The US Healthcare System

Accessing Medical Care as a Foreigner in the United States

The United States is home to some of the world’s most advanced medical technology and quality healthcare services. However, for foreigners, whether visiting briefly or living long-term, the U.S. healthcare system can be complex, confusing, and costly to navigate.

Unlike many countries with universal healthcare, the U.S. relies heavily on a mix of private insurance, government programs, and out-of-pocket payments. Without a clear understanding of typical costs and options, it’s easy to encounter unexpected bills or barriers to care.

This article explains how healthcare works in the U.S., breaking down key costs and practical tips to help foreigners confidently access medical care during their stay.

How Does the US Healthcare System Work?

The U.S. healthcare system is a vast and complex network of both public and private providers, including nonprofit and for-profit hospitals, clinics, specialty centers, university medical centers, and independent practices.

While many facilities are privately owned, some are government-run, and funding comes from a combination of public programs, private insurance, and patient direct payments.

Unlike many developed countries, the U.S. does not provide universal free healthcare. Instead, most medical services require out-of-pocket payments or insurance coverage.

While some cities and states offer free or low-cost clinics, access to these services is limited and varies significantly across the country.

As a result, most Americans rely primarily on health insurance to cover their medical expenses, often supplementing this coverage with out-of-pocket costs.

Federal and State Roles in Healthcare

Both federal and state governments shape healthcare policy in the U.S. The federal government sets nationwide standards and regulations, while states have significant control over the implementation of local healthcare.

This results in wide variation in access and policies across states. For example, Massachusetts has strong healthcare policies and funding aimed at expanding coverage and reducing the number of uninsured residents.

As of January 2025, the federal government has been restructuring national health agencies and introducing new regulations to improve the system.

Public Healthcare Programs and Eligibility

Public healthcare support is available at the federal level for specific groups, including veterans, seniors aged 65 and over, and people with disabilities.

Medicaid also covers specific populations, including children, pregnant women, and low-income individuals, but eligibility and benefits vary by state. Enrollment is not automatic; applicants must apply and prove their citizenship or legal residency.

The Affordable Care Act (ACA), enacted in 2010, also expanded access to health insurance and established a government-run marketplace for individuals to purchase coverage.

Private Healthcare in the US

The U.S. healthcare system is primarily private, with most hospitals and medical practices being privately owned.

According to the U.S. Census, over 65% of Americans rely on private coverage to access a combination of private and public healthcare services.

Private facilities often offer specialized care and amenities that are not available in public settings.

Services and Access in Private Healthcare

Private healthcare services range widely, from basic checkups to concierge-level care. Having a primary care provider (PCP) is essential for preventive care and coordinating specialist visits, especially for families.

Patients frequently use online reviews to choose providers, and many healthcare professionals in the U.S. are internationally trained, making it easier for expats in large cities to find doctors who speak their language.

While waiting times to see specialists exist, they are generally less than 30 days. Federal regulations require insurers to approve urgent care within 72 hours and standard care within seven days.

Funding and Costs in Private Healthcare

Private healthcare is mainly funded through health insurance premiums paid by employers and individuals, supplemented by out-of-pocket expenses, especially for elective or non-emergency care.

Most hospitals operate as privately owned nonprofit organizations, although some are government-run or for-profit.

Federal and state regulations influence healthcare costs in the private sector. However, pricing and billing can vary widely between providers, making it essential for patients to understand their coverage and costs in advance.

How Good Is US Healthcare?

The U.S. healthcare system offers some of the most advanced medical services in the world, particularly in complex and specialized fields.

Each year, between 100,000 and 200,000 international patients travel to the United States for treatments that may be unavailable or less accessible in their home countries, highlighting the country’s cutting-edge medical capabilities.

The 2024 U.S. News & World Report ranked the United States 19th globally for well-developed public health systems, placing it within the top 25 worldwide and ahead of several European countries struggling with overburdened healthcare systems.

Nearly 20% of the world’s top hospitals are located in the U.S., including prestigious institutions affiliated with major universities, such as Johns Hopkins Hospital in Baltimore and Stanford Health Care in California.

However, this level of care comes at a high cost. The U.S. spends more per capita on healthcare than any other developed nation and allocates a larger share of its GDP to health services than most wealthy countries. For patients without comprehensive insurance, costs can be exceptionally high.

The Pros and Cons of US Healthcare

Below is an overview of the main advantages and drawbacks of the U.S. healthcare system.

The Pros of US Healthcare

Despite the high costs, patients benefit from several key advantages, including:

• Choice of Care: With health insurance, patients can typically select their primary care doctor from within their insurer’s network, enabling personalized care tailored to individual needs.
• High-Level Care: The U.S. is home to world-renowned healthcare facilities, such as the Mayo Clinic and the Cleveland Clinic, which are renowned for their exceptional care and advanced treatments.
• State-of-the-Art Treatment: The country also boasts some of the world’s top hospitals specializing in cancer, cardiovascular disease, and brain surgery. These facilities utilize the latest technology to effectively treat complex and severe conditions.
• Wide Range of Facilities: Major cities offer a diverse range of healthcare options, including public and private hospitals, surgery centers, urgent care clinics, and specialty clinics, ensuring patients can find the care they need.
• Telehealth Infrastructure: The rise of telehealth services enables patients to consult with doctors remotely, making it easier to access medical advice and care without the need for travel.

