Au Pair Insurance in the USA: Agency Plans and Gaps

Au pair insurance in the United States is arranged by the sponsor agency and included in the program fees, and it must meet the federal J-1 minimums in 22 CFR 62.14. It is emergency style travel medical cover, not full health insurance. Routine care, pre-existing conditions, dental work and sometimes the travel month after the program are where au pairs and host families most often find gaps.

Key facts at a glance

• Federal minimums: 22 CFR 62.14 requires at least $100,000 per accident or illness, $50,000 for medical evacuation, $25,000 for repatriation of remains and a deductible of no more than $500 per accident or illness.
• Program length: the State Department describes the au pair program as 12 months with an option to extend 6, 9 or 12 more months, for participants aged 18 to 26 under 22 CFR 62.31.
• Agency plans differ: Au Pair in America's FAQ lists cover up to $250,000 per illness or accident with a $50 deductible per occurrence, and an upgrade to $500,000.
• It is emergency cover: AuPairCare's FAQ describes its plan as emergency travel insurance covering illness and emergencies.
• Subsidies have narrowed: KFF reports that the 2025 budget law limits subsidized Marketplace coverage to green card holders and a few other groups from January 1, 2027.

What insurance does an au pair agency have to provide?

Every au pair holds a J-1 visa, so the general exchange visitor insurance rule applies. Under 22 CFR 62.14, the sponsor must require each exchange visitor to have sickness and accident insurance in effect for the period of program participation. The policy must pay at least $100,000 per accident or illness, $50,000 for medical evacuation and $25,000 for repatriation of remains, with a deductible no higher than $500. Coinsurance may not exceed 25 percent, and the insurer must hold a strong financial rating, such as A minus or above from AM Best.

The au pair regulation itself, 22 CFR 62.31, sets hours, time off and education rules but adds no extra insurance standard. In practice each agency buys a group policy and enrolls every au pair, with the cost folded into program fees. Willful failure to maintain cover is grounds for ending the program, so the agency plan is not optional. Our explainer on the J-1 insurance requirements walks through each clause.

What do the major au pair agency plans actually cover?

Agencies publish different levels of detail, and the documents change, so treat the following as a starting point and ask for the current certificate.

• Au Pair in America: its FAQ lists medical cover up to $250,000 per illness or accident with a $50 deductible per occurrence, mental health limits of $500 outpatient and $10,000 inpatient, an optional upgrade to $500,000, and personal liability up to $100,000 that excludes automobiles.
• Cultural Care Au Pair: its host family FAQ says au pairs are insured by Erika Insurance Ltd., with Aetna Student Health handling questions. Its international site describes the cover as medical insurance for new illnesses and accidents during the term.
• AuPairCare: its FAQ says it provides United Healthcare insurance that is emergency travel insurance covering illness and emergencies, and acknowledges that this differs from the cover au pairs may know at home.

The pattern is consistent. These are travel medical plans built for a broken wrist, appendicitis or an emergency room visit, not a replacement for the health system an au pair knows at home.

Where does agency insurance fall short?

A KFF Health News report from September 2021 cited research finding that many au pair agency plans excluded routine or preventive services, care for pre-existing conditions, mental health, and maternity and reproductive health. Benefits have shifted since then, but the same categories are still the ones to check.

• Routine and preventive care: annual physicals, vaccinations and contraception visits are usually not covered.
• Pre-existing conditions: asthma, allergies, thyroid conditions and existing prescriptions may be excluded or capped at a small amount.
• Dental and vision: expect emergency treatment after an accident only. Fillings, wisdom teeth and glasses are out of pocket.
• Mental health: where covered, limits are low. See our guide to mental health coverage in travel insurance for how these caps work.
• Sports: skiing, snowboarding and similar activities may need an add on. Ask before the first winter trip.
• Driving: health insurance does not pay for damage or injuries to others, and Au Pair in America states its liability cover excludes automobiles. That risk belongs on the host family's auto policy.

For a sense of what an uncovered visit can cost, try the medical cost estimator.

Is an au pair covered during the travel month and an extension year?

This is the gap that catches people. The federal rule ties required insurance to the dates of program participation. After the program end date, J-1 visitors have a 30 day period to travel and prepare to leave, often called the travel month or 13th month, and agency practice during that period varies.

