Health insurance when moving to the USA: the points to check

In the USA, cover through the employer is the most common form of health insurance. There are also Medicare, Medicaid and the Marketplace.

The German Federal Foreign Office (Auswärtiges Amt) points out that treatment in the USA is given against advance payment or direct payment, and advises taking out evacuation insurance. Before the move, ask about the doctor network, advance payment and validity in the state.

Check in this order: federal level, state, employer, residence status.

Federal level and state

Federal law and California are covered at the top in the introduction. For other states, ask the responsible authority whether there is a requirement.

Employer

Whether a group plan has a waiting period is stated in your offer. Ask from which day it applies, who is covered and how you bridge the time until then.

Marketplace

Access is covered at the top in the introduction, the enrolment period in the checkpoints. Ask the Marketplace whether your visa and moving date fit.

Medicaid and Medicare

Before a Medicaid application, ask an immigration adviser whether receiving it has consequences for your right of residence.

Whether you need proof depends on who asks.

For visits with ESTA, see the note on travel insurance in the section “How health insurance works in the USA”.

You compare three routes: employer group plan, Marketplace plan and international health insurance.

Check the area of cover, waiting periods, deductible and exclusions in the contract. More on how it is structured is in the guide International health insurance.

Before you deregister (Abmeldung) in Germany, you clarify in writing what happens to your current insurance. The questions below apply to any destination country. They are questions, not legal advice: the answers are in your contract documents or come from the body you ask.

The German-American social security agreement, in force since 1979, only covers pension insurance; health and long-term care insurance are not part of it.

If you have statutory insurance: questions for your Krankenkasse

• What happens to my membership when I deregister in Germany, and on what date does it end?
• Can I suspend the membership or take it up again later, and under what conditions?
• What confirmation of my previous insurance periods do I receive, and how quickly?
• What applies to co-insured family members: who stays insured and who does not?
• Does the health fund still pay anything during a stay in the USA, and until which day?

If you have private insurance: questions for your insurer

• Does my contract end with the move, is it suspended or does it continue?
• Is there an Anwartschaft (a German option to keep certain rights in private insurance while abroad), and what is preserved under it? Ask about the difference between the small and the large Anwartschaft, and whether a new health assessment would be needed on a return.
• Does my contract apply in the destination country, and for how long at a stretch?
• Which documents do I receive in writing before I cancel?
• Does the plan apply in the USA, and is medical repatriation included?

Do not cancel any contract before it is clarified in writing what applies afterwards. We explain the connections on the pages Health insurance when emigrating and PKV and Anwartschaft. For families, there is more at Health insurance for the family abroad.

1. Confusing the penalty with the requirement

   Check your state’s rules separately from federal law and ask there.

2. Overlooking the gap until the plan starts

   Between arrival and the plan start, a period without cover can arise. Check whether interim cover includes the USA.

3. Counting on Medicaid

   Ask the state authority beforehand whether your status and length of stay are sufficient.

4. Choosing an international plan without checking the area of cover

   Check in the contract whether the USA and your state are included.