Emigration in Practice: Residence and Health Insurance in the USA

Two things that get lost in the emigration rush

Emigrating to the USA is full of talk about visas and companies – and two very practical questions easily fall behind: how am I covered for health care, and what actually happens to my residence? Both sound dry but can get expensive and complicated.

Our publisher put it bluntly from his own experience running a US company (in a conversation recorded on 15 July 2026): “As an entrepreneur today you have to spread yourself so wide and gather so much knowledge that it sometimes makes you sick.” That overwhelm is exactly why these two unglamorous topics deserve a checklist of their own.

This is information and replaces neither legal nor tax nor insurance advice. For decisions, consult qualified professionals.

Health insurance: German cover does not apply in the USA

The most important sentence first: German statutory health insurance (GKV) does not protect you in the USA. Within the EU there are agreements ensuring basic cover – that does not apply in the USA.

Health insurance is not a formal entry requirement, but strongly recommended. The reason is simple: without adequate cover you bear treatment, hospital and, where applicable, repatriation costs yourself – and in the USA these can be very high. The Federal Foreign Office makes the same point in the medical notes of its USA travel and safety information: costs incurred without adequate insurance cover must be borne personally (see sources).

Which type of cover you need depends on how long you stay:

• Travel health insurance (Reisekrankenversicherung) is designed for short stays only – typically weeks, not an emigration.
• International private health insurance (expat plans) covers longer stays and usually includes medical repatriation; premiums depend heavily on age, scope, deductible and the US state.
• Once you actually live in the USA, a US health plan becomes relevant – via an employer or, where eligible, the ACA marketplace (healthcare.gov). Note the important caveat: access to ACA marketplace plans depends on your immigration status – broadly, you must be lawfully present in the USA to enroll. Which visa or status qualifies is an individual question; check it before you count on marketplace coverage.

We deliberately quote no premium figures here, because there is no reliable blanket number: the spread between a young, healthy applicant with a high deductible and a family plan with full cover is enormous. What matters is obtaining concrete quotes before departure, not after – a coverage gap between GKV exit and new cover is the classic and avoidable mistake.

Residence: the LLC does not shift it by itself

The second point concerns a common misconception: a US LLC does not automatically relocate your residence. An LLC is a company – not a move and not a change of your personal status.

Our publisher’s own experience shows how tempting this confusion is: he formed a Wyoming LLC in practice – paid on a Wednesday, and the formation documents were in his inbox a few days later. Compared with founding a German GmbH, he called the process “a joke”. Precisely because forming is that fast and easy, it is worth stressing: nothing about your personal tax situation changed on that Wednesday. A formation certificate is not a change of residence, and a US LLC is no tax-freedom automatism – whether and where taxes arise depends on your residence, substance and activity, and belongs in the hands of a tax adviser.

The legal yardsticks in Germany are concrete: you remain subject to unlimited German tax liability if you keep a Wohnsitz (residence) under § 8 AO – broadly, a dwelling you retain and use – or a habitual abode (gewöhnlicher Aufenthalt) under § 9 AO. For the habitual abode, the law works with a time rule: a temporally continuous stay of more than six months is as a rule treated as a habitual abode, with short interruptions left out of account – it is the connected stay that counts, not scattered visits added up loosely. The law itself carves out an exception, though: a stay undertaken exclusively for visiting, recreation, cure or similar private purposes does not trigger the six-month rule as long as it does not exceed one year (§ 9 sentence 3 AO). These are two distinct German-law concepts and should not be lumped together.

Separate from both is the treaty level: if both Germany and the USA treat you as resident, the tie-breaker rules in Article 4 of the Germany–USA double taxation treaty decide which state prevails. The criteria the treaty works through include the permanent home available to you, your centre of vital interests, your habitual abode and your nationality – but for the exact sequence and wording in your case, do not rely on summaries (including this one): consult the official treaty text, which the Federal Ministry of Finance publishes among its country-specific treaty information (see sources). Anyone who forms an LLC but keeps a dwelling in Germany does not thereby shift their tax residence. For an overview of the corporate side, see LLC and taxes: Germany and the USA (coming soon).

Formalities: registration and deregistration are for the authorities

Topics such as deregistering (Abmeldung) your residence in Germany and registering (Anmeldung) locally are no side note either. The rule in § 17 BMG is more precise than the common shorthand “always deregister”: a duty to deregister exists only if you do not move into a new dwelling in Germany – which is exactly the emigration case, since your new home is abroad. If that applies to you, the deadline is within two weeks of moving out (deregistration is possible no earlier than one week before the move). Deregistration in turn feeds into your insurance and tax picture, so keep the paperwork.

A practical detail from our publisher’s experience with the banking side: he handled the US-capable account via Revolut, where he was already a customer – but the KYC review was very strict. Because he plans to sell e-commerce goods into the USA, he had to explain his sales activities in detail before the account was approved. Plan time for this step; it is not a formality.

For initial official orientation, see the Bundesverwaltungsamt’s country information for emigrants to the USA and the Federal Foreign Office’s USA page (both in sources). Further practical guides on relocation topics are collected in our emigration section.

In short

• German statutory health insurance does not apply in the USA – private cover is strongly recommended; choose the right type (expat plan vs. US plan) and sort it out before departure.
• ACA marketplace plans require lawful presence in the USA – check your immigration status before relying on them.
• Premiums vary enormously by age, plan and state – get concrete quotes instead of relying on rules of thumb.
• The LLC does not shift your residence: § 8 AO (Wohnsitz) and § 9 AO (habitual abode – continuous stay of more than six months, with an exception for purely private visiting/recreation stays of up to one year) are what count, plus the Article 4 tie-breaker of the Germany–USA treaty – check the official treaty text via the BMF. Tax questions belong to a professional.
• Deregistration in Germany (§ 17 BMG): required when you move out without taking a new dwelling in Germany – i.e. when emigrating – within two weeks of moving out.

Back to the overview: US LLC Hub.