Health Insurance for Digital Nomads (USA, 2025)

Updated: Aug 2025. If you’re a U.S.-based digital nomad—living around the country or hopping between countries—your health coverage needs are different from a typical resident. This guide explains the main options (and traps): ACA-compliant plans, travel medical, global expat policies, short-term plans, and alternatives. Rules and prices change by state and year, so verify on official pages before enrolling.

Quick Map of Options

• ACA marketplace plans (Healthcare.gov or state exchanges): Full essential benefits, pre-existing condition coverage, federal subsidies if eligible. You’ll choose a domicile state and network—great inside the network, limited out-of-area unless PPO/EPO allows it.
• Travel medical insurance: Designed for trips abroad (usually excludes U.S. home-country coverage). Strong for emergency care/evacuation, not for routine care or pre-existing conditions.
• Global expat plans: Long-term worldwide cover with optional U.S. treatment add-on (often expensive). Better for people spending most of the year outside the U.S.
• Short-term medical (U.S.): Stopgap coverage; usually excludes pre-existing conditions and ACA essential benefits. Varies by state; not a long-term solution.
• Health sharing ministries & “alternative” plans: Not insurance; reimbursements are discretionary and may exclude many conditions.

1) ACA Marketplace Plans (USA)

ACA plans cover essential health benefits, preventive care, prescriptions, maternity, mental health, and pre-existing conditions. If you qualify for premium tax credits, premiums can drop significantly. The challenge for nomads: networks and state domicile.

• Domicile: You must select a legal residence for enrollment. Many nomads use a friend’s address, a family home, or a mail service (check state rules). Changing states mid-year often requires a Special Enrollment Period.
• Network portability: PPO/EPO plans can allow out-of-area care, but availability varies by state and insurer. Confirm OON (out-of-network) rules, telehealth coverage, and nationwide urgent-care access before enrolling.
• Where to shop: Start at Healthcare.gov (federal) or your state exchange (e.g., Covered California, NY State of Health). Open Enrollment typically runs Nov–Jan; moving, losing coverage, or life events may qualify you for SEP.

2) Travel Medical Insurance

Ideal for U.S. citizens traveling outside the U.S. Emergency care, evacuation, and repatriation are the focus. It’s not meant for routine checkups or ongoing conditions and often excludes pre-existing conditions (some waive acute onset).

• Use case: You’re abroad for months at a time, returning to the U.S. only briefly, and want emergency-only coverage.
• Must-check: Country exclusions, sports/activities, evacuation limits, and requirement to pay upfront then claim.
• Tip: Pair with an ACA plan (catastrophic or low-cost bronze in your domicile) if you need U.S. coverage when you’re back.

3) Global Expat Plans

Comprehensive worldwide policies intended for long-term life abroad. You can usually add U.S. coverage, but that raises the premium a lot. These often include inpatient/outpatient care and sometimes maternity and dental add-ons.

• Who it fits: Full-time international nomads who want a single policy, often with higher limits and broad private networks overseas.
• Downsides: Premiums are higher, underwriting may apply, and U.S. treatment add-ons can be pricey.

4) Short-Term Medical (U.S.)

Short-term plans can bridge gaps of a few months, but they’re not ACA-compliant: pre-existing conditions are typically excluded; benefits may be capped; preventive/maternity/mental health may be limited or excluded. Availability and max duration depend on state rules.

5) Alternatives & Add-ons

• Telehealth memberships: Affordable for routine issues and prescriptions while traveling; not insurance.
• Emergency evacuation memberships: Separate from insurance; they coordinate and cover evacuations to a hospital of your choice (read the fine print).
• Health Savings Account (HSA): Only certain high-deductible ACA plans are HSA-eligible. If you plan to contribute, confirm HDHP and HSA rules before switching plans.

Picking a Plan: A Decision Framework

1. Where will you spend most months? If mostly in the U.S., start with ACA in a nomad-friendly state (look for PPO/EPO networks). If mostly abroad, compare global expat vs. travel medical + minimal U.S. coverage.
2. Medical history: Need pre-existing coverage? ACA or expat plans are safer; travel medical/short-term often exclude.
3. Budget & risk tolerance: Decide your acceptable deductible/out-of-pocket. Evacuation limits of $100k–$500k are common on travel/global plans—pick based on destinations and activities.
4. Network realities: Call a few clinics in states you frequent and ask if they accept your target plan (list the exact network name).
5. Tax & admin: Premium tax credits require a U.S. tax return with estimated income. Moving states mid-year may affect eligibility.

Common Mistakes to Avoid

• Assuming travel medical covers care in your home state—it usually doesn’t.
• Buying an ACA HMO with a very local network, then traveling nationwide.
• Skipping evacuation coverage for remote destinations.
• Relying on non-insurance “sharing” plans for major claims.

Checklist Before You Buy

Useful official resources: Healthcare.gov (federal ACA marketplace). For HSAs and HDHP definitions, see IRS guidance (e.g., “HSA eligible HDHP”) on IRS.gov. State rules vary—check your state exchange for plan networks and enrollment windows.

Disclaimer: This article is informational only and not legal, tax, or medical advice. Benefits, exclusions, and eligibility change frequently; always confirm on the insurer’s and exchange’s official pages before purchase.