Health Insurance for Expats in the US
Living abroad, especially in the USA, is a whole different level of adventure. As an foreigners or immigrant living in the USA you have left your home country to live in a new world. The transition to a new country comes with challenges. One of those challenges is securing adequate US health insurance to cover you in the United States as well as your home country and other countries around the world. Here we offer some guidance on the topic of Health Insurance America and some plans you might consider.
Health Insurance Plans for Foreigners in the USA
We would recommend two options for expatriates moving to live in the USA. Cigna Global is an excellent global insurer with great service and benefits. Cigna Global offers a flexible plan design allowing you to pick and choose different modules to tailor the plan to your needs and budget. The other suggested plan would be GeoBlue Xplorer which offers similar benefits and service to Cigna. GeoBlue Xplorer is offered in association with Blue Cross and Blue Shield of America and comes with the excellent BCBS network of doctors and hospitals associated with BCBS.
Medical Coverage for Expatriates in the USA
If you are relocating to the United States, it is important to know that the US does not require all expatriates (or even US citizens) to have medical coverage. However, the risk of being in the US without medical coverage are massive hospital bills or no access to medical care. There are newer requirements for certain immigrants or foreigners on select visa types that may require you to have health coverage.
Medical costs in the US tend to be higher than in other countries for a couple of reasons. American doctors tend to order more tests and scans than in other countries, and the US deals with a relatively high rate of medical inflation.
Health Insurance in the USA – An Overview
The quality of medical care available in the United States is generally of a high standard. In the United States, US health care is provided by private hospitals and clinics. This requires citizens to have private US healthcare insurance. Often, an employer provides insurance that covers the employee and their immediate family. A federal Medicare program is available for retirees. There is also Medicaid, which is a federal medical aid program for the poor. Most foreigners living in the US do not qualify for these plans. As a result most immigrants or foreigners purchase international health insurance themselves.
Immigrants to the USA: To obtain an immigration visa, foreigners must prove they will be covered by “approved health insurance,” such as a family or employment-based policy, within 30 days of entering the United States, unless they are affluent enough to cover their “reasonably foreseeable medical costs.” (US Customs)
How Much Does Health Insurance Cost in the USA?
How much is health insurance in America? Premiums, or the cost of the USA medical insurance coverage, are based on some factors including country of origin, age, medical history, etc. It is advised to have more comprehensive insurance for US medical care because it can cost a lot, but the costs of not having it can be much higher. For example, the tests and scans doctors often run are costly and typically not covered by budget medical insurance plans.
Cost of Health Insurance in the USA for International Applicants
Below are some example costs for internationals applying for medical expense coverage in the USA applying for the Cigna Global Gold Plan. Costs can be adjusted up or down by adding or removing benefits, deductibles, or cost share amounts.
30 Year old male: Cost is $563 per month
50 Year old female: Cost is 901 per month
40 year old husband and wife: $1,371 per month
Cigna offers a more comprehensive Platinum plan and a more affordable Silver plan. Ask your agent for guidance on which coverage and plan is best for your needs. Costs were calculated including worldwide coverage and a $750 core deductible and a $1,000 outpatient deductible and excluding dental, vision, and evacuation modules. Pricing will vary based on the plan selected and other factors.
US Insurance for Foreigners and the ACA Penalty
The shared responsibility provision is part of the Affordable Care Act, also known as ACA or Obamacare. The goal is to ensure that all US citizens and permanent residents have access to quality USA health insurance. Any non-resident aliens, including international students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for 2 years (out of the past six).
Starting with the 2019 plan year (for taxes filed in April 2020), the ACA or Shared Responsibility Payment no longer applies.
Details: Foreign nationals who live in the United States for a short enough period of time that they do not become resident aliens for federal income tax purposes are exempt from the individual shared responsibility payment even though they may have to file a U.S. income tax return. The IRS has more information available on when a foreign national becomes a resident alien for federal income tax purposes. Individuals who are exempt under this rule include:
Dual-status aliens in their first year of U.S. residency;
Nonresident aliens or dual-status aliens who elect to file a joint return with a U.S. spouse;
Individuals who file a Form 1040NR or Form 1040NR-EZ (including a dual-status tax return for their last year of U.S. residency); and Individuals who are claimed as a personal exemption on Form 1040NR or Form 1040NR-EZ.
All U.S. citizens living in the United States are subject to the individual shared responsibility provision as are all permanent residents and all foreign nationals who are in the United States long enough during a calendar year to qualify as resident aliens for tax purposes. This category includes nonresident aliens who meet certain presence requirements and elect to be treated as resident aliens.
