How does US healthcare work for Brits?

There is no NHS in the US. Most working people get health insurance through their employer, pay part of the cost from each pay cheque, and still pay towards care when they use it. Sort out cover before you fly: the FCDO says medical treatment is expensive and there are no special arrangements for British visitors.

The words you need

Employer cover

• Almost all employers with 1,000 or more staff offer health benefits. Under the Affordable Care Act (ACA), a waiting period can’t be more than 3 months
• You usually choose a plan for yourself, a spouse and children when you join. After that you can normally change only at the yearly open enrolment, or after a life event such as a birth or marriage
• Compare the total cost: premiums plus what you’d pay if someone in the family needs a lot of care. A cheap premium can hide a high deductible. At small firms (10 to 199 workers), the average single deductible was $2,631 in 2025
• With a qualifying high-deductible plan, you can put up to $4,400 (single) or $8,750 (family) into a tax-free health savings account (HSA) in 2026
• Ask for the plan summary before you accept. See Understanding a US job offer

Covering the gap when you arrive

Your NHS entitlement doesn’t follow you, and ordinary travel insurance may not cover you once you have moved. Before you fly, buy international or visitor health insurance that runs until your employer plan starts, and check how it treats existing conditions. In an emergency, dial 911 and contact your insurer quickly.

Buying your own: the ACA marketplace

If you don’t get cover through work (for example, as an E-2 founder), you can buy a plan on the ACA marketplace. Lawfully present immigrants, including people on valid work visas, can buy these plans, and moving to the US from abroad opens a “special enrolment period” so you don’t have to wait for open enrolment.

• Marketplace plans can’t reject you, charge you more or refuse to pay for essential benefits because of a condition you had before
• Help with premiums (the premium tax credit) is for incomes between 100% and 400% of the federal poverty level
• From 1 January 2027, only green card holders and a few other groups (Cuban or Haitian entrants and COFA migrants) can get that help. People on H-1B, L-1, E-2 and most other visas can still buy plans, at full price
• Open enrolment for 2027 plans starts on 1 November 2026. Sign up by 15 December for cover from 1 January
• Medicaid (low-income cover) generally isn’t open to people on work visas

New Jersey and Rhode Island also charge a penalty; the federal penalty ended after 2018. For other states, start at HealthCare.gov, which points you to your state’s own site if it has one.

Emergencies and surprise bills

• Hospitals with emergency departments that take Medicare must screen and stabilise you, regardless of ability to pay. You will be billed afterwards
• The No Surprises Act (in force since 1 January 2022) protects people with most types of insurance from surprise out-of-network bills for emergency care, some care at in-network hospitals, and air ambulances
• If you have no insurance, you can ask for a good-faith estimate of the cost before planned care
• Check each bill against your insurer’s statement, and ask about payment plans if a bill is large

Medicare and retiring in the US

Medicare is the federal scheme mainly for people aged 65 and over. Since July 2025 it is limited to citizens, green card holders and a few other groups. Premium-free hospital cover (Part A) needs about 10 years (40 quarters) of US work, yours or your spouse’s. A green card holder without that record can buy in only after living in the US for 5 years in a row. A retiree moving over later in life usually needs private cover until then, and it is expensive. Take advice before planning a US retirement around Medicare.

Medicines

What you pay for prescriptions depends on your plan’s list of covered drugs. UK prescriptions aren’t valid in the US. See Can I bring my medicines? and Renewing your health insurance.