The Coverage Gap: Swiss KVG Ends Long Before Medicare
When you deregister from your Swiss commune and leave the country permanently, your mandatory KVG health insurance ends with that deregistration. If you're in mid-career or approaching retirement age, Medicare likely won't start for several years, so you're responsible for arranging US health coverage in between. This is a solvable timing problem, not a reason to panic.
Your Move Is a Qualifying Life Event for an ACA Special Enrollment Period
Moving to the US from a foreign country is a qualifying life event that opens a 60-day Special Enrollment Period (SEP) on the federal or state Marketplace. You don't have to wait for Open Enrollment. And unlike most SEPs, the usual rule requiring you to have had minimum essential coverage in the 60 days before the move is waived for people moving from abroad. That means you can select a plan without proving prior US or Swiss coverage.
What the 60-Day Window Actually Means
You generally have 60 days after your move to pick a plan, and coverage starts the first day of the month after you select it. So if you arrive in March and enroll any time that month, coverage can start April 1. The exact start date can vary by Marketplace, so confirm as you enroll.
COBRA vs. the Marketplace: Most Swiss Exits Don't Have a COBRA Option
COBRA only applies if you had a US employer group health plan before leaving, and even then it usually lasts 18 months (with extensions in limited cases). If you've been working for a Swiss employer, there's no US group plan to continue, so COBRA generally isn't on the table. The Marketplace is your main route, and for many returning expats the premium tax credits can make it more affordable than paying full COBRA premiums.
Premium Tax Credits: Your MAGI Sets the Price
Marketplace premium tax credits (APTC) are based on your Modified Adjusted Gross Income (MAGI) for the coverage year, reconciled later on Form 8962. The enhanced subsidies from the ARPA/IRA era expired at the end of 2025, so for 2026 and 2027 the original ACA formula applies: credits phase out between 100% and 400% of the federal poverty level and stop entirely above 400% FPL. For 2027, 100% FPL is $15,960 and 400% FPL is $63,840 for a single person in the 48 contiguous states plus DC. If your income estimate is close to these thresholds, your credit can change sharply, so estimating your MAGI carefully matters.
Swiss-Side Deregistration: Time the Exit with Your US Start Date
Before you leave, you'll deregister at your Swiss commune and cancel your mandatory KVG with your insurer. That cancellation ends your Swiss coverage, so the core planning task is to align that end date with the start of your US Marketplace plan. If you're splitting time between the two countries or leaving gradually, read our Switzerland-US split time guide.
Short-Term Plans and Medicaid: Know the Limits
Short-term limited-duration plans are not ACA-compliant, can deny pre-existing conditions, and should be treated only as a last-resort temporary bridge, not a solution. If your income is low when you return, you can apply for Medicaid or CHIP at any time, not just during Open Enrollment. That's another safety net to avoid a gap.
A Practical Sequence to Close the Gap
- Deregister from your Swiss commune and set a final KVG cancellation date that matches your departure.
- Estimate your US MAGI for the coverage year to see if you're eligible for premium tax credits.
- Within 60 days of your move, create a Marketplace account and select an ACA-compliant plan.
- Confirm the coverage start date and keep proof of your move (flight records, deregistration confirmation) in case the Marketplace asks.
- If you're income-eligible, apply for Medicaid/CHIP any time as a fallback.
When to Get Personal Advice
This is educational information, not individual advice. Your premium tax credit eligibility, MAGI estimate, and Swiss-side timing all interact with your personal tax return and family situation. If you're close to the 400% FPL threshold, have self-employment income, or are also planning Medicare Part B enrollment later, a conversation with a cross-border specialist can save you from a costly misstep. See how Medicare Part B timing and Swiss Pillar 2 can affect you for the next chapter.