Of everywhere a Briton might move, the United States is the country where being uninsured is most dangerous. There is no universal public system, and medical costs are the highest on earth — a single hospital stay can run into tens of thousands of dollars.
This guide explains how healthcare works for British expats in the US, what cover your visa may already give you, and where international private medical insurance fits in.
Healthcare in United States: how the system works
The US has no universal public healthcare. Medicare and Medicaid exist for citizens and residents in specific categories — the elderly and low-income — and most working expats are not eligible. For everyone else, cover comes from an employer plan, the Affordable Care Act (ACA) marketplace, or private insurance.
British expats on a work visa are usually covered by an employer-sponsored plan; without one, you would buy cover through the ACA marketplace or privately, depending on your visa and residency status. There is no safety net equivalent to the NHS — if you are uninsured, you pay the full, undiscounted price yourself.
Why British expats take out private cover
US medical pricing is unlike anywhere else: an emergency-room visit can cost several thousand dollars before any treatment, and a serious illness or surgery can reach six figures. Comprehensive cover is not a nicety here — it is protection against genuinely ruinous bills.
What expat health insurance costs in United States
The US has the most expensive healthcare in the world, and premiums reflect it. Employer plans spread the cost; if you are buying your own, international cover including the US is a major expense but far cheaper than paying a hospital bill directly.
Good to know before you move
- There is no free emergency care — even an ambulance and ER visit are billed.
- Employer plans vary hugely on deductibles, co-pays and networks — read the detail.
- International cover that includes the US costs more, because US treatment prices are so high.
- Check whether your plan is "in-network" at the hospitals near you before you need them.
Private hospitals and where Britons settle
Hundreds of thousands of British nationals live in the US, many on employer-sponsored work visas that come with a health plan.
Renowned systems include the Mayo Clinic, Cleveland Clinic, Johns Hopkins and Massachusetts General — excellent, but priced accordingly.
Popular with British expats: New York, Los Angeles, San Francisco, Boston, Chicago, Miami.
How a UK broker helps expats in United States
International private medical insurance is a specialist market, and the right policy depends on your visa, your age, your medical history and how much time you spend outside United States. A UK-based specialist broker can compare the international insurers available through its service, check that a policy meets any local or visa requirement, and explain what is — and is not — covered before you commit.
A broker can compare only the insurers and policies available through its service, and may receive commission or charge a fee. Ask for the insurer panel, the remuneration disclosure and the total price. Requesting a quote is free and puts you under no obligation to buy.
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Expat health insurance in United States: FAQs
Does the US have free healthcare for expats?
No. There is no universal public system. Medicare and Medicaid are limited to citizens and residents in specific categories, and most working British expats are not eligible, so you must arrange your own cover.
How much can medical treatment cost in the US?
Far more than almost anywhere else. An emergency-room visit can cost several thousand dollars, and a serious illness or major surgery can run to six figures. This is why going uninsured in the US is so risky.
Will my UK health insurance cover me in the US?
A domestic UK policy will not, and travel insurance is only for short trips. If you are living in the US you need either an employer/ACA plan or international private medical insurance that specifically includes the United States.
Do I need my own insurance if I have a US work visa?
Often your employer provides a plan, but the cover, deductibles and whether your family is included vary widely. Many expats add international cover for portability and to cover trips back to the UK. Check exactly what your employer plan includes.
What is the difference between a US plan and international cover?
A US domestic plan covers you inside the US, usually within a network. International private medical insurance travels with you worldwide, including back to the UK, which suits expats who move around or split their time.
Other expat destinations
Visa, residency and insurance rules change and vary by individual circumstances. This guide is general information, not personal or regulated advice — always confirm the current requirements for your situation before you rely on them. Health Insurance UK is an information and lead-generation service, not an insurer or broker.