Health insurance in LA for Australians

In LA your health cover comes from your job or your own wallet, and the fine print matters more than the monthly price.

The short version

Medicare doesn't work in the US, and there's no reciprocal health care agreement between Australia and the United States [1].
Most Aussies on an E-3 get cover through work. In 2025 the average employer plan cost US$9,325 a year for a single person and US$26,993 for a family, with workers paying about US$1,440 and US$6,850 of that themselves [2].
What you pay when you're sick depends on the deductible, copays and the out-of-pocket maximum. The federal cap for Marketplace plans is US$10,600 for one person in 2026, rising to US$12,000 in 2027 [3].
From 2027, most work-visa holders can still buy a Covered California plan but lose federal financial help; green card holders keep it [4].
California fines residents who go without cover: the 2025 penalty was at least US$950 per adult [5].

Why Australians get caught out

At home, Medicare is the floor under everything. You can get sick, see a GP, end up in a public hospital and walk out without a bill. The US has no equivalent floor for working-age visa holders.

Smartraveller puts it bluntly: a visit for a minor issue can cost thousands of dollars, hospitals may ask for proof of insurance or ability to pay, and Medicare doesn't apply because there is no reciprocal agreement [1]. Your Australian private health fund won't help either. It covers treatment in Australia, not in Los Angeles.

So the question isn't whether to have US insurance. It's which plan, and how to read it. Our guide to Medicare when you live abroad covers what happens to your Medicare card back home.

How employer plans work

If you're on an E-3, your employer's plan is almost always your best deal. The employer pays the bulk of the premium, and you pay your share out of pre-tax salary, so it's cheaper than it looks on the payslip.

KFF's 2025 survey shows the typical split [2]:

Plan cost in 2025 (US average)	Single cover	Family cover
Total annual premium	US$9,325	US$26,993
Worker's share of premium	US$1,440	US$6,850
Average deductible (single, where there is one)	US$1,886	n/a

Those are national averages. LA employers in tech, film and finance often pay more of the premium; smaller firms and start-ups often pay less. Ask HR for the full benefits guide before you sign your offer, because a generous plan can be worth thousands a year.

Enrolment rules

You usually choose a plan when you start the job and then once a year at "open enrolment". Outside those windows you can only change plans after a qualifying life event, such as marriage, a baby or losing other cover, and the window to act is short, often 60 days. Many employers have a waiting period before cover starts, so check whether you need a gap policy for your first weeks in the country.

HMO, PPO and the alphabet soup

KFF found 46% of covered workers were in a PPO, 33% in a high-deductible plan, 12% in an HMO and 9% in a POS plan in 2025 [2]. Here's what each means in practice.

Plan type	How it works	Good for	Watch out for
HMO	You pick a primary care doctor who refers you to specialists, all inside one network	Lower premiums and copays, less paperwork	Out-of-network care usually isn't covered except emergencies
PPO	See any in-network doctor without a referral; some out-of-network cover	Choice, seeing specialists directly	Higher premiums; out-of-network costs climb fast
POS	A mix: HMO-style referrals, some out-of-network cover	Middle ground	Rules vary by plan
HDHP	High deductible, lower premium, often paired with a Health Savings Account	Healthy people who want to save tax-free for medical costs	You pay full negotiated price until the deductible is met

In LA, HMOs are common and often built around big medical groups, so the doctor you pick decides which hospitals you can use. If you want a particular hospital, such as Cedars-Sinai or UCLA, check that it's in the plan's network before you enrol.

Premiums, deductibles and out-of-pocket maximums

This is the part that confuses everyone. A US plan has four price tags, not one.

Premium. What you pay every month just to be covered, whether you use it or not.
Deductible. What you pay each year before the plan starts sharing costs. A US$2,000 deductible means the first US$2,000 of most care is yours.
Copay and coinsurance. After the deductible, you pay a flat copay (say, for a GP visit or prescription) or a percentage of the bill.
Out-of-pocket maximum. The most you'll pay in a year for covered, in-network care. After that, the plan pays 100%.

The out-of-pocket maximum is your real worst case. For Marketplace plans the federal ceiling is US$10,600 for an individual and US$21,200 for a family in 2026, and US$12,000 and US$24,000 in 2027 [3]. Most employer plans follow the same legal ceiling, and many set theirs well below it.

Preventive care, such as an annual check-up and standard vaccinations, is generally covered without you paying the deductible. Everything else, from an MRI to a specialist visit, may hit the deductible first.

A quick rule: if you expect regular care, such as a pregnancy, a chronic condition or kids who play sport, a higher premium with a low deductible is often cheaper over the year. If you rarely see a doctor, a high-deductible plan with an HSA can come out ahead.

Covered California: who can use it now

Covered California is the state's health insurance marketplace. Anyone who lives in California and is lawfully present can shop there, including people on work visas. The big change is who gets financial help.

The enhanced federal subsidies ended. Congress let them expire at the end of 2025 [6].
From 2027, most visa holders lose federal help. Under the 2025 federal law known as H.R. 1, from coverage year 2027 premium tax credits and cost-sharing reductions are limited to groups including green card holders. Work and student visa holders can still enrol, but without financial assistance [4].
State help is narrower. California's own subsidy programme covers people with incomes up to 200% of the federal poverty level in 2027, about US$31,920 for an individual [6].

For an Australian on an E-3 with a job offer, this rarely matters, because you'll take the employer plan. It matters if you're an E-3D spouse who isn't on your partner's plan, between jobs, freelancing on another visa, or recently got your green card (in which case you may now qualify for subsidies).

Open enrolment for 2027 runs from 1 November 2026 to 31 January 2027. Pick a plan by 31 December to be covered from 1 January [6]. Anyone under 30 can also look at a cheaper minimum coverage plan [6].

Losing your job on an E-3

If your job ends, your employer cover usually ends with it, often at the end of that month. You can typically keep the same plan through COBRA, but you'll pay the full premium yourself plus an admin fee. Losing job-based cover is also a qualifying event for Covered California. Compare both, then remember your visa clock is ticking too.

California's insurance mandate

Unlike the federal rule, California still fines residents who don't have qualifying cover. For the 2025 tax year, the penalty was the higher of US$950 per adult and US$475 per child, or 2.5% of household income above the filing threshold [5]. A gap of three consecutive months or less is exempt [5].

Employer plans count as qualifying cover [5]. Travel insurance from Australia usually doesn't, so if you plan to live here, don't rely on it beyond your first few weeks.

What to do in your first month

Get the benefits guide early. Ask for it with your offer, and compare plans on deductible and out-of-pocket maximum, not just premium.
Check your doctors and hospitals. Use the insurer's directory to confirm your preferred GP, paediatrician or hospital is in network.
Bridge the gap. If employer cover doesn't start on day one, keep comprehensive travel insurance until it does, as Smartraveller recommends for anyone in the US [1].
Set up the money side. Open an HSA if you choose a high-deductible plan, and an FSA for dependent care if you have kids.
Sort Australia. Decide what to do with your Australian private health cover; our guide to private health insurance when you move overseas explains suspending a policy and Lifetime Health Cover.
Keep your insurance card on you. You'll be asked for it at every appointment and pharmacy.

Want to know which plans other Aussies chose? Ask in Cooee USA, our Facebook group for Australians in the USA, where members compare employer plans, LA medical groups and paediatricians all the time.

Health insurance in LA: employer plans, Covered California and the deductible trap