The U.S. Healthcare System

Understanding the U.S. healthcare system can help you arrange treatment and plan for medical costs. This guide explains how expats, foreign residents, and visitors can access care, find doctors, manage prescriptions, and understand their coverage options.

How Does Healthcare Work in the U.S.?

The U.S. does not have universal healthcare coverage or a nationwide system that provides free care for everyone. Instead, the U.S. healthcare system is funded through public programs, private insurance, and direct patient payments. What you pay depends on the treatment, provider, and any health coverage or financial assistance available to you.

Care is delivered through hospitals, clinics, specialist centers, and independent medical practices. These include both privately owned and government-run facilities. A facility’s ownership does not, by itself, determine how patients pay: a private hospital, for example, may accept private health plans, public coverage, and direct payments.

Public Programs and Private Insurance

Most Americans have health coverage through an employer, an individually purchased plan, or a public program. Major public programs include:

• Medicare: Mainly for people aged 65 and over, plus certain younger people with disabilities or qualifying conditions.
• Medicaid: For eligible people with limited incomes, with eligibility and benefits varying by state.
• Children’s Health Insurance Program (CHIP): Primarily for eligible children whose families earn too much to qualify for Medicaid.

The federal government administers Medicare. States administer Medicaid and CHIP within federal guidelines, with funding shared between state and federal governments.

Private health coverage is commonly offered through employers or purchased individually, including through Affordable Care Act (ACA) marketplaces. These plans help cover treatment costs, but patients may still need to pay part of the cost themselves.

Who Pays for Healthcare in the U.S.?

Governments, employers, and households fund the U.S. healthcare system through taxes, insurance premiums, and direct payments for care. How much patients pay depends on their coverage and circumstances, with some qualifying for free or reduced-cost coverage or treatment under specific programs and state rules.

Together, these funding sources support substantial national spending. According to the Centers for Medicare & Medicaid Services (CMS), U.S. healthcare spending reached $5.3 trillion in 2024. This is equivalent to $15,474 per person and 18.0% of gross domestic product (GDP). The per-person figure reflects spending across the entire system, rather than the amount an individual patient pays.

This spending is also high by global standards. The Organisation for Economic Co-operation and Development’s (OECD) Health at a Glance 2025 report found that U.S. healthcare spending per person was the highest among OECD countries, at about 2.5 times the OECD average after adjusting for differences in purchasing power.

Can Foreigners Access Healthcare in the U.S.?

Yes. Foreign residents and temporary visitors can access the U.S. healthcare system for routine appointments, specialist consultations, and ongoing treatment. However, access to care does not automatically mean you qualify for public health coverage.

How you pay depends on your coverage and any financial assistance available to you. For those living in the U.S., immigration status and state of residence also affect coverage options.

Healthcare for Expats and Foreign Residents

If you live in the U.S., you may obtain coverage through an employer, an individual or international health insurance plan, or a public program if eligible.

Individual coverage options include Marketplace plans, which certain lawfully present immigrants can purchase if they meet the other eligibility requirements. See HealthCare.gov’s guidance for immigrants for details.

Eligibility for public programs follows different rules. Medicaid and CHIP eligibility depends on state rules, income, residency, and immigration status, with waiting periods applying to some applicants. Medicare has separate requirements based on age or qualifying medical conditions, as well as citizenship or residency.

Recent federal changes also affect some noncitizens’ coverage options:

• Medicaid and CHIP: Federal funding restrictions for full benefits for certain noncitizens took effect on October 1, 2026. Exceptions remain, including state options to cover lawfully residing children and pregnant people. Check your state’s current rules to find out whether you qualify.
• Marketplace savings: Starting January 1, 2027, federal Marketplace savings for noncitizens will be limited to certain immigration categories, subject to other eligibility requirements. Some people who lose access to savings may still qualify to purchase coverage. Check HealthCare.gov’s immigration guidance before applying.

When comparing plans, check both your eligibility and whether the policy covers care where you will live or travel. Our guide to health insurance for non-U.S. citizens explains coverage areas, provider networks, and eligibility in more detail.

