The E2 visa allows individuals who want to invest significant capital in the US to move to the country to develop and direct a business. Beyond the demands of business plans and visa requirements, a key, but often overlooked, part of any US-bound relocation strategy should be health insurance, and securing a personal safety net in the event of illness or injury.

The US healthcare system is expensive, unpredictable and unforgiving to the uninsured. As there is no national health service in the US, most visa holders will need to take out some form of health insurance.

The Affordable Care Act (ACA), sometimes referred to as Obamacare, was introduced in 2010. It requires everyone living in the US to have appropriate health insurance in place. While the federal tax penalty for not having health insurance was eliminated effective January 1, 2019, some states have enacted their own individual mandates with associated penalties. Regardless of penalties, having health insurance is crucial to avoid the high costs of medical care in the US.

As such, it’s important that you are aware of the E2 visa health insurance rules to ensure you and your family can access the care you need.

 

Eligibility for health insurance

 

While there is no longer a federal penalty for not having health insurance, obtaining adequate coverage remains strongly advised—both for financial protection and to meet state-specific requirements.

Under the Affordable Care Act (ACA), lawfully present noncitizens, such as E2 visa holders, are eligible to purchase health insurance through the Health Insurance Marketplace. You may also qualify for private health insurance plans or employer-sponsored coverage, depending on your circumstances.

Although the federal tax penalty for lacking minimum essential coverage was eliminated as of January 1, 2019, several states including California, Massachusetts, New Jersey, Rhode Island and Washington DC have implemented their own individual mandates. In those states, you could face a state tax penalty if you fail to maintain qualifying health coverage for the year.

To avoid a state-level penalty and ensure access to necessary care, E2 visa holders should secure one of the following:

 

• A plan purchased through the Health Insurance Marketplace
• A qualifying individual health insurance policy
• An employer-sponsored health insurance plan

 

Evaluating options early in your US stay can help prevent unexpected costs or compliance issues.

 

Insurance options for E2 visa holders

 

Under the Affordable Care Act (ACA), U.S. employers with 50 or more full-time employees are required to offer health insurance to their full-time staff. Many employers contribute toward the cost of premiums, making this a common and often valuable benefit for employees in the US.

If your US employer has fewer than 50 full-time employees and is not required to offer health insurance—or if no coverage is provided—you will need to purchase an individual health insurance plan. As an E2 visa holder, you are considered lawfully present and are eligible to buy coverage through the Health Insurance Marketplace. Most plans offered through the Marketplace meet ACA minimum essential coverage standards, but it’s a good idea to compare options and seek assistance if needed. Government-run Marketplaces provide support to help individuals find plans that fit their needs and budget.

If you’re arriving in the U.S. on an E2 visa for the first time, it’s wise to arrange short-term or visitor health insurance before traveling. This type of coverage can protect you during the initial period before your U.S.-based employer plan or Marketplace coverage becomes active, helping to avoid gaps in protection and out-of-pocket medical costs.

 

Insurance for family of E2 visa holders

 

Spouses and children accompanying E2 visa holders to the United States should also have appropriate health insurance coverage in place. Like the primary visa holder, they are considered lawfully present and are eligible to purchase health plans through the Health Insurance Marketplace.

If your family is traveling with you, short-term visitor health insurance is worth considering to cover any unexpected medical needs during your initial period in the U.S. before longer-term coverage begins. This temporary protection can help bridge the gap while waiting for employer-sponsored or Marketplace insurance to take effect.

If you are arriving in the U.S. before your spouse or children, you may want to explore purchasing a family health insurance plan in advance, so coverage is in place by the time they arrive. Marketplace plans offer various levels of family coverage, and enrolling early can help avoid lapses in care or delays in access to medical services.

Choosing a plan that covers both routine care and emergencies is important, especially for families adjusting to a new healthcare system. Reviewing coverage options ahead of time can give you peace of mind and ensure everyone in your household is protected from the start.

 

Exemptions

 

While most lawfully present individuals in the US are encouraged to maintain health insurance coverage, certain exemptions may apply under federal or state rules, particularly in states that enforce individual mandates.