The Cons of US Healthcare

Despite its many strengths, the U.S. healthcare system also faces significant challenges that affect patients nationwide.

• High Costs: Medical treatment in the U.S. can be costly, with bills ranging from thousands to hundreds of thousands of dollars, depending on the nature of the injury or illness. These high costs create financial burdens for many, especially those without comprehensive insurance.
• Hidden Coverage Gaps: Even with insurance, patients often encounter unexpected expenses that are not covered. It’s crucial to confirm that hospitals and doctors are within your insurer’s network because using out-of-network providers can lead to significantly higher out-of-pocket costs, as insurers may only cover a portion of the fees.
• Limited Care in Rural Areas: Access to quality healthcare is uneven across the country. Rural communities frequently face shortages of medical providers and facilities, forcing patients to travel long distances for necessary care.
• Impact of State and Federal Policies: Healthcare availability and costs can vary widely depending on where you live and changes in laws. For instance, a federal law passed in 2022 capped the cost of insulin, providing relief to some patients, but such protections are not uniform nationwide.

Healthcare Access for Foreigners in the US

Access to healthcare in the U.S. as a foreign national depends heavily on your immigration status, length of stay, and the state in which you reside.

Public Healthcare Access for Foreigners

Foreign visitors are not eligible for Medicare or Medicaid, and most “lawfully present immigrants” must wait five years before qualifying for these programs.

Additionally, the U.S. does not have reciprocal healthcare agreements with other countries, so any public or universal coverage from your home country does not apply while you are in the U.S.

Some states have more inclusive policies. For example, California allows all residents, regardless of immigration status, to enroll in Medi-Cal, the state’s Medicaid program.

Enrollment in public healthcare programs is not automatic. Applicants must apply, provide proof of citizenship or legal residency, and meet eligibility criteria, which vary by state.

Private Health Insurance Options for Expats

If you plan to live and work in the U.S. for six months or longer, securing health insurance is essential for non-U.S. citizens. While federal law does not require expats to carry insurance, some states impose tax penalties if you don’t.

Here are your main insurance options as an expat:

• Employer-Sponsored Insurance: Most full-time workers receive health, dental, and vision insurance through their employer. Employers usually cover part of the cost, but employees still pay monthly premiums and deductibles. Coverage often includes spouses and children (up to age 26), though adding family members increases costs. Family members not covered by your plan – and who cannot legally work in the U.S. – may struggle to obtain insurance on their own.
• Marketplace Coverage: Many expats qualify to purchase insurance through the federal Health Insurance Marketplace at Healthcare.gov. These plans meet ACA standards and are available to present immigrants lawfully.
• Insurance Brokers: Another option is to work with a health insurance broker. Brokers – often at no cost to you – can help you compare plans and find coverage tailored to your needs. Some specialize in assisting expats and foreigners living in the U.S.

Healthcare for Visitors and Short-Term Travelers

Visitors cannot access public healthcare programs and must rely on emergency care in the event of an urgent situation.

U.S. hospital emergency rooms are required to treat patients regardless of ability to pay, but the costs can be very high and often require upfront deposits.

Because medical bills can quickly add up, purchasing travel medical insurance before your trip is strongly recommended.

If you plan to travel across different states or visit other countries while using the U.S. as a home base, choose a travel insurance plan with nationwide and international coverage, as most U.S.-based plans limit care to one region.

If you are visiting the U.S. briefly, consider visiting a travel clinic that specializes in care for international travelers. You can find them in most large U.S. cities or search using the Global Travel Clinic Directory from the International Society of Travel Medicine.

Accessing Emergency and Routine Care

Hospital emergency rooms are legally required to treat all patients, but emergency care is costly and must be paid for out of pocket by uninsured foreigners. Urgent care clinics are usually a more affordable alternative for non-life-threatening issues.

Many expats and residents have a primary care provider for preventive care and general health needs. Seeing specialists often requires referrals from your PCP, depending on your insurance plan. It’s essential to confirm that your doctors and clinics accept your insurance to avoid unexpected costs.

Learn 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

Most adults in the U.S. establish care with a PCP for routine health needs like screenings, immunizations, and chronic condition management. Parents typically register their children with a pediatrician for regular check-ups and to address acute illnesses.

Dental and vision services are typically not covered by standard health insurance. However, most plans allow you to visit dentists and optometrists without a referral, and make sure they’re in-network for your specific dental or vision coverage.

