans post-election was actually up. This shows that many feel comforted that any changes to the law will take a significant period of time, so it still makes sense to apply for one of these ACA plans. After all, if Trump were to repeal the Act entirely, he would be effectively taking away health insurance from close to 20 million people, and that kind of decision won’t be taken lightly.

Mr Trump’s first budget is due to be handed to Congress on 6th February. This budget will be key to understanding the priorities of the Trump administration, and how the country’s healthcare system might be shaken up. We will keep you updated as new developments are made.

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