Health Insurance & Healthcare: Expensive, but Good

Many Europeans who don't know America assume that half the US population has no health insurance, or far too little. That is simply not the case. According to the U.S. Census Bureau, 86.6% of Americans were already insured in 2013, the last year before the major expansions of Obamacare. In 2024 the figure was 92%, or 310 million people (report P60-288, September 2025).

Most Americans have private health insurance through their employer, and spouses and children are usually covered too. People aged 65 and over use Medicare, the government program that pays for the medical care of all seniors. Veterans and their families have free access to a separate government health system with its own doctors and hospitals. People on welfare are covered by Medicaid, the government health assistance program.

1The misery of being underinsured, and Obamacare

Of course, the lack of care for the uninsured is a serious social problem that causes real suffering. And by European standards, people rightly expect the state to step in and protect them. In a wealthy country, healthcare should be recognized as a basic right for every citizen. Sadly, many US politicians don't share that view.

Obamacare introduced an insurance mandate for all US citizens in 2010. Since 2019 the penalty has been zero, so at the federal level the mandate no longer has teeth. People who can't afford coverage receive government subsidies, and insurers may no longer turn anyone down because of pre-existing conditions. Obamacare is meant to cover US citizens who don't get insurance through an employer, aren't yet 65 and earn too much to qualify for Medicaid.

In my view, Obamacare isn't perfect, but it is an important and bold step in the right direction. The fact that Republicans keep trying to torpedo the law is typical of the deep political divide and partisanship that have paralyzed American politics for years.

Obamacare or not: if you move to the USA, you will be very comprehensively insured and, like the vast majority of Americans, use a healthcare system that is second to none in comfort and modernity.

2A first-hand account of US healthcare: the ER at 22:00

A story from my time in the USA shows just how service-oriented American healthcare is. In 2017 my girlfriend at the time suddenly had unusually severe stomach pain. When it still hadn't eased late in the evening, I decided to drive her to the emergency room of a nearby hospital. Like most Americans, she was insured through her employer.

10 minutes after we arrived at the ER, she was already in a treatment room. 10 minutes later the doctor came in and gave her a first opioid injection for the pain.

Then things moved fast: ultrasound, CT scan, X-rays. Over the next hour and a half she got a complete checkup. The result: nothing. It really was just a stomachache.

By the way, she didn't have to pay anything at the hospital. The hospital billed her insurer directly.

This example also shows the problem with American healthcare: treatment quickly turns into total overkill, with procedures ordered that are plainly unnecessary and inefficient.

As so often in America, healthcare is about business and making money. In the USA, health is a business, not charity. No country spends more per person on healthcare than the USA. According to the National Health Expenditure Accounts of the federal agency CMS, US healthcare spending in 2024 came to 18.0% of GDP and $15,474 per person. In Germany, by comparison, it is around 12%.

Want to move to the USA yourself? You'll find more on your visa options here.

3Great care, rising premiums

For context, today's figures: according to the Kaiser Family Foundation's employer survey, a family policy cost an average of $26,993 a year in 2025, of which employees paid $6,850 on average; single coverage came to $9,325. The average deductible was $1,886. All current figures and their sources are on our page on the average US health insurance premium. The personal account below dates from 2017 and shows the scale of costs back then.

But you have to admit that most ordinary Americans also have access to excellent medical care. That is especially true for the latest drugs (in cancer treatment, for example), which public health systems in Europe often don't cover at all.

Of course the system has its price, and health insurance premiums keep climbing. In 2017 the premium for me and my children was $1,600 a month. The deductible for hospital treatment was $3,000 per family member per year (capped at $7,500 for the whole family). Every visit to the family doctor came with a $40 copay. But that was my specific policy. There are countless variations and options across insurers and plans. The rule of thumb: the higher the premium, the lower your out-of-pocket costs.

But here is the point: if you earn reasonably well (and that is the only reason you would move to the US anyway), even premiums like these are perfectly acceptable and affordable. On top of that, you would run the policy through your US business anyway and deduct the cost as a business expense. You will find more information and a detailed overview of US health insurance here. The key terms and facts about US health insurance are here.

Every other aspect of your move, from the cost of living and schools to US tax planning, is covered in our overview of moving to the USA.

In short

• In 2024, 92% of Americans had health insurance, 310 million people. In 2013 it was 86.6% (U.S. Census Bureau).
• Most are insured through their employer, people aged 65 and over through Medicare, welfare recipients through Medicaid, and veterans through their own system.
• Obamacare bans exclusions for pre-existing conditions. The penalty for being uninsured has been zero since 2019.
• Care is fast and modern, but expensive: in 2025 an employer family policy cost an average of $26,993 a year.
• If the policy runs through your US business, you deduct the cost as a business expense.

How we help you

• ConsultationOne hour with the firm: your case, your questions, a clear answer.
• Moving to the USAVisa, bank account, taxes and where to live: your move with Mount Bonnell Advisors.
• US Tax ConsultationYour US tax question, answered by people who know both sides.
• Tax structureA clean structure between parent company and US subsidiary, or between you and your US company, coordinated with your accountant.