There is no NHS in the United States. Healthcare is mostly private and employer-based, and being uninsured is a serious financial risk, so arranging coverage is one of the first things to do when you arrive. Most full-time trades jobs with an established employer come with a group health plan you pay into through your wages. If your job does not offer one, you buy a plan on the ACA Marketplace at healthcare.gov, usually with subsidies based on your income. A single trip to the emergency room without cover can cost thousands of dollars, and a serious illness can bury you in debt for years. This is the section for anyone coming from a country with public healthcare to read before they move.
The mental shift: cover is on you, not the state
In the UK and much of the world, healthcare is something the state provides and you barely think about at the point of use. In the US, health cover is a product you have to actively obtain and pay for, and if you do not have it, you are personally on the hook for the bills. There is no equivalent of free GP visits, free A&E, or subsidized prescriptions. The system is built around insurance, and the whole game is making sure you are insured before you need care, not after.
Route one: employer-sponsored insurance
For most tradespeople working full-time for an established employer, this is the main route. The employer offers a group health plan, and you pay a share of the monthly premium, usually deducted straight from your wages. The employer typically covers a significant part of the cost, so your share is smaller than the headline premium, but it is still a real monthly line in your budget, and there are usually deductibles and co-pays on top when you actually use care.
Two things to know:
- You sign up during a new-hire window, commonly the first 30 to 60 days from your start date. If you miss it, you generally have to wait for the next annual open-enrollment period unless you have a qualifying life event. Do not let this window close.
- There is an affordability rule. Under the ACA, the amount you can be asked to pay toward employee-only coverage is capped as a percentage of your household income (around 9.96% in 2026). If your share is above that, you may qualify for help elsewhere. Verify the current figure at healthcare.gov.
For seasonal and housed workers (for example on an H-2B arrangement where the employer provides accommodation), do not assume health cover is included. Ask directly whether insurance is part of the package or something you need to buy yourself.
Route two: the ACA Marketplace
If your employer does not offer a plan, or your family members are not covered by it, you buy insurance on the ACA Marketplace at healthcare.gov (some states run their own exchange). Key points for 2026:
- Open enrollment usually runs from around November 1 to January 15. Outside that window you generally need a qualifying life event to sign up.
- Moving to the US is a qualifying life event, which triggers a Special Enrollment Period so you can buy a plan when you arrive rather than waiting for the annual window. This is the route most new arrivals use.
- Subsidies are income-based. Premium tax credits scale with your household income, and in recent years most eligible people qualified for substantially reduced or even zero-premium plans after subsidies. What you get depends on your income and household size.
To start, go to healthcare.gov or call the Marketplace helpline (1-800-318-2596), or your state exchange if it runs one. Verify the current enrollment dates and subsidy rules there, because they move.
Medicaid and CHIP: for lower incomes, with immigrant-specific rules
If your household income is low enough, you may qualify for Medicaid (free or very low-cost coverage for low-income adults) or CHIP (low-cost coverage for children). The important caveat for new arrivals is that immigrant eligibility for these programs varies significantly by immigration status and by state. As a general structural rule, lawful permanent residents often face a five-year waiting period before Medicaid eligibility in many states, though there are exceptions, and children are sometimes treated more generously. Because this is where status and state rules intersect, do not guess. Check your state's Medicaid agency and, if your status is at all complex, confirm with an immigration attorney or an accredited nonprofit, since some benefits interact with immigration considerations.
Why this is urgent: the cost of being uninsured
This is not scaremongering, it is arithmetic. Without insurance, routine emergencies carry frightening price tags. As illustrative ranges, an uninsured emergency-room visit for something like a broken arm can run into the low thousands of dollars, and a single surgery can run into the tens of thousands. A serious accident or illness with no cover can generate medical debt that follows you for years and wrecks the credit file you are trying to build as a newcomer.
The takeaway is simple: arrange coverage before you arrive, or in your very first days, not after your first hospital bill. On a physical trade, the odds of needing care are not low.
Common questions
Is there free healthcare in the US like the NHS?
No. The US has no NHS or equivalent public system for the general population. Healthcare is mostly private and employer-based, and if you are uninsured you are personally responsible for the bills, which can run into thousands or tens of thousands of dollars. Most full-time trades jobs offer a group health plan you pay into; if yours does not, you buy cover on the ACA Marketplace at healthcare.gov, usually with income-based subsidies. Lower-income households may qualify for Medicaid or CHIP, though immigrant eligibility varies by status and state. Arrange cover before or as soon as you arrive.
How do I get health insurance when I move to the US?
Two main ways. If your employer offers a plan, sign up during your new-hire window, usually the first 30 to 60 days. If not, buy a plan on the ACA Marketplace at healthcare.gov, where moving to the US counts as a qualifying life event that opens a Special Enrollment Period so you do not have to wait for the annual window. Marketplace subsidies scale with your income. Do this early, because being uninsured on a physical trade is a serious financial risk. Verify current enrollment rules at healthcare.gov or call 1-800-318-2596.
Can immigrants get Medicaid or free coverage?
Sometimes, but it depends on immigration status and the state, so it cannot be answered in general. Medicaid and CHIP cover low-income adults and children, but immigrant eligibility varies: lawful permanent residents often face a five-year waiting period in many states, with exceptions, and children may be treated more generously. Check your state's Medicaid agency for its rules. Because some benefits interact with immigration considerations, if your status is complex, confirm with a licensed immigration attorney or an accredited nonprofit before applying, rather than guessing.
What happens if I just don't get insurance?
You carry the full cost of any care yourself, and US medical bills are high. As illustrative figures, an uninsured emergency-room visit can run into the low thousands and a single surgery into the tens of thousands, and unpaid medical debt can damage your credit for years. On a physical trade the chance of needing care is real, so going without cover is a gamble with large downside. Arrange employer coverage during your new-hire window, or a Marketplace plan under your move-triggered Special Enrollment Period, before you need care rather than after.
The honest bit
- This is general information about how US health cover works, not legal, medical, or immigration advice. Whether a particular program applies to you, especially Medicaid or CHIP, can depend on your immigration status, which is a matter for a licensed immigration attorney (aila.org) or an accredited nonprofit, not a notario or unlicensed consultant.
- The national figures here (ACA affordability percentage, enrollment dates, subsidy availability) are current for 2026 but change. Verify at healthcare.gov before relying on any of them. The uninsured-cost figures are illustrative ranges to show the scale of the risk, not quotes.
- Medicaid and CHIP eligibility rules, and much of how coverage plays out, vary by state. Route the specifics to your state's Medicaid agency and to Working in Your State.
- If you are self-employed rather than an employee, the coverage and tax angle is different; see the self-employed health-insurance guide in running your business.
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Templates you might need
Sources
- HealthCare.gov - Coverage for lawfully present immigrants · Which immigration statuses can buy a Marketplace plan, and that eligibility for coverage turns on lawful presence
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