Health care is one of the biggest expenses for people who move to the US, and the system is very different from Brazil's. Understanding the basics before you need care helps you avoid debt and surprises.
Emergencies: what the law guarantees
Under the EMTALA law, hospitals that take part in Medicare must examine and stabilize anyone who comes to the emergency room, regardless of insurance, money or immigration status. This does not mean the care is free: the hospital can bill you afterward. That is why it is worth asking about the hospital's financial assistance policy, which many have, and negotiating the bill.
Health plans: the options
- Employer plan. It is the most common option for people who work with authorization, and usually the company pays part of the cost.
- Marketplace (healthcare.gov). Lawfully present immigrants can enroll, generally during open enrollment, from November 1 to January 15, or in special enrollment periods after life changes. According to CMS, application information is not used for immigration enforcement.
- University plan, for students, when the school offers one.
- Travel or international health insurance, for people who are only passing through.
- Community health centers, which charge based on income.
Heads up: new rules in 2026 and 2027
According to HealthInsurance.org, in 2026 recent immigrants became subject to minimum income requirements to receive Marketplace subsidies, and starting in 2027 subsidies are limited to groups such as lawful permanent residents (green card holders), COFA migrants and Cuban and Haitian entrants. People on temporary work or student visas lose eligibility for subsidies. This changes quickly: confirm on healthcare.gov before you decide.
How to lower costs
- Use urgent care for problems that are not life-threatening, instead of the emergency room, which is usually much more expensive.
- Ask the price before a test or procedure, and ask for an itemized bill afterward.
- Ask for generic medicines and compare prices across pharmacies.
- When you get a large bill, ask for the hospital's financial assistance policy and negotiate a payment plan.
- Check that the doctor and the hospital are in your plan's network (in-network). Out of network, the cost can be much higher.
What to do before you move
Include the monthly cost of a health plan and an emergency reserve in your budget. If you are going to study, check the school's insurance requirements. For overall planning, also read about the documents you need when you arrive.