You may qualify for an exemption from health coverage requirements in the following situations:

• Religious Conscience: You are a member of a recognized religious sect that objects to insurance benefits on the basis of sincerely held beliefs. The sect must be acknowledged by the Social Security Administration under federal guidelines.
• Health Care Sharing Ministry: You participate in a qualifying health care sharing ministry, which is a nonprofit that facilitates the sharing of medical expenses among members with shared ethical or religious beliefs.
• Indian Tribes: You are a member of a federally recognized Native American tribe or qualify for care through the Indian Health Service or an affiliated provider.
• Low Income: Your income is below the federal threshold that requires you to file a tax return.
• Affordability: The lowest-cost available coverage would cost more than a set percentage of your household income, making it considered unaffordable under the law.
• Hardship: You experienced a qualifying hardship that prevented you from obtaining coverage. Examples include homelessness, eviction, or domestic violence, as outlined by the Department of Health and Human Services.
• Incarceration: You are incarcerated in a jail, prison, or other correctional institution.

 

Each exemption may require documentation or approval depending on your state of residence. Be sure to check current state-specific requirements if you reside in a state with an active individual mandate.

 

Individual Shared Responsibility Payment

 

Although the federal penalty for not having health insurance was eliminated as of January 1, 2019, several states have implemented their own health coverage mandates.

If you’re relocating to or living in a state with its own health insurance mandate, it’s important to check local requirements to understand your responsibilities and avoid unexpected penalties.

You may be exempt from state-level penalties if you are:

 

• A nonresident alien
• A dual-status alien in the first year of residency
• A nonresident or dual-status alien filing jointly with a U.S. citizen or resident spouse
• Filing Form 1040NR or Form 1040NR-EZ
• Claimed as a dependent on a Form 1040NR or 1040NR-EZ

 

If you or your family do not maintain minimum essential coverage and do not qualify for an exemption, you may be subject to a state-level individual shared responsibility payment when filing your state income tax return.

You may be required to make a payment for any months you did not have qualifying coverage or a recognized exemption. However, this only applies in states with their own health insurance mandates, such as California, Massachusetts, New Jersey, Rhode Island and Washington DC. No federal-level penalty applies for tax year 2025.

If you are a foreign national living in the United States for a short time, you may not be required to make a state penalty payment if you do not qualify as a resident alien for tax purposes. This may apply even if you are required to file a US tax return. The Internal Revenue Service (IRS) provides specific guidance on determining tax residency.

 

When to Enroll for Health Insurance

 

In the United States, health insurance enrollment typically takes place during the Open Enrollment Period, which occurs annually near the end of the calendar year. During this window, individuals can sign up for new coverage, renew existing plans, or make changes to their health insurance for the upcoming year.

Outside of the open enrollment period, coverage can only be obtained through a Special Enrollment Period (SEP), which is triggered by certain qualifying life events. These events allow you to apply for health insurance outside the standard timeframe and usually grant a 60-day window to enroll following the event.

Qualifying life events include:

• Loss of health coverage: This includes losing employer-based insurance, individual coverage, or eligibility for government programs such as Medicare, Medicaid, or CHIP.
• Household changes: Getting married or divorced, having a baby, adopting a child, or experiencing the death of a dependent can qualify you for a SEP.
• Recent immigration to the US: New arrivals, including E2 visa holders and their families, may be eligible to enroll in a health insurance plan immediately upon arrival.
• Planning ahead and understanding your eligibility can help you secure timely coverage and avoid unnecessary gaps in access to care.

 

 

Need assistance?

 

US health insurance rules are challenging but it is vital as an E2 visa holder that you have adequate cover in place for you, and your family if applicable.

As specialist US immigration attorneys, we can guide you through the complexities of the E-2 visa application process, providing expert guidance to ensure the petition, documentation and business plan are comprehensive and effective in demonstrating your eligibility.

For advice on your E-2 visa application, contact us.

 

FAQs

 

Do E2 visa holders need health insurance in the US?

E2 visa holders and their families should have health insurance since there is no national healthcare system in the US Without coverage, medical expenses can be extremely high.