If you have an existing medical condition, confirm whether your plan covers related appointments, medicines, and ongoing treatment. Our guide to international health insurance for pre-existing conditions explains what to check when comparing policies.

Healthcare for Visitors

If you are visiting the U.S. temporarily, you can arrange non-emergency treatment through a doctor’s office, walk-in clinic, or urgent care center. Confirm that the facility offers the service you need and has an appointment available. Specialist care may require a referral and advance arrangements.

Visitors generally pay for treatment themselves unless their health plan covers the cost. Before traveling, check whether your home-country plan covers care in the U.S. If it does not, consider travel insurance for the USA that includes medical coverage.

Whichever policy you use, review its medical benefits, limits, exclusions, and payment arrangements. Keep receipts and treatment records for any claim.

If your trip is specifically for planned treatment, confirm that your policy covers it and arrange care and payment in advance. A plan that covers unexpected illness may not cover treatment planned before departure.

Where to Go for Medical Care in the U.S.

The table below explains where to seek care within the U.S. healthcare system, when to use each service, and how to access it.

Emergency Care and Your Rights

Under the Emergency Medical Treatment and Labor Act (EMTALA), Medicare-participating hospital emergency departments must provide an appropriate medical screening examination to determine whether an emergency medical condition is present. If one is found, they must provide stabilizing treatment or arrange an appropriate transfer when necessary.

These protections apply regardless of coverage status, ability to pay, or U.S. citizenship. Hospitals cannot delay required screening or stabilizing treatment to demand an upfront deposit.

However, the right to emergency care does not mean treatment is free. You may still receive bills for hospital care and ambulance transport, and these costs can be substantial if you are uninsured.

How Much Does Healthcare Cost in the U.S.?

The cost of healthcare in the U.S. varies widely by provider, location, and treatment. Your final bill also depends on your health coverage, including your plan’s benefits, provider network, and cost-sharing rules.

If you are paying for care yourself, ask about self-pay prices, discounts, and financial assistance before booking.

For an idea of what common services can cost, here are published self-pay prices checked in October 2026:

• Virtual consultation: CVS MinuteClinic lists $89 for most eligible virtual visits. Medication or additional treatment may cost extra.
• Primary care or urgent care appointment: Urgent Team lists a $150 self-pay visit fee that covers the provider evaluation and services such as on-site lab tests, X-rays, and routine procedures related to the visit. Outside laboratory testing, certain vaccines, and medical equipment cost extra.
• Urgent care with testing or a minor procedure: Brown University Health lists $175 for a clinic visit alone, $225 for a visit with polymerase chain reaction (PCR) testing or imaging, and $275 for a visit involving minor procedures such as stitches. These discounted rates require full payment at the time of the visit. Certain lab services, vaccinations, and medical equipment are not included in these prices.

These are provider-specific examples, not national averages or estimates for emergency or hospital care. They also show why the consultation fee alone may not tell you the full cost: tests, procedures, and other services may be included or billed separately.

Before planned treatment, request a written estimate and confirm what it includes. For more examples, see our guide to healthcare costs in the United States.

Understanding Premiums and Out-of-Pocket Costs

Your coverage and treatment costs may include:

• Premium: The regular payment you make to maintain coverage.
• Deductible: An amount you pay for certain covered services before your plan begins paying its share.
• Copayment: A fixed amount you pay for a covered service.
• Coinsurance: A percentage of the covered cost that you pay.

If your plan has an out-of-pocket maximum, it limits qualifying spending during the plan’s coverage period. Check which expenses count toward it. Premiums and services your plan does not cover generally do not count toward the maximum. Out-of-network spending may be excluded or subject to a separate limit.

For detailed explanations and examples, see our guide to deductibles, cost sharing, and out-of-pocket maximums.

Why Is Healthcare So Expensive in the U.S.?

Healthcare is expensive in the U.S. largely because many medical services and branded prescription drugs cost more than in other high-income countries. Complex insurance and billing systems also add substantial administrative costs, while higher clinical salaries contribute to spending.

These factors help explain why the U.S. spends more on healthcare, even though Americans do not always receive more care than people in other high-income countries. For more details, see the Commonwealth Fund’s analysis of U.S. healthcare spending.

