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What is Obamacare: Clearing the confusion for expats in 2024 (Open enrollment 2025)

One thing I've seen a lot of confusion about was around the question “do expats qualify for Obamacare” and I want to clarify a few things to help sort an answer to that out. Healthcare in the United States is incredibly important and it's not something you should just choose to opt-out of, because it could very possibly one day send you bankrupt.

First things first, what is “Obamacare”? You may know a little, but it's important that we frame this conversation properly.

The Affordable Care Act (ACA – “Obamacare”)

I'll start with the real obvious things: The name Obamacare came around because it was introduced by one, President Obama. It's not actually the name of the bill, it's just what gets thrown around both by supporters, and detractors of the bill. It's the easy way of referring to the Affordable Care Act, and that basically, it provides for three things:

  • Make affordable health insurance available to more people. The law provides consumers with subsidies (β€œpremium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
  • Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Although not all states have expanded their Medicaid programs.)
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

So basically: It was designed to make healthcare more affordable and cover more people.

For expats, we can generally ignore the vast majority of what was included in the ACA because to get a visa in the U.S., you most likely do not fall into these levels around the poverty level.

First, we should be very thankful for that.

What Obamacare is not

Therefore, what Obamacare is not is an easier way to describe it. It is not a subscription/membership/service that is provided where you fill in a form entitled “Obamacare” and you get healthcare.

If only it was that easy.

There is no health insurance or policy that was created, and instead what was created, was a means of standardizing the coverage that already existed and an aim to create a service that makes signing up to these much more straightforward.

So what does Obamacare do for you?

One very important provision of the Act was that it made healthcare much more comprehensive by law. You may have heard talk of “pre-existing conditions” and this basically says that an insurance company can't turn you away because they already have something that would be covered.

Obamacare meant that you are covered for preventative care of your pre-existing conditions, meaning that you stay healthier, and therefore avoid getting more bills down the road as your condition may worsen.

The second thing that it created was “health insurance marketplaces” or “exchanges”. The theory is that by putting all insurances that meet certain requirements in one place that can be compared will result in better and more affordable insurance for all.

Now, in practice, the websites are not great and incredibly difficult to navigate and understand, but they're better than nothing!

Insurance options for those new to the country

If you are an individual who is not covered for health insurance by their employer, you need to get individual health insurance.

If you've had no major events nothing has changed for you, then you don't qualify for a “Special Enrollment” and you need to wait for the “Open Enrollment period”.

Open Enrollment happens around November 1 each year. Miss this window, and you'll have to wait a year to get insurance. BAD! VERY BAD!

An alternative option for health insurance for expats with Cigna Global

Personally, I've used Cigna Global, a service that exists outside of the U.S. but provides coverage inside as an expat.

Instead of using the exchanges, and comparing coverage that way, I found that Cigna Global could provide me with better coverage for less money, and I jumped on it.

I have now had a doctor's visit and a dentist's visit, and both were completely covered by my insurance.

Everyone is different, do your research, and ask lots of questions! Most importantly though it is very important that you have health insurance while being in the U.S. Even a minor incident can bankrupt you and fast.

I've written a whole article about health insurance for those who are new to the country here.

In the months of November & December 2023, Cigna Global is offering 10% off their health insurance plans for the lifetime of the policy*. This means you get the full coverage but for a reduced price for the whole time you keep the insurance policy active.

2022 Open Enrollment (starting in November 2021)


  1. You must sign up by January 15, 2022. If you want 2022 coverage, there is just the one deadline. Beat the rush and sign up early.
  2. Coverage could be more affordable than you think. Last year, 8 in 10 people qualified for financial help.
  3. If you already have coverage, shop and save. Already have health coverage through, on November 1 head back to update your information and compare your options for 2022. There may be plans available that save you money.
  4. Free in-person help is available. If you have questions about signing up or want to talk through your options with a trained professional, free help is just a call or click away. Call 1-800-318-2596 or visit


The yearly period in the fall when people can enroll in a health insurance plan for the next calendar year. Open Enrollment for 2022 runs from November 1 through January 15, 2022. Enroll by December 15 for coverage that starts January 1.

Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period. You’re eligible if you have certain life events, like getting married, having a baby, or losing other health coverage.

– Job-based plans may have different Open Enrollment Periods. Check with your employer.
– You can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.

Josh Pugh

Josh Pugh

Josh is a business founding, digital marketing focused, charity driving, community builder from South Australia, living in New York City. After moving in 2017, Josh realized that there was an opportunity to curate and help the community of expats who moved to the United States – and launched America Josh. Josh is also the President of Variety – the Children's Charity of New York, Secretary at The Mateship Foundation, and Founder & CEO at Fortnight Digital.View Author posts

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