Health insurance in the United States

I just arrived in the U.S.: how does the health system work?

When we arrive in the United States to study or start a new chapter of life, even a simple doctor’s visit can raise questions: do I need insurance? Can I get a plan with government help? How much does a visit cost? And what if I need to go to the hospital without insurance?

The American health system is different from what many newcomers know. There is no single public plan that automatically covers everyone. Understanding your options before you get sick can help you avoid financial surprises.

Can an international student have health insurance?

Yes. International students can buy health insurance. But before you choose or buy any plan, it is important to consult an immigration attorney, who can review your individual situation and program, visa type, residence, and the plan’s rules.

After you receive legal guidance, compare coverage carefully: deductible, provider network, prescriptions, emergencies, mental health, pre-existing conditions, and out-of-state coverage.

What are the insurance options?

Note: before you accept or buy any of these options, consult an immigration attorney to confirm whether you can accept that type of coverage given your immigration situation.

Individual private insurance: can be bought directly from an insurer or through other channels. Some products for students, visitors, or short periods may have limited coverage and may not be equivalent to a comprehensive plan.

Health Insurance Marketplace: the official marketplace at HealthCare.gov. Some people with an eligible immigration status can buy plans. But buying a plan and qualifying for subsidies that lower the price are two different things.

Financial help: depends on current rules, income, tax situation, and immigration status. Starting January 1, 2027, federal rules published by HealthCare.gov limit eligibility for Marketplace savings to certain statuses. Other statuses may still be able to buy coverage, but without subsidies.

F-1 students should not assume they will receive financial help; confirm the rule for the coverage year and your individual eligibility.

Medicaid and CHIP: public programs with their own criteria for income, residence, state, and immigration eligibility.

Students on a temporary visa should not assume they qualify for regular Medicaid. Eligibility for children and other family members may be different. Confirm directly with the state agency.

Do not make decisions based only on someone else’s experience or on social media posts. Immigration status, income, residence, and program rules can change the answer.

How much does a doctor’s visit cost?

There is no single price. The amount depends on the city, clinic, type of visit, tests, and coverage. A simple visit paid out of pocket can cost from tens to a few hundred dollars; tests, specialists, and procedures can add costs. This is only a general reference, not a quote.

Before you book, call and ask:

• “What is the self-pay price for a regular visit?” — Qual é o preço para quem paga do próprio bolso?
• “Do you offer a sliding fee scale?” — O valor pode variar conforme a renda?
• “Are lab tests included?” — Os exames estão incluídos?
• “Can I get a cost estimate in writing?” — Posso receber uma estimativa por escrito?

Even with insurance, you may pay a monthly premium, a deductible, a fixed copay, and coinsurance (a percentage of the cost). Ask whether the doctor, clinic, and lab are in-network.

Having insurance does not mean every visit will be free.

How do you get an appointment?

For something that is not an emergency, look for a primary care provider or a community clinic. Call to confirm they accept new patients, which documents to bring, whether they take your insurance, and what it will cost.

• Have your ID, contact information, and insurance card, if you have one.
• Say: “I’m a new patient and I’d like to schedule an appointment.”
• Confirm whether you need a referral or prior authorization.
• If you do not have insurance, ask: “I’m self-pay. Do you have a discounted rate?”

Primary Care, Urgent Care, or Emergency Room?

Primary Care: routine visits, prevention, follow-up, and non-urgent problems.

Urgent Care: problems that need attention soon but do not seem life-threatening, such as a sore throat, earache, mild flu symptoms, small cuts, or sprains. Services and hours vary.

Emergency Room (ER): the hospital emergency department for potentially serious situations, such as severe chest pain, serious trouble breathing, signs of a stroke, loss of consciousness, heavy bleeding, or a severe allergic reaction. In an emergency, call 911.

The federal EMTALA law requires covered hospital emergency departments to provide a medical screening to identify an emergency and to offer stabilizing treatment or an appropriate transfer, regardless of insurance or ability to pay. That does not mean free care: a bill may come later.

