For many foreigners, earning an income is a financial cornerstone, and it’s what keeps professional and immigration plans on track. For doctors and other high-income professionals on J-1 or H-1B visas, an unexpected illness or injury can threaten both. And with the 2025 H-1B curveball, a proposed $100,000 one-time fee for many new petitions, the conclusion is simple: Rules may wobble, but your paycheck cannot. Disability insurance won’t protect your visa, but it will protect cash flow if you’re sidelined due to illness or injury.
In this post, we’ll discuss how to buy disability insurance and how claims actually work for foreign doctors practicing in the US.
The journey of a foreign medical graduate
Consider the story of a foreign medical graduate The White Coat Investors Forum. This family – a doctor and a software engineer with two young children – worked hard to achieve their professional and personal goals. After years of dedication and sacrifice, the doctor finally landed a coveted residency position in internal medicine.
Their journey was far from easy. The family spent almost all their savings on obtaining a residential position. This included expensive USMLE exams, unpaid observers at programs across the country, and applications to more than 200 residency programs. Each step brought financial and logistical challenges, forcing the couple to juggle parenting responsibilities, moving costs and the uncertainty of whether their efforts would pay off.
When the residency position was finally secured, it was a big win. However, it also came with the realization that their financial security now depended heavily on the doctor’s ability to continue working. As immigrants, they had built their lives and their futures around this income. Any disruption to their income due to illness or injury can have devastating consequences. This is why income protection, regardless of citizenship, should be one of the first things you purchase as a foreign doctor.
But there are also things to think about.
Disability insurance plays a crucial role in ensuring financial stability for foreigners. Statistics show that a doctor has a 1 in 7 chance of experiencing a disability during their working years, preventing them from earning an income for a period of time. Furthermore, 90% of all long-term disability claims are due to illness and 10% are due to injury. While obtaining disability insurance is essential, foreigners face unique challenges and considerations when navigating their options.
Main challenges for foreigners
Disability insurance for foreigners often has specific limitations due to concerns about:
- Residence status: The policy may require applicants to have permanent residency or meet specific visa requirements.
- Travel abroad: Many insurers impose restrictions on benefits if the insured stays outside the US for an extended period of time.
- Claim administration: Managing claims internationally can pose logistical challenges for insurers.
Insurers generally address these risks in a number of ways:
- Limiting benefit periods to a specific duration (typically up to 12 months outside the US).
- Require the insured to live in the U.S. for a certain period each year to maintain full benefits – sometimes at least six months per year if a claim is ever filed.
- Adding exclusion clauses to policies issued to visa holders, limiting claims for incidents abroad.
More information here:
Buy disability insurance!
Why are some doctors turned down for disability insurance?
How the ‘Big 5’ disability insurers deal with disability insurance for foreigners
First name
Principal offers disability coverage to foreign nationals with the following considerations:
- Green card holders: Treated the same as US citizens after living in the US for at least one year.
- Visa holders: Eligibility on a case-by-case basis for those holding H1B, L1, J1, O1, or TN visas, subject to questionnaire for non-US citizens.
- Travel abroad: The benefits may be limited if the trip lasts longer than three months per year or involves high-risk locations.
Guardian life
Guardian Life offers cover under specific visa and residence conditions:
- Eligible visas: Coverage available for G1, H1B, J1, L1, O1 and TN visa holders.
- Student is shown (F1): Eligible if intent to reside permanently in the US is documented.
- Exclusion from travel: The policy generally limits passengers’ benefits during foreign travel, except for Canadian citizens on temporary visas.
Mass mutual
MassMutual evaluates foreign nationals based on stricter residence and lifestyle factors:
- Eligibility conditions: Applicants must:
- Stay in the US for at least three years.
- Owns personal property and has family ties in the US.
- Avoid frequent foreign travel.
- Being in specific professional classes (e.g. 5A, 5P).
- Travel abroad: Applicants with extensive travel plans may not be eligible.
America
Ameritas distinguishes applicants based on their length of stay in the US:
- Permanent residents: Green card holders who have lived full-time in the US for at least five years are treated as US citizens.
- Recent immigrants (1-5 years): They are eligible on a case-by-case basis if they:
- Plan to stay in the US permanently.
- Be in possession of an acceptable visa and have a full-time job.
- Speak and understand English.
- Travel only occasionally to their native country.
The standard
The standard considers applicants based on their visa status and residency history:
- Permanent residents: Green card holders who have resided in the US for five or more years are treated as US citizens.
- Temporary visa holders: Applicants with at least one year of US residency and intent to stay permanently may be considered on a case-by-case basis.
- Travel abroad: Extended or frequent travel abroad may result in benefit limitations or ineligibility.
More information here:
How to Get a Doctor Job in the US While on a J-1 Visa
What physicians need to know about receiving gifts from abroad: tax pitfalls and filing requirements
Investing in tax-advantaged accounts for non-US citizens
Strategies for Foreigners to Ensure Coverage
The best approach depends on your residency status, visa type and long-term plans:
Green card holders
Consider a policy that excludes passengers from foreign travel, but avoids benefit period restrictions in the base policy if possible. Once a green card is obtained, insurers are often willing to remove exclusion riders, giving you a more comprehensive policy.
No green card
Shop around by contacting one of the WCI vetted insurance agents for a quote and see what’s available. They know what the best option is in your situation. Focus on policies that, even with limitations, offer some benefits. If possible, try to find policies without exclusions for foreign travel, as these may leave you unprotected in the event of a disability.
Disability Claims and Foreign National Physicians
The claims mechanism is standard. If you are a foreign physician on J-1, H-1B or similar, notify the carrier, comply with the elimination period, obtain medical proof, and document your employment. Disability insurance does not protect against immigration problems, but it is the safety net if you become ill or injured and your income decreases or disappears because your ability to work efficiently decreases or you are unable to work at all. Many policies limit payments while you are abroad (often 6-12 months) or require you to reside in the US for part of each year during a claim, so confirm those terms now, and not halfway through disability. Use a US bank for deposits, plan for ongoing doctor’s notes (and translations abroad), and remember that individual DI is transferable, while group long-term disability generally is not. Prioritize true self-use with residual/partial benefits (some doctor claims are not all or nothing), and if you get a green card, try to remove any restrictions on foreign travel or residency in the US.
The value of professional guidance
Disability insurance for foreigners can be a challenge, but you don’t have to face it alone. The White Coat Investor is here to help you find the best unbiased options available. Policies and provisions vary by company and state. Working with an experienced WCI insurance agent who specializes in serving foreign physicians can help you evaluate your options and make informed decisions.
As a foreigner, have you had difficulty obtaining disability insurance? What other experiences or questions do you have?
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