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Healthcare system in the USA

The healthcare system in the USA is a unique mix of government programs and private providers worldwide. Our guide gives you an overview of your insurance options.

Public health insurance

The basis for public health insurance in the USA is the Social Security Act of 1935, which was passed in the wake of the Great Depression to protect mainly older people from poverty. In the 1960s, it was extended to include health care.

Today, about one-third of the US population is protected by government health insurance. However, the three major government programs Medicare, Medicaid, and Tricare, are only available to certain groups of people.


The Medicare program was introduced in the United States in 1965 as an addition to the Social Security Act. Medicare benefits are available to any American 65 years of age or older. Furthermore, persons with a diagnosed disability or acute kidney failure are also covered by Medicare.

Permanent residents (Green Card holders) aged 65 and older are also eligible for Medicare benefits if they have lived in the USA for five consecutive years. Permanent Residents are not subject to co-payments if they can demonstrate a total of ten years of service in the United States.


The state welfare program Medicaid (short for Medical Assistance) mainly covers health care for children and people with low incomes. In some US states, pregnant women are also supported by Medicaid.

Medicaid is a social assistance-type benefit that is granted only after a thorough assessment of the individual means. Just like the Medicare program, Medicaid has been in place since 1965.


Tricare is the health care program of the U.S. Department of Defense. Established in 1966 under the name Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the program provides health benefits to active and former members of the US military and their family members.

Medical records and stetoscope

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Private health insurance

The majority of the US population has private health insurance. This can be taken out either through the employer or independently. The range of products offered by American insurance companies is huge.

Group insurance by the employer

The most widespread type of health insurance in the USA is group health insurance through the employer. These are often offered as so-called "benefits" and are usually paid for proportionally by the employer and the employee. However, some companies only offer insurance, and the employee pays the premiums himself entirely.

Since private insurance policies in the USA can vary greatly in their range of benefits, it often happens that employees are only partially covered by company health insurance. For example, they often need additional insurance of their own for dental care. An even bigger problem with group insurance is that it is tied to a specific job. If employees lose their job, the insurance coverage usually also ends.

Own private health insurance in the USA

Anyone who does not have the option of securing coverage through a job must look for private health insurance on their own. In doing so, it is important to carefully examine the various offers to ensure that one's own needs are covered.

The US government's Marketplace is a useful guide that helps you find your way through the jungle of private health insurance policies in the USA. It was launched as part of the 2010 healthcare reform known as "Obamacare" and helps people to find and purchase suitable health insurance.

Uninsured persons in the USA

In contrast to most other industrialized countries, there is no obligation to be enrolled in a health insurance plan in the USA. Because of the high health costs, many people choose not to take out insurance coverage.

According to the U.S. Centers for Disease Control and Prevention (CDC), more than 31 million Americans are uninsured in 2022. The rate is particularly high among young adults in their twenties. They often have not yet gained a foothold in the job market and therefore cannot afford the high insurance premiums.

Uninsured persons are treated in case of an emergency but have to pay all medical costs out of their own pockets. Because health care costs are very high in the USA, private bankruptcies often occur because medical bills cannot be paid.

Insurance documents and stetoscope

Strengths of the health care system in the USA

The USA is home to many excellent medical educational and research institutions and major pharmaceutical companies. American practices and hospitals generally have good quality, modern equipment. Also, the medical staff is well trained.

Weaknesses of the health care system in the USA

The high quality of healthcare in the USA comes at a price. For example, the extremely high cost of drugs and treatment is the biggest problem in the US healthcare system. They are about 2.5 times higher in the United States than in other industrialized nations. This makes the healthcare system in the USA the most expensive in the world!

The private health insurance market is diverse and complex. Private insurance policies usually have a very different range of services. Therefore, take all the time you need to check and compare the various offers.

How to find a suitable health insurance policy

Our guide to health insurance in the USA gives you an overview of the questions you should ask yourself as an expatriate before taking out private health insurance.

For detailed information on how to find the perfect job, take a look at our ranking of the best employers in the USA.

More tips for the USA

Do you need more tips on living in the United States? Check out our guides on the driver's license, retirement, credit score, and bank account in the USA.

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