The single biggest financial mistake you can make as an Australian moving to America? Not having health insurance for expats from day one. There's no Medicare safety net here. A broken arm can cost $20,000. One hospital admission can clear $100,000. And a serious illness can bankrupt you. Here's the full 2026 expat guide. How American health insurance actually works. The four routes available to you as a new arrival. And how to compare options without getting lost in the jargon.
This is a hub piece that links out to deeper articles on every topic below. The short version: get insured before you fly. Prefer your employer's plan if one's offered. If it isn't, Cigna Global or a broker like International Citizens Insurance are both solid options. Either works for an Australian arriving in the US.
Why health insurance for expats matters more than you think
If you grew up with Medicare, your mental model of healthcare goes something like this. Get sick, see a doctor, the cost is mostly covered, you pay a small gap. Maybe you have private health on top for hospital choice and dental.
That's not how this works in America.
In the US, without insurance, you pay full price for everything. “Full price” means hospital list prices. Those are some of the most aggressive in the world. A few real numbers, for context:
- An ambulance ride: $1,000-$3,000 (often not covered fully even with insurance)
- An ER visit, no admission: $2,000-$5,000
- A scan (MRI/CT): $1,500-$5,000
- A single night in a hospital: $3,000-$10,000+
- A broken arm with surgery: $15,000-$30,000
- Childbirth without complications: $30,000-$50,000
- A heart attack with treatment: $100,000+
Hospitals require about a third of uninsured adults to pay the full cost of medical care upfront. They want it before you can see a doctor. If you can't pay, you don't get treated for non-emergency care. Emergency care goes to collections. That destroys your US credit score and follows you for years.
This is the part that genuinely shocks Australians. The US healthcare system isn't designed to catch you when you fall. There's no public option for visitors or new arrivals. Your Australian Medicare doesn't cover you here. Australia has reciprocal agreements with several countries. The US is not one of them.
The point of this article isn't to scare you. It's to make you take this seriously enough to get coverage before you board the plane.
The four routes to health insurance for expats
Every Australian arriving in the US ends up using one of these four paths:
| Route | Who it's for | Typical cost (single person) |
|---|---|---|
| Employer-sponsored | You have a job offer with benefits | $0-300/month (employer pays the rest) |
| ACA marketplace (HealthCare.gov) | US tax resident, no employer coverage | $300-700/month before subsidies |
| International expat plan | New arrivals, self-employed, between jobs | $200-700/month depending on age |
| Travel medical (interim only) | Bridging the first 1-2 weeks | $50-200/month — not real coverage |
Each route has trade-offs. Let me walk through them.
Route 1 — Employer-sponsored health insurance
If you have a job offer with US benefits, this is almost always your best option. American employers typically pay 60-80% of the monthly premium. That makes employer plans the cheapest path to good coverage.
What to ask your employer before you sign:
- When does coverage start? (Some plans begin day 1; others have a 30, 60, or 90-day waiting period — that gap matters)
- What plan tiers are offered? (Usually presented as “platinum, gold, silver, bronze” — corresponding to how much the plan covers vs how much you pay out-of-pocket)
- What are the deductibles, copays, and out-of-pocket maximums for each tier?
- Is dental and vision included or separate?
- Does the plan include prescription coverage?
- What's the network? (Network = which doctors and hospitals are covered. PPO networks are bigger and more flexible than HMO networks.)
- Is there an HSA option? (Tax-advantaged savings, only available with high-deductible plans — see the FAQ below)
- Are dependents (spouse, children) eligible, and what does adding them cost?
The most common mistake: picking the cheapest plan tier without thinking about your actual healthcare needs. If you have any chronic condition, take regular medications, or are planning a family, the cheap plans cost you more in the long run because of higher copays and out-of-pocket maximums.
For more on the terminology you'll encounter, I've written a glossary of the 10 health insurance terms every expat needs to know.
Route 2 — ACA marketplace health insurance (HealthCare.gov)
The Affordable Care Act marketplace is where Americans without employer coverage shop for insurance. As an Australian on a visa, you can use it too, with two important caveats:
- You generally need to be a lawful resident with a US tax filing status to qualify for marketplace plans
- Most plans only cover you inside the US — if you fly home to Australia, you're not covered for medical care there
Open enrollment runs roughly November 1 through January 15 each year. Outside that window, you can only enroll if you have a “qualifying life event.” Good news for new arrivals: moving to the US qualifies as one (the special enrollment period gives you 60 days from the date you arrive). Losing employer coverage also qualifies.
What to know about ACA plans:
- Each US state runs its own marketplace, and plans available vary by ZIP code
- Costs are subsidized based on income — most expats earning a regular salary won't qualify for full subsidies, so plan to pay $300-700/month for an individual plan
- Plans are tiered the same way as employer plans: Bronze, Silver, Gold, Platinum
- All plans cover the “ten essential benefits” by law, including emergency care, prescriptions, mental health, and maternity
For the full breakdown of how the marketplace works for non-citizens, see my Obamacare explainer for expats.