Travel Medical Insurance for Visitors to the US
If you are an expatriate living in the US, additional medical coverage should be purchased for the period that you will be in the country. You will want to ensure this coverage protects you in case of an accident, a medical emergency as well as repatriation. You should investigate if you will need this travel insurance before entering the country and if the insurance needs to come from your home country, the U.S. or both!
For periods of less than one year in the US, a travel medical insurance plan may be enough to cover your needs. For younger travelers wanting basic emergency medical insurance (instead of comprehensive major medical cover), a travel medical plan will work well. Most travel medical insurance plans provide coverage for accidents or illness, saving you from large medical expenses if you require a visit to the doctor or hospital while in the U.S. as well as give you access to universal pharmaceutical care and translation services, should they be required.
Cost of Short Term Medical Insurance Plans in the USA
The cost of these plans varies greatly. Short-term travel medical plans start at about $1.50 per day and can be as high as $10+ per day for older clients or higher-end coverage. As mentioned above, Global Medical plans offer options from very affordable catastrophic coverage (only covering the worst-case scenarios) to high value comprehensive medical plans. Our most affordable plans cost $400 – $500 per year, and we have plans that would cost as much as $30,000 – $40,000 per year.
How Much Health Insurance Cover Do I Need in the USA?
We often get asked, “what are the typical costs for medical expenses in US healthcare facilities or hospitals?”. People ask this as they want to know how much insurance coverage to buy (the maximum coverage or benefit amount per policy period) when traveling to the USA, as a visitor or an expatriate. Unfortunately, this is not an easy question to answer. Healthcare costs in the US vary by illness, procedure, and healthcare facility. The costs of treating different illnesses vary significantly. Treating a fever is less expensive than removing a kidney stone. Some facilities will charge dramatically more for a procedure than the hospital down the street.
How to Determine the Amount of International Health Coverage You Need
There are many factors to consider, including how long you will be staying (a more extended stay might require a higher maximum coverage amount) and how comfortable you are with paying above the max coverage amount if you have to.
You might also want to consider how easy it would be for you to return to your home country should you need additional services. If you do not need to stay in the US for extended care and have free insurance in your home country, you can get by with a lower maximum coverage amount. However, if your job or personal situation requires that you remain in the US for treatment, you would need to consider higher maximum coverage amounts.
Costs for Acute or Emergency Care in the USA
People also ask how much it will cost for an emergency room visit. According to a National Institute for Health study, “The average cost of a visit to the ER for over 8,000 patients across the U.S. was $2,168. But the interquartile range (IQR), which represents the difference between the 25th and 75th percentile of charges, was $1,957 — meaning many patients were paying a lot more or a lot less than that.”
The chart to the right shows some of the variations you see at different hospitals and clinics for various illnesses (Minimum and Maximum charges) by illness. One benefit of working with an international health insurance provider is that they will often direct you to the best healthcare facility at the lowest prices. You can receive treatment from your doctor at his office or clinic in many cases, and it can be 3-4 times less expensive than obtaining that same treatment (from the same doctor) in a hospital!
How much Medical Coverage Should Foreigners in the U.S. Purchase?
Buying health insurance is a personal decision. First, consider the issues outlined above (risks, length of stay, ability to return home, etc.) and consider how much you can afford to pay. Policy maximums typically start at as little as $50,000 per policy period (maximums are typically per person) and can be as high as $5 million; some are uncapped or unlimited. Some guidelines:
5 days to 1 month, we recommend $50,000 – $100,000 in medical coverage
One month to 3 months, we suggest $100,000-$500,000
For three months or longer, $250,000 or more.
For a year or longer, we suggest at least $1 million in coverage per year – more if you have family, want to be treated in the USA if you get critically ill, or will be staying in the USA for multiple years. Select plans offer unlimited coverage.
Of course, if you are older or have more people in your family traveling, the risks are more significant, so that you might consider higher limits.
Also, make sure you choose the right type of plan. We offer short-term Travel Medical (typically for travel less than a year or two) and long-term Global Medical (for those moving abroad for multiple years) plans.
Most Popular Health Insurance Plans for Foreigners in the USA
The Cigna Global Medical plan offers multiple plan levels and a modular design allowing you to pick you benefit package and coverage options.
The GeoBlue Xplorer plan offers a comprehensive plan design with access to the premier network of doctors and hospitals in the USA administered by the BlueCross / Blue Shield association. Their plans provide a high level of coverage across the board and their service is excellent.
The IMG Global Medical plan is an affordable option that we recommend to younger clients or individuals on a budget. Their Bronze and Silver plans provide a basic level of cover primarily for emergency care or with limited benefits. Their Gold and Platinum level of cover provide more comprehensive benefits.