When choosing to live or work abroad, navigating healthcare coverage and U.S. healthcare laws can be tricky.
As a U.S. citizen living abroad, you may wonder whether or not you still have to comply with Affordable Care Act (ACA) health insurance requirements, even though you aren’t residing in the United States for an extended period of time.
Not complying with ACA requirements can lead to facing penalties, so it is important to understand how to navigate this complex situation and what your options are as a U.S. citizen living or working internationally.
What This Guide Will Cover:
- What ACA requirements are for US citizens
- How ACA requirements apply for citizens living abroad
- Options for expats who do not meet exemptions to ACA requirements
- Health insurance options for expats
- How expats can find the right plan for them
What Are the ACA Requirements?
The Affordable Care Act, enacted in 2010, introduced several key requirements aimed at expanding access to health insurance, reducing healthcare costs, and protecting consumers.
Most importantly, the ACA required that U.S citizens and permanent residents to have and maintain health insurance that meets Minimum Essential Coverage (MEC).
Prior to 2019, not maintaining a health insurance plan as a U.S. citizen or resident would result in a federal tax penalty. While this is no longer in effect, some states may apply a tax penalty if you don’t meet the ACA requirements.
Are U.S. Citizens Living Abroad Subject to ACA Requirements?
The Affordable Care Act (ACA) requirements generally do not apply to U.S. citizens living abroad for extended periods.
The ACA mandates that U.S. residents maintain minimum essential health coverage or potentially pay a penalty depending on your state of residence; however, expats who meet certain criteria are exempt from this requirement.
Expat exemptions to the ACA requirement include:
- U.S. citizens who reside abroad for at least 330 full days within a 12-month period qualify for exemption.
- Expats can also qualify for exemption if they are bona fide residents of a foreign country for an entire tax year. This means that if you can prove you genuinely live and work abroad, you will not be subject to ACA requirements.
Definition: Bona fide residents are individuals who have established a genuine, non-temporary home in a foreign country or specific jurisdiction for an uninterrupted period that includes an entire tax year.
While some expats are exempt from the coverage mandate, they must still report their income to the IRS, and they may need to claim the exemption on their U.S. tax returns.
If you return to the U.S. and establish residency again, you will be required to comply with ACA requirements and may need to enroll in a qualified health plan to avoid penalties, if applicable.
What Are The Options for Expats That Don’t Meet Exemption Eligibility?
If you are an expat that doesn’t meet exemption eligibility, it is important to do your research to understand any state laws regarding ACA compliance and penalties.
If you live in a state that has a penalty for not meeting ACA requirements, you may want to consider the cost of the penalty versus maintaining an ACA-compliant health insurance policy while living abroad.
Most importantly, most U.S.-based health insurance plans will not cover you while living abroad. So while you may want to maintain a health insurance plan in the U.S. to avoid a state tax penalty, you should still consider getting expat health insurance to remain covered outside of the United States.
What Are Health Insurance Options for Expats?
When living abroad, it is crucial to make sure that you have adequate health coverage. Expat health insurance can cover you while living outside of your home country, and can cover all of your essential healthcare needs such as emergency medical care and routine care.
Expat health insurance can cover things like:
- Preventative care
- Routine care
- Emergency medical care
- Mental health assistance
- Maternity care
There are also add-on coverage options for factors like dental, vision, life insurance, terrorism, accidental death and dismemberment, etc.
Not having health insurance while living abroad can pose significant issues financially when getting medical attention if you do not qualify for healthcare coverage in your host country.
With expat health insurance, you can have access to quality medical care and comprehensive coverage in your host country.
Why Is Health Coverage Abroad Crucial for Expats?
While some U.S. citizens living abroad may not need to meet ACA requirements, it is critical to do your research and weigh your options to understand ACA exemption eligibility and potential penalties for non-compliance.
Above all, having health coverage while living abroad is crucial for expats to ensure that you have access to the medical care you need to continue living happy and healthy.
Want to learn more? Read on about expatriate health insurance or compare our available expat health insurance plans to get covered today.
