Country guide — Americas
Expat insurance and health insurance in the United States
In short
In the United States, there is no general federal health insurance requirement since the federal penalty under the Affordable Care Act was removed at the end of 2018, but the requirement becomes real again depending on visa type and state of residence: J-1 visa holders are subject to an explicit federal requirement for minimum cover, while H-1B, L-1 or F-1 visas carry none but often come with a requirement from the employer or university. Five states and Washington D.C. also impose a requirement on their tax residents, under penalty. No health-related social security agreement exists between France and the United States: the carte Vitale has no effect there. The financial risk of going without cover is considerable — an ER visit can exceed $20,000.
Key figures
- 168,529 French nationals registered at the end of 2025 (+5.3% year-on-year) — the 2nd largest host country for the French community, just behind Switzerland.
- Life expectancy at birth: 79.0 years in 2024, a record level.
- Health spending: $5.3 trillion in 2024, or $15,474 per capita and 18.0% of GDP — the highest share in the OECD.
Local healthcare system
The United States has no universal public health system comparable to European systems. Coverage mainly relies on private insurance, overwhelmingly tied to employment, supplemented by targeted public programmes: Medicare (age 65 and over, subject to contribution requirements), Medicaid (very low income, run state by state) and the ACA marketplaces for individuals. A foreign resident in principle has no automatic access to Medicare or Medicaid. There is neither a regulated national rate nor an agreement setting the price of medical procedures: each hospital sets its own rates freely, resulting in considerable price differences for an identical procedure.
Legal and visa obligations
- J-1 visa (exchange, Work and Travel, intern): explicit federal requirement (22 CFR § 62.14). Minimum cover: $100,000 per accident/illness, $50,000 for medical evacuation, $25,000 for repatriation of remains, deductible ≤ $500. Any gap can end the programme.
- F-1 visa (student): no federal requirement, but almost every university imposes one, with or without a possible waiver on proof of equivalent cover.
- H-1B and L-1 visas: no federal requirement tied to the visa. The sponsoring employer must offer the same benefits as to its American employees.
- Retiree visa: does not exist in the United States. A retiree must use other visa categories, none of which impose federal insurance.
- State-level requirement: Massachusetts (≈$1,620/year/adult), New Jersey (from $750), Rhode Island (from $750 or 2.5% of excess net income), California (from $950/adult) and Washington D.C. impose a tax penalty on uninsured residents.
Cost of some medical procedures
Orders of magnitude from specialised sources, not official fee schedules.
| Procedure | Public sector | Private sector |
|---|---|---|
| GP consultation | — | $150 to $500 |
| ER visit, non-critical case (intake) | — | $1,500 to $3,500, up to $20,000+ with imaging/hospitalisation |
| Ambulance | — | $500 to $1,300 |
| Fracture (surgery + hospitalisation) | — | $20,000 to $50,000 |
| Vaginal delivery (average) | — | ≈$14,768 |
| C-section delivery (average) | — | ≈$26,280 ($15,000 to $50,000 depending on state) |
| MRI | — | ≈$400 to $1,200 at an independent imaging centre, $1,500 to $3,500 at a hospital (2 to 3x more expensive) — gaps remain very large from one facility to another |
Social security agreements with France
France and the United States have an agreement classified as partial by the CLEISS: it only coordinates the old-age, survivors and disability branches (totalisation of periods, subject to a minimum of 6 quarter credits on US soil). It never covers health insurance.
- No cross-coverage of health costs, in either direction.
- Pension coordination does not extend to Medicare, which has its own eligibility rules.
- Voluntary affiliation with the CFE is possible, as a complement or alternative to US insurance.
Which insurance for my profile
General matrix — does not recommend any specific product or insurer.
| Profile | Regulatory constraint | Points of attention |
|---|---|---|
| Working holiday visa / youth mobility | No classic working holiday visa; the J-1 Work and Travel is the closest option, with mandatory federal insurance | Check that the policy precisely meets the J-1 minimums |
| Student (F-1) | No federal requirement, but almost always required by the university | Check the institution's exact policy |
| Seconded employee (L-1, H-1B) | No federal requirement tied to the visa; state-level requirement possible depending on tax residency | Check the employer's offer and any state penalty |
| Retiree | No dedicated visa; no access to Medicare; no CLEISS health coordination | Private or international cover essential; consider the CFE as a complement |
| Family | Derivative visas (J-2, F-2, H-4, L-2) generally follow the same requirements | Check that each member is individually covered |
Hospitals and care network
- New York: NewYork-Presbyterian, NYU Langone, Mount Sinai — listed in the embassy's directories of French-speaking doctors.
- San Francisco / Bay Area: Kaiser San Francisco Medical Center (includes the former French Hospital site).
- Miami: Jackson Memorial Hospital, Baptist Health, with a growing number of French-speaking practitioners.
Practical steps
- Before departure, whatever the visa: take out health and repatriation insurance covering at least the required minimums.
- J-1 visa: check with the sponsoring organisation that the policy precisely meets the regulatory thresholds before departure.
- F-1 visa: contact the university's international students office before the start of term.
- Tax resident in California, Massachusetts, New Jersey, Rhode Island or D.C.: check the requirement and penalty when filing your tax return.
- Within a few months of settling: register with the roll of French nationals living abroad.
Frequently asked questions
Does the carte Vitale work in the United States?
No, not at all. There is no health-related social security agreement between France and the United States; the carte Vitale has no effect on US soil.
Is health insurance mandatory to enter the United States?
There's no general federal requirement for all visitors, but some visas explicitly impose one (notably J-1), and lacking cover exposes you to considerable financial risk, with no possible support from the embassy.
What does the France-United States social security agreement cover?
Only pensions (old age, survivors, disability), via totalisation of contribution periods. It never covers health insurance.
Is there a retiree visa for settling long-term in the United States?
No. A French retiree must use other visa categories, none of which impose health insurance at the federal level.
Why do US medical prices vary so much from one facility to another?
There is neither a regulated national rate nor an agreement setting the price of medical procedures: each hospital and each provider sets its own rates freely.
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Written by Expavy
Sources
- CLEISS — France-United States social security agreements
- France Diplomatie — Register of French nationals living abroad (carte-registre, 2025 data)
- France Diplomatie — United States, Health
- CDC/NCHS — U.S. Life Expectancy Hits Record High (2024)
- CMS — National Health Expenditure Fact Sheet
- U.S. Department of State — 22 CFR § 62.14, J-1 requirements
- CareRoute — Cost of an MRI in the United States (Healthcare Bluebook / CMS methodology)