Route 3 — International health insurance for expats
This is the route that confuses most new arrivals because it doesn't exist in Australia. International health insurance specifically targets expats — people living outside their home country. It covers you in the US. It follows you when you travel anywhere in the world. And it doesn't require US residency, an SSN, or US tax filings to enroll.
For Australians arriving in America without an employer plan, this is often the cleanest option. Two main approaches:
Going direct: Cigna Global
Cigna Global is the international plan I've personally used. It's purpose-built for expats. The plan has a strong global network. Coverage extends to both the US and back home in Australia when you travel. And it's been around long enough that the claims process is well-tested.
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The trade-off with going direct to a single insurer is that you only see Cigna's pricing. For some readers, especially those over 40 or with specific conditions, other carriers may price more competitively for the same coverage.
Going through a broker: International Citizens Insurance
International Citizens Insurance (ICI) is an international insurance broker. They don't sell their own product. They shop the market across multiple carriers (Cigna, BCBS Global Solutions, GeoBlue, IMG, Trawick, Unisure, and WorldTrips) and present you with quotes from several at once.
This is the option I'd suggest if you want to compare options before committing. Different carriers price differently based on your age, country of residence, and family structure. So the quote that comes back cheapest might not be the carrier you'd have picked. ICI has been the #1 broker of Cigna Global plans worldwide for years, so even if you end up on Cigna, you may get there cheaper through ICI than directly. ICI rates 4.9/5 from 800+ reviews, and the quote is free with no obligation.
Get free quotes from multiple carriers via ICI →
When international plans make the most sense
- You're newly arrived and don't have employer coverage yet
- You're self-employed or contracting
- You travel home to Australia regularly and want continuous coverage
- You're between jobs and need a non-employer plan
- You want a single plan that follows you globally without paperwork
- You're an entrepreneur whose business doesn't yet have a group plan
Route 4 — Travel medical insurance (interim only, not a real plan)
If you're between routes — for example, you've arrived in the US but your employer's plan doesn't kick in for 30 days — a short-term travel medical insurance policy can bridge the gap.
Important: this is not a substitute for real health insurance. Travel medical:
- Only covers emergencies, not routine or preventive care
- Excludes pre-existing conditions in most cases
- Has low overall coverage caps (often $50,000-$250,000)
- Doesn't satisfy the ACA “minimum essential coverage” rule
For a 2-week gap, fine. For a year, you're under-insured and one expensive medical event from financial trouble. I've written separately on whether you can get away with travel insurance instead of health insurance — short version: don't try.
What health insurance for expats actually costs in 2026
This is the question that derails most new arrivals. It's also the one that comes up most when readers tell me a plan is “too expensive.” The truth is that international health insurance is priced for the global market. What looks expensive next to Australian Medicare is often cheap next to US ACA plans for the same coverage.
Rough 2026 ballparks for international expat plans (single person, comprehensive coverage including the US):
| Age | Approximate monthly cost |
|---|---|
| 25-30 | $200-350 |
| 30-40 | $250-450 |
| 40-50 | $400-650 |
| 50-60 | $500-800+ |
| 60+ | $700-1,200+ |
Family plans run roughly 2-3x the single rate.
For comparison, a 30-year-old's ACA marketplace plan in 2026 typically runs $400-600/month before subsidies. It often only covers you in one state's network, and won't follow you back to Australia. So when readers say “international insurance is expensive,” it's worth asking what they're comparing it to.
The cost can also be dialed down significantly by:
- Choosing a higher deductible (you pay more out-of-pocket if you claim, but lower monthly premium)
- Excluding the US from your coverage area (cheap, but defeats the purpose if you live here)
- Choosing a more focused network within the US
- Building outpatient and dental coverage as add-ons rather than included
I've written a separate piece on the top 6 things to compare when looking at international plans — that's where to go if you're actively shopping.
The mistakes Australians make with US health insurance
I've seen each of these enough times to call them patterns:
- Arriving uninsured “just for a few days” until employer coverage kicks in. Then breaking an ankle on day three. The hospital bill exceeds what you saved on a few weeks of premiums by orders of magnitude.
- Picking the cheapest employer plan tier without reading the fine print. Then needing care that's “covered” but only after a $5,000 deductible.
- Assuming travel insurance from the airline or credit card is enough. It rarely is, and it definitely isn't for living in the country.
- Not understanding what “in-network” means. Going to a doctor who's in your network but having them order tests at a hospital that isn't. Surprise bills are a real thing.
- Thinking “I'm young and healthy, I don't need much.” Then getting hit by a car / having an appendix issue / discovering a chronic condition. Healthy until you're not.
- Letting a partner or kid go uninsured to save money. A child's hospital admission is just as expensive as an adult's. Family coverage is non-negotiable.
- Not enrolling during open enrollment because they “weren't sure yet.” Then needing care in March and discovering they have to wait until next November to enroll, unless they have a qualifying life event.
Your first 30 days in America: a health insurance checklist
The order I'd run this in if I was starting over:
- ✅ Before you fly — confirm whether your employer offers health benefits and when coverage starts. If there's a gap, plan to bridge it with a short-term plan.
