Healthcare in the United States

What this section covers

The United States section of AMDA-IMIC provides reference information about the US health system for people who were not raised in it — foreign residents, recent immigrants, international students, exchange visitors, and short-term workers. Content covers how insurance works, what rights you have to language access and emergency care, how to find affordable services when uninsured, and the forms and phrases you will encounter in clinical settings.

Start here — three common situations

1. New to the US and need to understand health insurance

The US health system operates primarily through private insurance rather than a single national program. Most working-age residents receive insurance through their employer; others purchase coverage through the Health Insurance Marketplace (HealthCare.gov) or qualify for public programs (Medicaid, Medicare, CHIP). The guide How US Health Insurance Works is the best starting point — it explains premiums, deductibles, copays, networks, and how to use your coverage once you have it. (Guide coming in Batch U2.)

2. Uninsured or underinsured and need affordable care

Federally Qualified Health Centers (FQHCs) provide comprehensive primary care regardless of insurance status or ability to pay, using a sliding fee scale based on income. There are over 1,400 FQHC organizations with more than 14,000 service sites across the US. Non-profit hospitals are required to offer financial assistance programs (charity care) for patients who cannot pay. The guide Community Health Centers and Sliding Fees explains how to find and use these resources. (Guide coming in Batch U2.)

3. Non-English speaker seeking care or information in your language

You have a legal right to a qualified medical interpreter at no cost at any healthcare facility that receives federal funding. This right comes from Section 1557 of the Affordable Care Act. The language portals below provide country-specific entry points to this section in each of the nine languages covered. See the Interpreter Rights and Language Access guide for details. (Guide coming in Batch U2.)

How the US health system works

The United States does not have a single national health insurance system for working-age adults. Instead, coverage comes from a mix of sources: employer-sponsored plans (covering about half the population), individually purchased Marketplace plans subsidized by income-based tax credits, the public Medicare program for people 65 and older and certain disabled individuals, and the joint federal-state Medicaid program for low-income individuals and families. Understanding which category applies to your situation is the first step to navigating coverage.

Health insurance in the US involves multiple layers of cost-sharing. The premium is the monthly cost of having insurance. The deductible is the amount you pay out of pocket each year before the insurer begins sharing costs. Copays are fixed amounts for specific services (such as a $30 doctor visit). Coinsurance is your percentage share after the deductible (such as 20% of the allowed amount). All of these accumulate toward an annual out-of-pocket maximum, after which the insurer covers 100% of covered in-network costs for the rest of the year.

Provider networks are a defining feature of US insurance. Seeing a provider who is in your plan's network results in significantly lower costs than going out of network. HMO plans restrict coverage to in-network providers (except in emergencies) and require referrals to see specialists. PPO plans allow out-of-network access at higher cost and generally do not require referrals. EPO plans restrict to network but do not require referrals. Understanding your plan type helps you know when referrals are needed and whether a provider you want to see is covered.

The Affordable Care Act (ACA), enacted in 2010, introduced the Health Insurance Marketplace where individuals and families without employer coverage can shop for standardized plans. Plans are grouped by metal tier (Bronze, Silver, Gold, Platinum) indicating the share of costs the insurer covers on average. Income-eligible enrollees can receive Advanced Premium Tax Credits (APTC) that reduce monthly premiums, and Cost-Sharing Reductions (CSR) that lower deductibles and copays on Silver plans.

For people who cannot afford any private coverage, Federally Qualified Health Centers (FQHCs) and community health centers funded by HRSA provide primary care, dental, mental health, and pharmacy services on a sliding fee scale based on income and family size. Non-profit hospitals must have written financial assistance policies and cannot send bills to collections without first offering financial assistance applications. These safety-net resources exist in every state and are open to immigrants and undocumented individuals for most primary care services.

Language access rights

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of national origin — which includes language — in any healthcare program or activity receiving federal financial assistance. This covers virtually every hospital, clinic, health center, and insurance marketplace plan in the country. Covered entities must provide free qualified interpreter services and translated written materials to patients with limited English proficiency. Using your own family member or a minor child to interpret at a clinical appointment is considered inappropriate under professional medical ethics standards. Complaints about language access violations can be filed with the HHS Office for Civil Rights.

Looking for Japan healthcare information?

The Japan section covers Japan's national health insurance system, the 30% copay structure, emergency care, hospital navigation, and consultation forms in nine languages for foreign residents in Japan.

Resources in your language

Last reviewed: September 2026