 

Is health insurance required by law for E2 visa holders?

There is no federal penalty for not having health insurance since 2019 However, some states still require residents, including visa holders, to have coverage or face a state-level penalty.

 

Can an E2 visa holder get employer-sponsored health insurance?

If an E2 visa holder works for a US company with at least 50 full-time employees, the employer is required to provide health insurance Smaller employers are not required to offer coverage.

 

What if my employer does not provide health insurance?

If your employer does not offer a health plan, you must purchase one through the Health Insurance Marketplace or a private insurer to ensure you have medical coverage.

 

Can I buy short-term health insurance when I first arrive in the US?

Temporary visitor health insurance can be purchased before arrival to cover medical expenses until a long-term plan is in place.

 

Do my spouse and children need health insurance in the US?

Spouses and children accompanying an E2 visa holder should have health insurance They may be included in an employer-sponsored plan or purchase individual coverage.

 

What happens if I do not get health insurance in a state with a mandate?

States like California, Massachusetts, New Jersey, Rhode Island, and Washington DC may impose a penalty for not having insurance Check state regulations to confirm the rules where you live.

 

When can I enroll in a US health insurance plan?

Most people can only enroll during the open enrollment period at the end of the year However, recent immigrants and those with qualifying life events may apply at any time.

 

What is a Special Enrollment Period?

A Special Enrollment Period allows someone to buy health insurance outside of open enrollment due to life changes such as getting married, having a baby, or losing previous health coverage.

 

Can I keep my foreign health insurance while living in the US?

Some international health plans may offer coverage in the US, but they are often limited It is recommended to get a US-based health plan for better access to care.

 

How do I find the best health insurance plan for my family?

You can compare plans on the official Health Insurance Marketplace website or work with a licensed insurance agent to find a plan that meets your needs.

 

Can I switch my health insurance plan after enrolling?

Unless you qualify for a Special Enrollment Period, you can usually only change plans during the annual open enrollment period at the end of the year.

 

Do I need health insurance if I plan to stay in the US only for a short time?

Even if your stay is temporary, having health insurance is important to avoid unexpected medical bills Short-term health plans are available for visitors.

 

 

Glossary

 

 

Term	Definition
E2 Visa	A nonimmigrant visa allowing investors and their families to live and work in the US after making a substantial business investment.
Affordable Care Act (ACA)	A healthcare law that expanded health insurance access and set minimum coverage requirements for residents, including some visa holders.
Health Insurance Marketplace	A government-run platform where individuals can compare and purchase health insurance plans that meet ACA standards.
Employer-Sponsored Health Insurance	Health coverage provided by an employer to full-time employees, sometimes covering dependents as well.
Temporary Visitor Health Insurance	Short-term medical coverage for new arrivals in the US before enrolling in a long-term plan.
Minimum Essential Coverage (MEC)	The level of health insurance coverage required to meet ACA guidelines and avoid state penalties where applicable.
Individual Mandate	A legal requirement for individuals to have health insurance, which still applies in some states.
Special Enrollment Period (SEP)	A limited time outside the normal enrollment period when individuals can sign up for health insurance due to major life events.
Open Enrollment Period	A designated time each year when individuals can enroll in or change their health insurance plans.
State Health Insurance Mandate	A law in certain states requiring residents, including visa holders, to have health insurance or face penalties.
Health Sharing Ministry	A religious-based alternative to traditional health insurance where members share medical expenses.
Medicaid	A government healthcare program for low-income individuals, generally not available to E2 visa holders.
Medicare	A federal health insurance program for individuals aged 65 and older or with certain disabilities, usually not available to visa holders.
Qualifying Life Event (QLE)	A significant change in circumstances, such as marriage, birth, or job loss, that allows someone to enroll in health insurance outside the open enrollment period.
Individual Shared Responsibility Payment	A tax penalty for not having health insurance, which no longer applies at the federal level but may still exist in some states.
Resident Alien for Tax Purposes	A tax status based on substantial presence in the US, which can affect health insurance requirements.
Nonresident Alien	A foreign national who does not meet the substantial presence test for tax purposes and may not be subject to state health insurance mandates.