Medical Bills, Estimates, and Reimbursement

Before planned treatment, ask what the estimate includes and whether consultations, tests, facility charges, or other professional services will be billed separately.

How you pay will depend on the provider and your coverage. Providers often submit claims to your insurer, then bill you for your share. The insurer’s explanation of benefits (EOB) is not a bill.

Some arrangements require payment up front, followed by a reimbursement claim. For help preparing and submitting that claim, see our guide to filing an international health insurance claim.

When a bill arrives:

1. Compare it with your estimate and any EOB.
2. Request an itemized bill if charges are unclear.
3. Ask the provider or insurer to investigate possible errors.
4. If you cannot afford the bill, ask about discounts, financial assistance, or a payment plan.

You may also have protections against certain unexpected charges. The No Surprises Act limits certain out-of-network bills, but it does not cover every policy or service.

For uninsured or self-paying patients, a separate protection allows eligible patients to dispute a bill when a provider or facility charges at least $400 more than its good-faith estimate.

Eligible patients generally must start the dispute process within 120 calendar days of the date on the initial bill. See CMS guidance on disputing a medical bill for eligibility requirements.

Who Can Get Free or Low-Cost Healthcare?

Some people qualify for help paying for health coverage or medical treatment in the U.S.

Help Paying for Coverage

• Medicaid and CHIP: May provide free or low-cost coverage to eligible applicants. Check income, household, immigration, and state requirements.
• ACA Marketplace premium tax credits: Help eligible applicants reduce their monthly premiums.
• Cost-sharing reductions: Lower deductibles, copayments, and coinsurance for eligible people enrolled in Silver-tier Marketplace plans.

Medicare generally involves premiums and other patient charges, although some beneficiaries qualify for help with these costs.

Help Paying for Treatment

• Community health centers: Provide care whether or not you have health coverage, with fees adjusted according to income and family size. Use the Health Resources and Services Administration’s (HRSA) health center finder to locate a provider.
• Hospital financial assistance: May provide free or discounted care to patients who meet the hospital’s requirements. Ask its billing department how to apply.
• Veterans Affairs (VA) healthcare: Eligible veterans may receive care without copayments or at reduced cost, depending on income, disability status, and the service received. See the VA’s healthcare eligibility guidance for details.
• Prescription assistance: Patient assistance programs may help eligible patients pay for medicines. Ask your pharmacist about lower-cost generic options.

Eligibility varies by program and may depend on income, residency, immigration status, and existing coverage. Check current requirements before applying.

Finding Doctors and Getting Prescriptions

Planning ahead can help you navigate the U.S. healthcare system, find a doctor, continue ongoing treatment, and get the medicines you need.

How Do I Find a Doctor in the U.S.?

If you have health coverage, check your plan’s provider directory to find nearby doctors in your plan’s network. If you are uninsured, contact practices directly to ask about self-pay appointments and prices, or use HRSA’s health center finder to locate a community health center.

Adults often choose a family doctor or an internal medicine doctor, while parents typically choose a pediatrician or family doctor for their children.

Your primary care provider (PCP) can manage everyday health concerns, preventive care, and long-term conditions, as well as coordinate specialist treatment.

To arrange your first appointment:

1. Confirm that the practice accepts new patients and is in-network for your specific plan. A practice may accept some plans from a company but not others.
2. Call the practice or use its online booking system. Explain that you are a new patient and briefly describe the reason for your visit.
3. For specialist care, ask whether you need a referral from another clinician or prior authorization from your insurer, and who will arrange it.
4. Confirm your expected costs. If you are paying yourself, request an estimate before planned care.

Prior authorization is the insurer’s advance review of a proposed service. It is not a guarantee that the final claim will be paid, so check your benefits and any remaining conditions.

For your first appointment, bring photo identification and your referral, if required. Also, bring your membership card or policy details (if applicable) and any relevant medical records, including those listed in the next section.

For broader provider-search advice, read our guide to finding a doctor abroad.

Preparing for Routine and Ongoing Care

If you need ongoing treatment, schedule an initial appointment early so your new provider can review the care you need. Our guide to managing chronic conditions abroad offers more advice on planning appointments and maintaining treatment.

