Because of the costs of medical treatment in the United States, many European insurance companies will not insure expatriates going out for a long period. Instead they advise you to get your insurance from a US company such as Blue Cross or a company which specializes in expatriate and travel insurance.

It is not uncommon to find expatriates who decide to take the risk of having no insurance at all, weighing up the cost of treatment against the lifetime costs of an insurance policy. One expatriate estimated that his family's medical costs had been $18,000 over a ten-year period, which has included having pneumonia, having a baby, and various other expenses. He decided that as this was marginally cheaper than what he would have been paying in insurance, the risk was worth it.

When choosing an insurance policy you need to look out for certain conditions that apply to different policies. In particular:

Pre-existing conditions: Make sure that the policy defines this term. It can either mean the existence of a medical condition that has been treated, or simply a condition that has existed prior to taking out a policy. It becomes crucially important if you are unaware of such conditions as heart murmur or ulcers. It is expensive to include pre-existing conditions in a policy, so look for policies with loose interpretations of the term.

Co-payment: This is the reserve on a policy. Some policies pay out 70%-80% up to a certain amount and 100% thereafter. There may also be different co-payments for different medical conditions.

Specific limits: some policies may specify dollar limits for certain conditions and ailments, and will only pay up to a certain amount.

Exclusions: Some policies exclude certain injuries, for example for certain sports.

Medical Evacuation: J-1 exchange visas are required to have medical evacuation coverage. This will pay to have the insured transported home for treatment. It is rarely used, and so is not an expensive addition to the policy.

Repatriation: The policy pays to have the insured's remains transported home if they should die while in the USA. This is also a required benefit for J-1 visa holders.