- The Affordable Care Act (ACA) aimed to expand access to health insurance, reduce healthcare costs, and protect consumers.
- ACA requirements generally do not apply to U.S. citizens living abroad for extended periods.
- The ACA requires US residents to maintain minimum health coverage, however expats who meet certain criteria may be exempt.
- Expat health insurance can cover your essential healthcare needs while living outside of your home country.
Frequently Asked Questions About Affordable Care Act for US Citizens Living Abroad
Are Affordable Care Act plans required for expats?
No, Affordable Care Act (ACA) plans are not required for US citizens who are living abroad. The ACA’s individual mandate (requiring minimum essential coverage) exists at the federal level, but expats can qualify for an exemption so they do not have to maintain ACA-compliant insurance.
Who qualifies for the Affordable Care Act?
To qualify for coverage under the Affordable Care Act (ACA), you must live in the United States, be a U.S. citizen or lawfully present immigrant, and not be incarcerated. There are no income limits to buy a plan, but your income determines whether you qualify for financial help.
Does the ACA cover pre-existing conditions?
Yes. The Affordable Care Act (ACA) requires health insurance plans to cover pre-existing conditions. That means insurance companies cannot deny you coverage, charge you higher premiums, or refuse to pay for treatment because of a health condition you had before your coverage started.
Does the affordable care act cover dental?
The Affordable Care Act (ACA) does not generally require adult health plans to cover dental care. The Affordable Care Act (ACA) does require all Marketplace health plans to cover dental care for children (18 and under) as an essential health benefit. For adults, dental coverage is usually sold separately as a standalone plan or sometimes included as an add-on to a Marketplace plan. These plans can cover routine preventive services like cleanings and X-rays, and sometimes more extensive procedures like fillings or crowns, depending on the plan.
If as an expat I do not meet exemption eligibility, can I choose to simply pay the penalty instead of getting proper insurance?
If you are an expat in a country with mandatory health insurance and you do not meet exemption criteria, you generally cannot simply pay a penalty instead of obtaining coverage. Penalties are usually applied retroactively for failing to enroll on time and are meant to enforce compliance, not serve as an alternative. In almost every case, paying the penalty actually ends up being more expensive than having proper insurance. The safest approach is to enroll in the required local or approved private insurance as soon as you become aware that you are not exempt.
Can I change my insurance plan as an expat returning to the US?
Yes, you can change your travel insurance plan as an expat returning to the U.S., but there are some key considerations. Travel insurance is typically designed to cover temporary trips outside your home country, so once you return to the U.S. and reestablish residency, most travel insurance policies will no longer cover you for routine health needs in the U.S.
Is there a deadline to purchase ACA insurance?
Yes, there are deadlines to purchase ACA insurance. The main period is the Open Enrollment Period, (fall of 2026) during which anyone can enroll in or change Marketplace plans. Outside of this period, you can still enroll through a Special Enrollment Period (SEP) if you experience a qualifying life event, such as returning from living abroad, losing other coverage, getting married, having a baby, or moving to a new state. Typically, you have 60 days from the event to sign up. If you miss both the Open Enrollment or SEP, you generally must wait until the next Open Enrollment period, though some states may offer additional options.
Is travel insurance enough if I am living abroad long term?
No, travel insurance is generally not enough for long-term living abroad. Travel insurance is designed to cover temporary trips, typically lasting days to months, and usually focuses on emergency medical care, trip interruption, lost luggage, or evacuation. It does not provide comprehensive, ongoing health coverage.
What are ACA subsidies and who qualifies?
ACA subsidies are financial assistance from the federal government that reduce monthly health insurance premiums for low-to-moderate-income individuals purchasing plans through the Health Insurance Marketplace. Most enrollees qualify if they do not have affordable, employer-sponsored coverage, or are not eligible for Medicare or Medicaid.
Does my US health insurance cover me abroad?
If you are living abroad or traveling for an extended period, you typically need either international health insurance or expat coverage designed for residents outside the U.S., which provides broader protection including routine care, prescriptions, and hospitalization. Short-term travel insurance can help for temporary trips but is not a substitute for comprehensive long-term coverage.