Before your first appointment, prepare:

• A brief medical summary
• Relevant test results
• Vaccination records
• A medication list showing active ingredients and doses
• A list of allergies

Include English translations where needed. Share these with your new practice before the first appointment if requested.

Immigrant visa and permanent-residence applicants may have vaccination requirements as part of their immigration medical examination. Check the requirements for your application route and bring your vaccination records. See U.S. Citizenship and Immigration Services (USCIS) vaccination guidance.

Check coverage separately for services such as dental care, vision care, maternity care, and mental-health treatment. Benefits and exclusions depend on your policy.

Pharmacies and Prescriptions

U.S. pharmacies fill prescriptions and sell over-the-counter medicines. They include independent stores, chains such as CVS and Walgreens, and pharmacies within some clinics and grocery stores. Ask whether a lower-cost generic equivalent is available.

For prescription medication, an authorized prescriber can send a prescription to your chosen pharmacy. Check that the pharmacy participates in your plan and that your medication is covered. Request refills before your supply runs out.

Do not assume a U.S. pharmacy can fill a foreign prescription. Consult a U.S. clinician who can review your treatment and issue a local prescription if appropriate.

Before traveling, check whether your medication is available in the U.S. and how you will continue treatment. Keep medicines in their original labeled containers and carry a prescription copy or a doctor’s letter in English. For more preparation advice, see our guide to traveling internationally with prescription medication.

Bringing medicine into the country is separate from filling a prescription locally. U.S. Food and Drug Administration (FDA) guidance allows visitors who are neither U.S. citizens nor permanent residents to bring or ship a 90-day supply for personal use, subject to restrictions.

Controlled substances have separate requirements. Check FDA guidance on personal importation and the relevant Drug Enforcement Administration (DEA) rules before traveling.

Healthcare Quality and Access in the U.S.

The U.S. healthcare system offers advanced medical care, but access, costs, and quality vary. Understanding these differences can help you compare providers and plan your care.

The Pros and Cons of Healthcare in the U.S.

For expats and residents, the main strengths and limitations of U.S. healthcare include:

Where Does the U.S. Rank in Healthcare?

There is no single universally accepted ranking of the U.S. healthcare system. It placed 15th among 110 countries in CEOWORLD’s 2025 Health Care Index, but last among the 10 countries assessed in the Commonwealth Fund’s Mirror, Mirror 2024 report.

These studies use different measures and comparison groups. Neither result determines the quality of an individual hospital or the care you will receive.

For more context, see our guide to healthcare systems around the world.

How Accessible Is Healthcare in the U.S.?

Access to the U.S. healthcare system depends on your location, ability to pay, coverage, and the availability of local providers.

Major cities generally offer a wider range of hospitals and specialists, while rural residents may need to travel farther for some services. In either setting, transport difficulties, provider shortages, and appointment availability can affect access.

There is no single nationwide waiting time. Availability varies by specialty, location, provider, and urgency.

How Can I Compare Hospital Quality?

Look at measures relevant to your treatment, such as patient safety, infection rates, patient experience, and outcomes for the procedure you need.

Hospitals are subject to state licensing requirements and other applicable laws. Medicare hospitals must also meet federal health and safety standards. Accreditation involves an external assessment of standards and practices.

You can use Medicare Care Compare to compare participating hospitals’ quality ratings and patient experience information, even if you are not enrolled in Medicare.

Quality ratings do not establish whether a hospital accepts your insurance. For more guidance on hospital options and choosing a facility, see our guide to hospitals in the United States.

Find Coverage for Your Stay in the U.S.

Whether you are visiting or moving to the U.S., start with coverage suited to your stay:

• Visiting temporarily? Explore travel insurance for the USA for coverage options for unexpected illness or injury during your trip.
• Moving to the U.S.? Read our guide to health insurance for non-U.S. citizens to explore options for expats and foreign residents.

Before choosing a policy, check its U.S. provider network, medical benefits, deductibles, and exclusions, including restrictions on pre-existing conditions.

For help comparing your options, request a quote from our licensed insurance advisors.

U.S. Healthcare System FAQs