US Health Insurance System Explained: Universal Healthcare? Employer, Obamacare, Medicaid & Medicare

Dongni Chen is a licensed health insurance agent who speaks Mandarin and Cantonese, and can help you compare plans and enroll in Chinese. The United States does not have universal health insurance.

Information compiled in October 2026. If policies change, follow the official announcements.

By Dongni Chen, licensed insurance agent, NPN 20635222 · RedNote (Xiaohongshu): 咚咚在美国 · Updated October 25, 2026

Key points

The United States does not have universal health insurance. Where you get coverage depends on your age, income, job and immigration status.
Four common types are employer coverage, Obamacare (ACA), Medicaid and Medicare.
Generally: If you have a job, check your employer's coverage; without employer coverage, look at Obamacare; with a low income, check Medicaid; at age 65 or older, check Medicare.

1. Does the US have universal health insurance?

No. Unlike China, Canada and the United Kingdom, the United States does not have a single government system that provides health insurance for everyone. Several systems operate alongside one another:

Some coverage comes from employers.
Some is purchased by individuals, with government subsidies based on income.
Some is provided directly by the government, for people with low incomes, older adults, people with disabilities, military personnel and others.

So when you move to the United States, change jobs, retire or have an income change, you need to review which type fits your situation.

2. Comparing four common types of coverage

	Employer coverage	Obamacare (ACA)	Medicaid	Medicare
Who runs it?	Employer and insurance company	Government marketplace and insurance company	State government, with some federal funding	Federal government
Who is it for?	Employees and their families	Individuals and families without employer coverage	People with low incomes	People age 65 or older, or people with qualifying disabilities
What does it cost?	The employer usually pays part of the premium	Subsidies may be available based on income	Usually no cost or very little	Part B has a monthly premium
When can you join?	When starting a job or during the employer's annual enrollment period	Annual Open Enrollment or a Special Enrollment Period	Applications accepted year-round	Enrollment periods around age 65 and other enrollment periods

3. Employer coverage

This is group insurance an employer buys for employees. The employer usually pays part of the premium, and the employee pays part through payroll deductions.
You can generally add your spouse and children.
After leaving a job: You can choose COBRA to keep the coverage, generally for up to 18 months. But you pay the full premium plus an administrative fee of up to 2%, which is often expensive. You can also switch to Obamacare within 60 days after leaving the job.
If your employer's coverage is affordable, you generally cannot receive Obamacare subsidies. For 2027, the affordability threshold is an employee-only premium contribution of no more than 10.22% of household income.

4. Obamacare (ACA)

Individuals and families buy this health insurance themselves through a government marketplace. Many states use the federal marketplace, HealthCare.gov, while some have their own.
Your health does not affect eligibility or price. You can enroll with a medical history, and the price is the same.
Premium subsidies may be available based on household income. For 2027, income above 400% of the federal poverty level, about $63,840 for a single person or $132,000 for a family of 4, means no federal subsidy.
Open Enrollment starts on November 1 each year. At other times, you need a qualifying life event, such as job loss, a move, marriage or childbirth, to enroll.

For details, see How to Get Obamacare (ACA): Cost, Who Qualifies & How to Apply.

5. Medicaid (names vary by state)

Government health insurance for people with low incomes, administered by states. Each state has its own program name and eligibility standards.
In most states, adults can apply with income below about 138% of the federal poverty level, about $22,025 a year for a single person in 2026. Children and pregnant women have higher income limits.
Some states have not expanded Medicaid, so adults may not qualify even with very low incomes.
It usually costs little or nothing, and you can apply year-round.

6. Medicare

Federal health insurance for adults age 65 or older. People under 65 can also qualify after receiving Social Security disability benefits for 24 months, or if they have end-stage renal disease or ALS.
Chinese speakers sometimes call it the “red and blue card” because of the red and blue stripes on the card.
It has several main parts:

Part	What it covers	Costs in 2026
Part A	Hospital stays, skilled nursing facilities and more	Generally no premium with 10 years (40 quarters) of work and tax contributions. Otherwise, you must buy it, at $311 or $565 a month.
Part B	Doctor visits, outpatient care, tests and more	Standard premium of $202.90 a month and an annual deductible of $283. Higher-income people pay higher premiums.
Part C	Medicare Advantage, offered by private insurers, combines Parts A and B and usually includes prescription drugs	Depends on the plan
Part D	Prescription drugs	Depends on the plan

You can also buy Medigap supplemental coverage to help pay your share of Part A and Part B costs.
Immigration status: US citizens and green card holders can qualify for Medicare. Green card holders with 10 years of work and tax contributions can get premium-free Part A directly. Those without enough work history who need to buy Parts A and B generally must have lived continuously in the United States for 5 years.
For people with both Medicare and Medicaid, Medicaid can help pay Medicare premiums and out-of-pocket costs.

How can you tell which type fits your situation?

Start with these questions:

Does your employer or your spouse's employer offer insurance?
Is anyone in your family approaching or already age 65?
About how much is your household's annual income?
What is each family member's immigration status: citizen, green card holder or another status?

If you are unsure, contact me and I can help you review your situation.

Main sources: HealthCare.gov; the Centers for Medicare & Medicaid Services (CMS) announcement of 2026 Medicare premiums; IRS Rev. Proc. 2026-26.

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