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Retiring in United States

Residency routes, healthcare and pension tax · USD

Routes to residency

Healthcare

Access to US public healthcare for immigrants depends on legal status and category. Lawfully present immigrants with a green card generally must wait 5 years before qualifying for means-tested federal programs like Medicaid, and Medicare eligibility at 65 generally requires the immigrant to have a sufficient US work history (or that of a spouse) paying Medicare payroll taxes, or to pay a premium buy-in after meeting residency requirements; undocumented immigrants are excluded from federally funded coverage except emergency care.

Lawfully present immigrants typically face a 5-year waiting period before eligibility for federal means-tested programs such as Medicaid/CHIP; Medicare Part A premium-free coverage generally requires ~10 years (40 quarters) of US work history paying Medicare taxes, otherwise a premium buy-in is possible after 5 years of continuous lawful residence.

There is no general federal legal requirement to hold private health insurance as a condition of maintaining a visa or green card (unlike some other countries); however, specific visa categories may require proof of insurance, and the Affordable Care Act marketplace is open to lawfully present immigrants, often with subsidies depending on income.

US Medicare: Not directly applicable here since this entry concerns residence in the United States rather than care abroad; Medicare generally only pays for treatment received within the US and its territories.

Pension income tax

United States taxes foreign pension income of its residents.

The US taxes worldwide income of its citizens and residents, including foreign pension and annuity distributions; per the IRS, such income is generally taxable in the US unless a tax treaty provides an exemption or reduced rate, and foreign social security payments may also be taxable to a US resident.

There is a US income tax treaty with United States.

The US has income tax treaties with many countries; these treaties typically contain a pensions article that assigns primary taxing rights over private pensions to the recipient's country of residence, with government/social-security pensions sometimes taxed by the source country, subject to the specific treaty's wording.

Sources: The taxation of foreign pension and annuity distributions · Older Immigrants and Medicare - Justice in Aging · New Immigrant Eligibility Restrictions Coming to Federally-Funded Health Coverage · Does the U.S. have a tax treaty with my country of residence that affects pension taxation?

Checked Oct 2026

Customs & etiquette

• Greetings and Personal Space — A firm handshake with eye contact is the standard greeting in most professional and first-meeting situations in the United States. In casual settings, a simple "Hi" or "Hello," sometimes with a quick hug among friends, is common. Americans value personal space and can react uncomfortably if someone stands or sits too close during conversation.
• Eye Contact in Conversation — In the United States, maintaining eye contact during conversation is expected and signals honesty and engagement. Visitors from cultures where avoiding eye contact is a sign of respect should be aware this can be misread by Americans.
• Tipping in Restaurants and Services — Tipping is deeply embedded in American culture, especially in the service industry. It's considered a major part of a worker's income, particularly in restaurants, and applies broadly to servers, taxi drivers, hairdressers, and hotel staff.
• Dining as a Guest in a Home — When dining as a guest in someone's home, it's customary to wait for the host to begin the meal before eating, and to remain seated with everyone else before digging in. If food or a meal is offered to a guest, it is polite to accept it rather than decline the host's generosity.
• Table Manners and Utensils — In American dining, the fork is typically held in the left hand tines-down while cutting, then switched to the right hand to eat; Continental style (fork staying in the left hand) is also acceptable. A napkin should be placed on the lap immediately after being seated and kept there throughout the meal, and diners signal a server by raising a hand or index finger and making eye contact.
• Dress at Sacred and Religious Sites — Visitors should dress respectfully when visiting sacred or religious places in the United States. Casual beachwear such as shorts and t-shirts, while fine for informal outings, is not appropriate attire in these settings.

Religion

Protestant 46.5% · Roman Catholic 20.8% · Jewish 1.9% · Church of Jesus Christ 1.6% · other Christian 0.9% · Muslim 0.9%

Other countries in North America

Canada

Reference information compiled from the sources cited above and reviewed by hand. Immigration, healthcare and tax rules change and are applied at the authorities' discretion — confirm with the consulate, an immigration adviser or a tax adviser before making plans. Nothing here is tax or immigration advice.

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