Navigating the US Healthcare System as an Expat: Your Go-To Guide for Staying Healthy in America

Updated for 2026: This post was originally published in 2023. For the latest IRS figures and a comprehensive guide, see Expat Healthcare Benefits in the US: HSA, FSA & HDHP Guide (2026).

I have to admit — the US healthcare system was probably the single most confusing thing I encountered after moving from Singapore. In Singapore, healthcare is relatively straightforward: you have Medisave, MediShield Life, and the public hospital system. It's not perfect, but you generally know what you're getting into. In the US? I spent my first open enrollment period staring at plan documents like they were written in a foreign language. Which, in a way, they were :P

This post is my attempt to share what I've learned so far. I'm definitely not an expert — please double-check everything against the latest information before making decisions — but I hope this gives fellow expats a reasonable starting point.

Understanding the US healthcare system

The first thing to wrap your head around: healthcare in the US is primarily private and employer-sponsored. The government programs (Medicare for seniors, Medicaid for low-income families) probably won't apply to most expats. So you'll be dealing with private insurance, likely through your employer.

The alphabet soup: HMO, PPO, POS

These are the main types of private plans, and understanding the differences matters:

• HMO (Health Maintenance Organization) — Generally more affordable, but you pick a primary care physician (PCP) and can only see specialists within the HMO network. Less flexibility, lower cost.
• PPO (Preferred Provider Organization) — More expensive, but you have more freedom to see any doctor or specialist. From my experience, this is what most expat families end up choosing because the flexibility feels more familiar.
• POS (Point of Service) — A hybrid. You pay less for in-network providers, but you need a referral from your PCP for specialists. Think of it as the middle ground.

The costs that catch you off guard

This is the part that really surprised me. Beyond your monthly premium, there are:

• Deductibles — The amount you pay out of pocket before insurance kicks in. This can be thousands of dollars.
• Co-pays — A fixed amount you pay per visit (say, $30 for a doctor's appointment)
• Co-insurance — A percentage you pay after meeting your deductible (say, 20% of the bill)

Coming from Singapore where a GP visit costs about SGD 30-50 out of pocket, these numbers were a rude awakening T.T

Finding the right coverage

Most expats get insurance through their employer, which simplifies things somewhat. But you still need to make smart choices during open enrollment. Some questions I'd recommend asking yourself:

• What kind of healthcare do you expect to need? Just annual check-ups, or do you have ongoing conditions?
• Do you have pre-existing conditions? Make sure the plan covers them (and check if your employer's plan does specifically).
• How much can you realistically afford in premiums vs. out-of-pocket costs?
• Do you prefer paying more monthly for lower surprise bills, or are you comfortable with a higher-deductible plan that costs less up front?

Government programs probably aren't relevant for most of us, so I won't go deep into those.

For actually comparing plans, I found it helpful to:

• Look at the plan documents your HR provides (boring, but necessary)
• Ask other expats what they chose and why
• Consult with your insurance representative if your company has one
• Be prepared to adjust as your needs change — what works for a single person might not work once you have a family

Choosing a healthcare provider

Once you have insurance, you need to find actual doctors. The system works roughly like this:

Primary Care Physician (PCP) — Your main doctor, who coordinates your overall care. They handle check-ups, common issues, and refer you to specialists. Finding a PCP you trust and feel comfortable with is really important. I'd suggest asking other expat parents or colleagues for recommendations.

Specialists — Cardiologists, dermatologists, etc. You usually need a referral from your PCP, especially with HMO plans.

Hospitals — For emergencies, surgeries, and serious conditions. Choose one that's conveniently located and in your insurance network.

A practical tip: most insurance companies have a provider directory on their website. Use it. Staying in-network can save you a lot of money. I learned this the hard way when I nearly booked an out-of-network specialist without realizing it.

If you're an expat who prefers a provider who speaks your language or understands your cultural background, that's completely valid — and it's worth searching for. Many areas with large immigrant populations have providers who cater to specific communities.

Navigating appointments and procedures

A few things that tripped me up:

• Book appointments well in advance. Unlike in Singapore where you can usually see a GP same-day, specialist wait times in the US can be weeks or even months.
• Bring everything. Insurance cards, list of medications, medical history. The more prepared you are, the smoother it goes.
• Don't be shy about asking questions. If something isn't clear, ask your doctor to explain. This is your health — and your money.
• Emergency care (911) is available 24/7 for life-threatening situations. But be prepared for the bill — emergency visits are expensive, even with insurance.

Prescription drugs

Medications can be pricey. Always ask about generic alternatives (same active ingredient, fraction of the cost). Some plans offer lower prices through mail-order pharmacies, which is worth looking into.

Mental health

I think this is something the expat community doesn't talk about enough. Moving across the world is genuinely stressful, and mental health services are covered by most healthcare plans. Counseling, therapy, medication management — it's all available, and there's no shame in using it.

Managing costs

Healthcare costs in the US can be shocking. Some things that have helped me:

• Know your plan. Understand what's covered and what your out-of-pocket maximum is.
• Consider an HSA or FSA to set aside pre-tax money for medical expenses.
• Shop around. Prices for the same procedure can vary wildly between providers.
• Always ask about costs upfront before any procedure.
• Get second opinions for anything major.

I also highly recommend the book "The Price We Pay" by Marty Makary, MD. It opened my eyes to how healthcare pricing works (or doesn't work) in this country. Here's my review of the book.

Pediatric care

If you have kids (like Sophie), you'll need a pediatrician — a doctor who specializes in children from birth to 18. Some things to know:

• Routine check-ups, immunizations, and developmental screenings are standard and important to keep up with.
• Many schools and sports programs require a physical exam before your kid can participate.
• When choosing a pediatrician, ask for recommendations from other parents. Location and availability matter a lot when you've got a sick kid at home.

Dealing with language and cultural barriers

If English isn't your first language, ask about interpreter services — many providers offer them in person or over the phone. Some insurance companies also have multilingual staff. And community organizations in areas with large immigrant populations often offer help navigating the system.

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I know this is a lot of information, and honestly, I'm still figuring out parts of it myself. The US healthcare system is one of those things where you learn by doing (and occasionally by making mistakes). The key is to be proactive, ask questions, and not be afraid to seek help.

What's been your biggest surprise or challenge with US healthcare as an expat? I'd love to hear about your experience.

Cheers,

Chandler