What if I am treated without insurance?

In an emergency, get help. Not having insurance should not prevent the emergency screening required by law.

Afterward, you may receive a bill from the hospital, doctors, labs, or other services; separate bills may arrive.

If you cannot pay, do not ignore the bill. Contact the billing department and ask:

• Whether financial assistance or charity care is available.
• Whether there is a discount for uninsured or self-pay patients.
• Whether you can get an itemized bill to check the services charged.
• Whether a monthly payment plan is possible, and what the terms are.
• How to request a review if there is an error or a duplicate charge.

Discounts and payment plans are not automatic; terms vary by institution. Ask for the terms in writing and ask about interest and fees before you accept any financing.

Why is it important to have insurance?

Insurance does not eliminate all costs, but it can reduce the risk of facing very high expenses for illness, an accident, a hospital stay, or surgery. Compare not only the monthly price but also the deductible, limits, exclusions, and provider network. If you are a student, ask your school which coverage it accepts and compare the options you are eligible for.

Essential vocabulary

• Health insurance — seguro de saúde
• Premium — mensalidade do seguro
• Deductible — franquia
• Copay — coparticipação fixa
• Coinsurance — porcentagem do custo paga pelo paciente
• In-network — dentro da rede do plano
• Self-pay — pagamento do próprio bolso
• Primary care — atenção primária
• Urgent Care — atendimento urgente não emergencial
• Emergency Room (ER) — pronto-socorro hospitalar
• Billing department — setor de faturamento
• Itemized bill — conta detalhada
• Payment plan — plano de pagamento parcelado
• Financial assistance / Charity care — assistência financeira / programa de redução de custos
• Appointment — consulta agendada
• Referral — encaminhamento

Do I need to have health insurance?

There is no federal rule that requires every person in the U.S. to buy insurance.

Even when it is not required, going without insurance carries financial risk: accidents, hospital stays, and surgeries can lead to very large bills.

Can I get a plan with government help?

Maybe, but it is not automatic. People with certain immigration statuses can buy plans through the Health Insurance Marketplace (HealthCare.gov). Buying a plan and receiving a subsidy are two different things. For 2027 coverage, starting January 1, federal financial help will be limited to certain statuses, including permanent residents (Green Card holders), Cuban/Haitian entrants, and COFA migrants. Other statuses — including some student visas — may still be able to buy coverage, but without a subsidy. F-1 holders should not count on financial help without checking their situation on HealthCare.gov.

Medicaid and CHIP have their own criteria. In Florida, federal changes in effect since October 1, 2026 limited full coverage for non-citizens to specific categories; lawfully residing children may have their own rules. Do not assume an international student qualifies. Check Florida DCF / MyACCESS.

Anyone who does not qualify for a subsidy can still compare private plans at full price.

How much does a doctor’s visit cost without insurance?

There is no single price. As a reference, a simple primary-care visit paid out of pocket usually runs about US$100 to US$200, but it can be cheaper at community clinics or more expensive at hospital-affiliated clinics. Specialists cost more. Tests, X-rays, medications, and procedures are usually billed separately.

Before you book, ask: “What is the self-pay price for the visit?”, “Are tests included?”, and “Can I get a Good Faith Estimate?” For scheduled care, patients who are uninsured or not using insurance may have the right to a written estimate. Community health centers may offer income-based prices.

What if I need to go to the hospital without insurance?

In an emergency, do not avoid care out of fear of the bill. The federal EMTALA law requires most emergency departments at hospitals that participate in Medicare to provide a medical screening and, if there is an emergency, to offer treatment to stabilize the condition or arrange an appropriate transfer, even without insurance or the ability to pay. That does not mean free care: the hospital may send a bill later.

When you get the bill, ask for an itemized bill and talk to the billing department. Ask about financial assistance / charity care, discounts for uninsured patients, and a payment plan. Nonprofit hospitals must have a written financial assistance policy, but approval and discounts depend on the hospital’s criteria. Ask for the form and the rules in writing.

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