Expatriate, Missionary and Marine

ACA Requirements for US Citizens Living Abroad

ACA Requirements for US Citizens Living Abroad

What is the PPACA?

The Patient Protection and Affordable Care Act (PPACA), also called the Affordable Care Act (ACA) or Obamacare, requires most U.S. citizens, permanent residents, and certain other U.S. residents to purchase and maintain a compliant insurance plan that meets the Minimum Essential Coverage (MEC). This is fairly straightforward for Americans who live in the US, but can get a little murky for those who need health insurance for living abroad. But there are options when it comes to health insurance for US expats.

Exemptions to PPACA Rules

If a U.S. citizen spends at least 330 full days outside the U.S. during a given calendar year, they are exempt from maintaining ACA compliant health insurance. This means you can have health insurance while living abroad that is not PPACA compliant.

Short term insurance plans, travel insurance plans or even expatriate health insurance plans are not ACA compliant; therefore, they do not count towards maintaining Minimum Essential Coverage.


The situation can be frustrating to U.S. citizens that live abroad for more than 3 months but less than 330 days. Before 2019, some U.S. citizens abroad were required to have Obamacare compliant medical insurance, which is most likely not going to cover them abroad or even provide a limited coverage; if they didn't have coverage, they would be penalized at tax time. The good news for U.S. citizens residing abroad is that as of January 2019, the federal tax penalty is no longer applicable to U.S citizens and residents, including U.S. citizens living abroad. However, for U.S. citizens and residents of some states, a state tax penalty may apply –– if a U.S. citizen living abroad is considered a resident of such a state, they should be sure to consider the costs of maintaining ACA compliant insurance or paying the state tax penalty.

Of course, while any expatriate is abroad, they should be covered under expatriate health insurance while living overseas.

When US citizens abroad visit the USA temporarily, they can purchase short term travel insurance. If already covered under expatriate health insurance with worldwide health coverage, it isn't necessary to purchase any travel insurance. Your medical insurance for living abroad should be sufficient.

If they are going to be moving back to the U.S. permanently, they can try to enroll into Obamacare using a special enrollment period. If that does not work out, then purchase domestic short term medical insurance until they are eligible to enroll into ACA compliant medical plan.

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Visiting USA?

Healthcare costs are very high in the U.S.

Buy U.S. based visitors insurance and enjoy your trip.

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Traveling abroad?

Did you know that your insurance may not cover you abroad or that it may only provide limited coverage?

Purchase travel medical insurance that includes emergency medical evacuation.

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New immigrant to USA?

You are not eligible to enroll in Medicare for the first 5 years.

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Going on a vacation?

You could lose your non-refundable trip costs if you had to cancel your trip.

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Are you an exchange visitor to USA?

The U.S. Department of State requires all J visa holders to purchase compliant insurance.

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Traveling to Europe?

Schengen countries require most non-US citizens to purchase Schengen visa insurance.

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Traveling frequently throughout the year?

You don't need to purchase travel insurance for every trip.

Purchase annual multi trip travel insurance for your travels.

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International student in the U.S.?

Most schools require international students to purchase health insurance.

Purchase international student health insurance that meets most school requirements.

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