For Brits who are used to the NHS, the American healthcare system can seem daunting. You’ve probably heard the horror stories about Americans who ended up going broke trying to pay for their treatments, or getting into massive debts just because they had the misfortune to suffer from ill health.

It’s pretty simple: obtaining quality health insurance is essential if you’re moving to the U.S.

To get you started, here’s a quick and dirty guide to some of the basics. We’ll cover insurance, medicare and what to do if you get sick.

Do I need health insurance?

Yes, you do.

The U.S. does not have an NHS equivalent or—as you may hear certain Americans describe it (sometimes seriously)—’socialised medicine’.

Almost all doctors, pharmacies, and anything healthcare-adjacent—including using an ambulance—will be operated by private companies, and you’ll have to pay for them!

If you’re moving to the USA as a non-citizen, you won’t qualify for Medicaid or Medicare upon arrival (emergency state-run healthcare).

‘Qualified non-citizens’ can obtain access to Medicaid, but there is a five-year waiting period for this. So if you arrive on a green card, you’d need to wait five full years before being able to take advantage of this, and there are other limiting factors too.

You need to be aware that without insurance, healthcare is extremely expensive. Even basic treatments can cost thousands of dollars. You need to be insured from the second you arrive in the USA.

Will my job provide me with health insurance?

There’s no guarantee that your job will give you health insurance, but it’s pretty common if you’re moving to the USA for work.

Many American employers will provide health insurance as a basic employment benefit, and the type of employer who will pay the expense of hiring a British employee will most likely offer insurance.

But that does not mean that you should just relax and not look into the details. Here are some really important things to consider:

What does my health insurance actually cover?

You do need to look at the small print of your health insurance, even if you get it through work.

This is because American health insurance isn’t always comprehensive. You can’t just go into any hospital, or see any doctor. Many insurers will cover specific hospitals, or specific ambulances or doctors and types of care.

If your work gives you options, it’s best practice to obtain the most comprehensive coverage you think you can reasonably afford.

You need to be especially careful if you have a pre-existing condition (e.g. diabetes) because your boilerplate work insurance might not be enough, and you may need additional coverage.

What’s a co-pay? Doesn’t my health insurance cover my costs?

You may not be familiar with the word ‘co-pay’.

A copayment is basically the amount of money that you will have to pay to obtain an insurance benefit when you make a claim. Think of it as a bit like a premium.

Example: If your copayment is $100, your treatment costs $200 and your insurance accepts your claim, you will still have to pay $100.

The idea is to stop excessive claims.

So if, for example, you did not have to make any copayments to make an insurance claim, you might try making a claim on your insurance policy for any treatment you receive or drug you’re prescribed.

Make sure you check out what your copayments are so you don’t have a nasty surprise if you need to see a doctor.

Can my family use my health insurance?

Many American insurers will allow you to extend your coverage to families, but you should check with your policy provider.

What happens if I get sick?

Make sure you’ve checked which doctors will work with your insurer. Check in with the doctor and discuss your policy so that they can help you out in a way that is likely to be covered by your provider.

Always keep receipts and a record of what you’ve been asked to pay and keep your insurer updated when making a claim.

There’s no getting round it, insurance can be daunting, and healthcare expensive. But the care and facilities themselves in the USA are often high quality.