- ✅ Before you fly — if you don't have employer coverage, get an international plan in place. Compare quotes via ICI or sign up directly with Cigna Global so you arrive with coverage active.
- ✅ Before you fly — gather any prescription medications and dental work that's pending. Easier to get done in Australia than the US.
- ✅ First week in the US — confirm your insurance card has arrived (digital is fine), download your insurer's app, and add the customer service number to your phone contacts.
- ✅ First two weeks — if you have employer coverage, complete the onboarding paperwork to elect your plan. Read every page of the benefits guide.
- ✅ First month — pick a primary care doctor in your network and book a “new patient” visit. This establishes you in the system before you actually need care. (Why this matters)
- ✅ Within 60 days — if you arrived without coverage and need to use the marketplace, your special enrollment period closes 60 days from arrival. Don't miss it.
- ✅ At each annual open enrollment — re-evaluate your plan. Plans, prices, and your needs all change.
More on US health insurance topics
This hub points to deeper articles on each piece of the puzzle:
- What is Obamacare? Clearing the confusion for expats
- Health insurance if you're new or if you have lost your job
- Intro to health insurance and 10 terms you need to know
- The top 6 things to look at when comparing international plans
- Can I use travel insurance instead of health insurance?
- How to find a primary care doctor in the US (and why you need one)
- Reciprocal Health Care for Australian expats abroad
- Free medicine and prescription delivery to your home
Health insurance for expats: FAQs
Yes. Unlike Australia, the US has no universal healthcare system that covers visitors or new arrivals. A single hospital admission without insurance can cost tens or hundreds of thousands of dollars. There's no public safety net. You need coverage in place from the day you land — even a 24-hour gap is a financial risk.
No. Australia's Reciprocal Health Care Agreements do not include the United States. Medicare provides zero coverage for any treatment received in America. If you'd been planning to rely on it, you can't.
Travel insurance is for short trips and emergencies, not for living somewhere. It typically excludes pre-existing conditions, has low overall coverage limits, and won't pay for routine care like check-ups, prescriptions, or chronic condition management. For anything more than a 6-month stay, a real health insurance plan is what you need.
International expat plans (Cigna Global, GeoBlue, IMG, and similar) cover you in the US AND globally, follow you when you travel home, and don't require US residency, an SSN, or US tax filings to enroll. Domestic US plans (employer-sponsored or ACA marketplace plans) typically only cover you within the US, often only within a network, and require you to be a US tax resident.
Costs vary significantly by age, coverage area, and deductible. As a rough guide, a healthy 30-year-old can expect to pay $200-400/month for a global plan, while a 50-year-old pays $400-700/month. Family plans run higher. Plans get cheaper if you exclude US coverage — but for someone living in America, US coverage is the whole point.
Brokers like International Citizens Insurance shop multiple carriers (Cigna, BCBS Global Solutions, IMG, GeoBlue, Trawick, and others) and present quotes from several at once. This is usually faster and often surfaces a cheaper plan than going direct, because different carriers price differently for different age and country combinations. Going direct to a single insurer like Cigna makes sense if you already know that's the brand you want.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are tax-advantaged accounts you fund with pre-tax dollars to pay for medical expenses. HSAs require you to be on a high-deductible health plan (HDHP) and roll over year-to-year. FSAs don't require a HDHP but generally don't roll over. Both can save you 20-40% on eligible medical costs depending on your tax bracket.
If your insurance was employer-sponsored, you'll typically lose coverage at the end of the month or 30 days after termination. You have three options: COBRA (continue your existing plan at full unsubsidised cost — expensive), a marketplace ACA plan (you qualify for special enrollment when you lose job-based coverage), or an international plan that doesn't depend on US employment. On most work visas, you may also have a limited window to find new employment, so insurance is the second priority after the visa itself.
If you have a job lined up with health benefits, the employer plan is almost always cheapest because the employer pays 60-80% of the premium. If you don't have employer coverage, an international plan from Cigna Global or via a broker like ICI is typically cheaper than a US ACA plan for the same coverage level — and it covers you globally, which most ACA plans don't.
Yes. Employer plans typically have a 30-90 day onboarding window where you elect coverage, and once you've started the new plan you can cancel your international plan. Most international plans are month-to-month or annual with refundable unused months, so the switch is clean. Just make sure your new employer coverage is active before you cancel.
Most do, but with a waiting period — typically 10-12 months from policy start before maternity benefits kick in. If you're planning a family, sign up before you need to use the benefit. Coverage levels for maternity vary widely between insurers and plan tiers, so this is one area where comparing multiple quotes through a broker tends to surface real differences.
Disclaimer: I'm not a licensed insurance agent or financial advisor, and US health insurance is genuinely complex. The information here is general guidance — for advice specific to your situation, talk to a licensed broker or your employer's benefits team. Some links in this article are affiliate links that earn America Josh a small commission if you sign up. I only recommend services I've used or that have been vetted through the community.