Cultural Care's international site states that au pairs remain covered during vacation time and the 13th month, anywhere in the world except their home country. Other agencies may end cover on the last program day or sell an extension. Ask for the exact end date in writing. Our guide to insurance during the J-1 grace period explains the options if your plan stops early.

For an extension of 6, 9 or 12 months, the agency normally renews its own policy. Confirm two things: that there is no break between the first year and the extension, and whether any condition treated in year one will be treated as pre-existing on the renewed certificate. Trips home during the year are another point to check, since Cultural Care's cover excludes the home country.

Can an au pair buy other health insurance?

In practice an au pair does not swap the agency policy for a private one, because agencies enroll every participant in their group plan. What you can do is add cover where the agency plan stops.

A private J-1 plan for uncovered dates. If your agency cover ends on the program end date, a short J-1 plan can carry you through the travel month. In Ombrela's catalog, IMG's Patriot Exchange is written for J-1 and J-2 holders up to age 64 and offers an optional rider for limited high school and college sports. Like agency plans, it excludes pre-existing conditions for the first 12 months and, per its 2026 certificate, excludes maternity and routine physical examinations.

A Marketplace plan. J-1 holders are lawfully present and may enroll in ACA Marketplace plans. It is now far less affordable than it once was: KFF reports that since January 1, 2026 lawfully present immigrants with income under the federal poverty level no longer receive premium tax credits, and from January 1, 2027 subsidies are limited to green card holders and a few other groups. An au pair would generally pay the full premium. This is general information, not legal or tax advice.

Be aware of purchase limits. Patriot Exchange cannot be purchased from New York, the StudentSecure plans cannot be purchased from Maryland, New York or Washington, and each plan excludes residents or citizens of certain countries. In those states your private options through Ombrela are limited, and the agency's own extension may be the practical route.

What should host families check before the au pair arrives?

• Ask the agency for the full certificate, not the summary, and read the exclusions together with your au pair in the first week.
• Call your auto insurer and add the au pair as a driver before she or he uses the car. Ask how a claim would affect your premium.
• Agree in advance who pays the deductible and any uncovered bills from an accident that happens while working.
• Decide how routine needs such as a dental cleaning or a prescription refill will be handled, since the plan will not pay.

To work through all of this in one sitting, download our free Au Pair Insurance Gap Checklist below. It lists the limits to confirm with the agency, the exclusions that matter for sports and travel, the dates to verify for the travel month and extension year, and the questions host families should settle early.

How to get covered

Start with the agency policy, because it is mandatory. Then look at your dates. If there are days in the United States that the agency plan does not cover, such as the travel month, you can compare J-1 plans on Ombrela and choose start and end dates that match the gap exactly. Premiums depend on age, coverage length, policy maximum and deductible, so use the live quote.

If you later change sponsors or leave the program early, read our guide to switching J-1 insurance mid program before you cancel anything, and check J-1 quotes so that the new cover starts the day the old cover ends.

Frequently Asked Questions

Do au pairs need their own health insurance in the USA?

Au pairs must be insured, but they do not usually buy the main policy themselves. The sponsor agency arranges a group plan that meets 22 CFR 62.14 and includes it in program fees. You may want extra cover for periods or services the agency plan leaves out, such as the travel month if your agency's cover ends on the program end date.

Does au pair insurance cover doctor visits for routine care?

Generally no. Agency plans are emergency style travel medical policies. AuPairCare describes its plan as emergency travel insurance covering illness and emergencies, and research cited by KFF Health News found many agency plans excluded routine or preventive services. A sick visit for a new illness is normally eligible, while checkups, vaccines and ongoing prescriptions for existing conditions are not.

Who pays if an au pair has a car accident?

Medical bills for the au pair go to the agency health plan, subject to its deductible. Damage to the car and injuries to other people are an auto insurance matter. Au Pair in America states that its personal liability cover excludes automobiles, so host families should add the au pair to their auto policy and agree beforehand who pays the deductible.

Can an au pair use an ACA Marketplace plan?

A J-1 au pair is lawfully present and may enroll, but help with premiums has narrowed. According to KFF, premium tax credits ended in 2026 for lawfully present immigrants with income below the poverty level, and from 2027 subsidies are limited to green card holders and a few other groups. Most au pairs would pay full price, so check the cost first.

Agency insurance keeps an au pair compliant, and a short private plan can close the dates it leaves open. Read the certificate, confirm the end date, and compare J-1 plans on Ombrela if you find days without cover.