If you have arrived from a country with national health coverage or a national insurance regulator, the US system is structured differently enough that assumptions carried over tend to be wrong.
This is an overview of the structure, not advice about what to buy.
The organising principle: states, not the nation
Insurance is regulated by each state, not by the federal government. Each state has a Department of Insurance that licenses insurers, approves rates, and handles consumer complaints.
The practical consequences: requirements differ by state, prices differ substantially between states for the same person, and a policy bought in one state is written to that state's rules. Moving means rewriting your policies.
When you read anything about US insurance — including this site — the first question to ask is "does this apply in my state?" Very little is uniform nationally. Your state Department of Insurance is the authority for your situation.
Health insurance
There is no universal system. Coverage comes from one of several places.
- An employer. The most common source for working-age adults. The employer typically pays part of the premium and you pay the rest from your salary.
- The Marketplace. Individual plans sold through HealthCare.gov or a state exchange. Income-based subsidies are available to many people.
- Medicaid. For low-income residents. Eligibility rules are set state by state and differ significantly.
- Medicare. Primarily for people 65 and over, and for certain disabilities.
Enrolment is time-limited. Marketplace plans have an annual open enrolment period, and outside it you can only enrol after a qualifying life event such as moving, marrying, having a child, or losing other coverage. Missing the window can mean waiting until the next one.
The vocabulary that costs people money
Premium What you pay monthly to have the plan, whether or not you use it.
Deductible What you pay yourself each year before the plan starts paying. Often thousands of dollars.
Copay A fixed amount per visit or prescription.
Coinsurance A percentage of the cost you pay after the deductible is met.
Out-of-pocket maximum The most you pay in a year. After this, the plan pays fully for covered in-network care.
Network The doctors and hospitals contracted with your plan. Going outside it costs far more, and sometimes is not covered at all.
A low premium with a high deductible is not the same as cheap coverage. The figure that describes your worst year is the out-of-pocket maximum.
Auto insurance
Required in nearly every state, in amounts each state sets. Driving without it carries penalties that can include fines, licence suspension, and vehicle impoundment.
Two things frequently surprise new arrivals.
Your driving history from another country usually does not transfer. Most insurers rate you as an inexperienced driver regardless of decades of experience elsewhere, because they cannot verify the record. Some insurers accept a letter of experience from a foreign insurer; it is worth asking, and worth obtaining before you leave if you can.
The minimum required is genuinely a minimum. Anything above your liability limit in an accident you cause is your personal obligation.
Home and renters insurance
Not legally required, but a mortgage lender will require homeowners insurance, and many landlords now require renters insurance in the lease.
Renters insurance is inexpensive relative to what it does, and it contains three coverages: your belongings, your liability if you injure someone or damage property, and your additional living costs if the home becomes uninhabitable. The landlord's insurance covers none of these for you.
Credit history and insurance
This one has no equivalent in many countries.
Most states allow insurers to use a credit-based insurance score when pricing auto and home policies. Arriving without US credit history means having no score, which insurers handle in different ways — some rate it neutrally, others less favourably.
A few states restrict or prohibit this practice. It is one of the more significant state-by-state differences for new arrivals.
What to do first
- Find your state's Department of Insurance and read its consumer guides. They are written for exactly this purpose and cost nothing.
- Sort health coverage inside the enrolment window that applies to you.
- Arrange auto insurance before driving, and ask about a letter of experience from your previous insurer abroad.
- Get renters insurance if you are renting — your lease may require it in any case.
- Read every declarations page you receive and confirm the details are right.
What we are not saying
We are not recommending any insurer, plan, or coverage level. We do not sell insurance, take referrals, or receive commissions.
What we are saying is that the system is organised by state rather than nationally, that health enrolment is time-limited in a way that catches people, and that your driving record from abroad usually does not follow you unless you obtain documentation of it.
Where to verify this yourself
- Your state Department of Insurance — requirements, consumer guides, and complaint records by insurer. The NAIC maintains the directory of all state regulators.
- HealthCare.gov or your state Marketplace — enrolment periods, plan options, and subsidy eligibility.
- Your state DMV — licensing and registration requirements for new residents.
- Your previous insurer abroad — a letter of experience, ideally obtained before you move.
This is general education, not advice. Insurance law and claim rules vary by state and change over time. Nothing here is legal, financial, or insurance advice for your situation, and reading it does not create any professional relationship. For your specific case, consult a licensed professional in your state or contact your state Department of Insurance.