Health & Insurance

Q. How does US health insurance work for Brits moving to America?

There is no NHS equivalent. Most working-age people get health insurance through an employer. Others buy a plan on the Health Insurance Marketplace at HealthCare.gov. Moving to the US from abroad can qualify you for a Special Enrollment Period, generally 60 days, so you do not have to wait for the annual Open Enrollment. Medicaid offers free or low-cost cover on low incomes, though many new immigrants face a waiting period.

• Premium: what you pay each month to have the plan.
• Deductible: what you pay for covered care before the plan starts to pay.
• Copay and coinsurance: a fixed fee per visit, or a percentage share of the bill.
• Out-of-pocket maximum: the most you pay in a plan year for covered in-network care.
• In-network: doctors and hospitals with agreed prices. Others can cost much more.

Medicare starts at 65, and Part A is premium-free for people who, or whose spouse, paid Medicare taxes long enough, generally at least 10 years. Whether UK National Insurance years count towards Medicare: get advice. A licensed broker can explain the health plan options. The Directory lists specialists.

Q. When is Open Enrollment for US health insurance, and do I need to do anything?

Open Enrollment is the once-a-year window to buy or change a health plan on the government Marketplace (HealthCare.gov, or your own state's marketplace). For 2027 cover it runs from 1 November 2026 to 15 January 2027. To be covered from 1 January, you need to sign up by 15 December. Some states run their own marketplace with slightly different dates, so check yours.

Who it matters to, and what to do:

• If you buy your own cover, or have none yet: this is your chance to sign up. Outside this window you generally need a qualifying life event, such as moving to the US, losing job-based cover or having a baby, which opens a Special Enrollment Period.
• If you already have a Marketplace plan: do not just let it roll over. Premiums, the doctors in the network and the help with costs can all change for the new year, so compare plans before 15 December.
• If you get health insurance through work: your employer runs its own open enrollment, usually in the autumn, with its own deadline. Look out for an email from HR, as it is often the only time in the year you can change your plan or add family members.
• If you are on Medicare: its own Open Enrollment runs from 15 October to 7 December, for changing Medicare Advantage and drug plans.

Just arrived? Moving to the US usually counts as a qualifying event in itself, so you may not have to wait. You generally have 60 days from the move.

Q. What happens to my US health insurance if I lose my job in America?

Employer health cover normally ends when the job does. People usually look at three routes.

• COBRA: a federal law that lets you stay on your former employer's plan for a limited time, usually up to 18 months, for employers with 20 or more employees. You can be charged the full premium, including the part your employer used to pay, plus up to 2%. You get at least 60 days to decide.
• Marketplace: losing job-based cover opens a Special Enrollment Period, with 60 days before or after the cover ends to choose a plan.
• Medicaid: if income drops, you may qualify, though many new immigrants face a waiting period.

One detail matters: ending COBRA early without a new qualifying event generally means waiting until Open Enrollment to join a Marketplace plan.

Q. How do life insurance and disability cover work in the US?

• Term life: covers a set number of years and builds no cash value.
• Permanent life: such as whole or universal life, with a death benefit and sometimes a savings element, so premiums tend to be higher.
• Group life at work: many employers include some life cover as a benefit. It is usually tied to your job.
• Disability insurance: replaces part of your income if illness or injury stops you working, for a short or a longer period. It comes through employers or individual policies.

Disability cover comes up more often in America because there is no national equivalent of UK Statutory Sick Pay. Social Security Disability Insurance exists, but it is tied to your US work history and has strict rules, so recent arrivals may not qualify.

Whether any of this is needed depends on personal circumstances. Insurance is regulated by each state, and a licensed broker can explain the options.

Q. Is my UK life insurance still valid if I move to the US?

It depends on the policy wording. Some UK policies carry on after a move abroad as long as premiums are paid. Others have residence conditions, exclusions for living overseas, or limits on where a claim can be assessed, and critical illness cover can have its own conditions. The policy documents and the insurer are the places to check, and many policies require you to tell the insurer about changes like a move.

There is also a US tax angle. The US charges a 1% excise tax on life insurance premiums paid to foreign insurers, but the UK-US tax treaty says this is not charged on policies with a UK insurance business, except in certain conduit arrangements. Policies with an investment element, such as some UK investment bonds, can be treated differently under US tax rules.