Pharmacies and Medication

Pharmacies are the go-to places for over-the-counter and prescription medications in the United States. They may be independent small businesses or part of major regional or national chains, such as Walgreens and CVS. Many clinics and large grocery stores also include an in-house pharmacy.

Over-the-counter medications are available at pharmacies, big-box stores, and online retailers. When shopping for typical medications, check whether a lower-cost generic equivalent is available.

If you bring prescription or over-the-counter medications from your home country, keep them in their original labeled containers.

The U.S. Food and Drug Administration (FDA) recommends bringing a supply of no more than 90 days. It’s also a good idea to carry a doctor’s note in English explaining why you need the medication.

Recommended and Mandatory Vaccinations

In the U.S., vaccinations are available at pharmacies, doctors’ offices, and clinics. Most health plans cover standard vaccines.

Travelers to the United States are not required to receive any mandatory vaccinations. However, many countries recommend updating routine immunizations before traveling, such as vaccines for measles, mumps, and rubella (MMR), as well as COVID-19.

It’s wise to consult your doctor for personalized advice and to bring documentation supporting any medications or prescriptions you are taking.

If you are immigrating to the U.S. and applying for permanent residency, certain vaccinations are required. For details on state-specific vaccine rules, refer to this list.

How Much Does Healthcare Cost in the US?

Healthcare in the U.S. is notoriously expensive, especially without insurance. Even basic treatments can be extremely costly. For example, visiting a doctor without insurance may cost 2 to 4 times more than if you are insured and in-network.

Prices vary by location, with higher costs in states like Connecticut, New York, or Hawaii.

Below are average price ranges (in USD) for common services:

• Pharmacy clinic visit: $60–$169
• Urgent care clinic visit: $60–$200
• Primary care visit: $100–$300
• Ambulance service: $400–$1,200
• Emergency room visit: $700–$3,400+
• Dental check-up: $50–$350
• Optometrist visit: $150–$250

Even with insurance, most people pay some portion of their medical bills. Typical out-of-pocket expenses include:

• Copayments: Fixed fees per visit or prescription
• Coinsurance: A percentage of the total cost after meeting your deductible
• Deductibles: The amount you must pay each year before insurance starts covering costs
• Prescription costs: Covered by some plans, but not all

Although out-of-pocket spending accounts for about 6% of total U.S. healthcare expenditures, it can be a significant burden, especially for those without insurance.

Healthcare Payment Systems and Subsidies

You usually pay copayments and prescription costs upfront. However, providers will bill your insurance to determine coverage and your remaining balance for more complex care, such as surgery or hospitalization.

Sometimes, you may need to pay first and seek reimbursement later. Providers of elective care, like dentists, opticians, or cosmetic surgeons, may offer payment plans or financing, often with interest.

If your insurer declines coverage, you will be responsible for the full cost. There is no fallback public healthcare system or financial assistance for foreign visitors. Because of this, most travelers and expats consider U.S. health insurance essential.

Registering for Healthcare and Insurance

Visitors do not need to register to receive emergency care, as hospitals and clinics are required to treat all patients. Long-term residents typically select healthcare providers through their insurance plans.

While primary care providers (PCPs) usually do not charge a formal registration fee, some may charge administrative fees during initial visits.

Most U.S. insurers require documentation such as:

• Identification: Passport, driver’s license, or possibly a birth certificate
• Proof of immigration status: Visa confirmation, immigration status certificates, or documents
• Social Security number: Tax forms or pay stub documentation may qualify
• Proof of residency: Rental or lease agreement, mortgage documents, or utility bills
• Proof of work and income: Employer and salary information, proof of income, or other employment status

If your insurance is employer-sponsored, your employer can often assist with the paperwork and help you obtain a Social Security number.

Processing new insurance applications can take up to 90 days; however, enrolling during open enrollment periods can expedite the approval process. Once registered, you will receive an insurance card and access to provider directories and plan resources.

“Land of the Free” Doesn’t Mean Free Healthcare

For expats and visitors to the United States, having quality coverage is the only way to access medical care without facing extremely high costs. Be sure to secure the right coverage before you travel or move.

Wherever you are in the U.S., know the location of the nearest urgent care clinic and the closest hospital in case of an emergency. It’s also vital to confirm in advance that your insurance covers treatment at those facilities.

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 planning to stay for years, taking care of your health will help you make the most of your time there.

If you’re unsure which plan to choose, we can help guide you through the process. Speak with or email one of our licensed brokers for personalized advice. We work with trusted international insurers and offer free quotes to help you compare plans and find coverage that meets your needs in the U.S.

Learn More About the US Healthcare System

Envisage International and International Student Insurance (ISI) have created a six-minute video explaining how the U.S. healthcare system works. It highlights common challenges and provides helpful tips for maintaining good health while in the country.

While the video is designed for international students, the information is also helpful for anyone new to the U.S. It includes advice on preparing for your stay, examples of medical costs, guidance on finding healthcare providers, and explanations of key insurance terms.