Health Insurance Is Non-Negotiable
The US has the most expensive healthcare system on Earth. There is no free public healthcare for visitors. An ambulance ride can cost $800–$2,500. A single night in hospital can run $5,000–$20,000+. Even a simple ER visit for something minor averages $2,500–$10,000.
Real costs visitors face
- Broken arm: $2,500–$7,500 (without surgery)
- Appendectomy: $30,000–$50,000+
- 3-day ICU stay: $50,000–$150,000+
- Air ambulance evacuation: $50,000–$250,000
What to do
Buy comprehensive travel insurance with at least $500,000 medical coverage ($1 million recommended). Make sure it covers emergency evacuation and repatriation. Keep your policy number accessible at all times — hospitals will ask.
Tipping Culture
Tipping in the US isn't optional — it's how service workers earn their income. Many waitstaff earn as little as $2.13/hour in base wages. Not tipping is considered extremely rude and can cause genuine distress to your server.
Standard tipping rates
- Restaurants: 18–20% of the pre-tax bill (15% minimum)
- Bars: $1–2 per drink, or 18–20% of a tab
- Taxis/Uber: 15–20%
- Hotel housekeeping: $2–5 per night (leave on the pillow daily)
- Valet parking: $3–5 when your car is returned
- Hair/beauty services: 20%
You'll often see a tip line on card payment screens — even at counter-service spots. You're not obligated to tip at counter-service places, but at sit-down restaurants, always tip.
Driving & Distances
The US is enormous. Distances between cities are much greater than most visitors expect. New York to Los Angeles is 4,500 km — roughly the same as London to Baghdad. Outside major cities like New York, Chicago, and San Francisco, public transport is limited or non-existent.
Key differences for international drivers
- You drive on the right side of the road
- Speed limits are in mph (not km/h)
- Right turn on red is legal in most states (unless signed otherwise)
- School buses: you must stop when they flash red lights — it's the law in all 50 states
- Some states require you to move over a lane for stopped emergency vehicles
- Gas stations often require pre-payment or card authorisation
Practical tip
Rent a car outside major cities. Use Google Maps for real-time traffic — some American highways have brutal rush-hour congestion (LA, Atlanta, Houston). Always carry your passport and international driving permit.
Emergency Numbers
911 is the universal emergency number for police, fire, and ambulance. It works from any phone, including locked phones without a SIM. Dispatchers speak English but many centres have access to translation services.
Other useful numbers
- 988: Suicide & Crisis Lifeline (call or text)
- 211: Community services, shelters, food banks
- Poison Control: 1-800-222-1222
- Non-emergency police: Varies by city — Google "[city] non-emergency police"
Important warning
Calling an ambulance in the US is not free. A single ambulance ride can cost $800–$2,500+, and you will be billed even if you didn't request it. If your situation is not life-threatening, consider an Uber/Lyft to an urgent care centre instead — it's significantly cheaper than an ER visit.
Border Entry & ESTA
US border security is thorough and can be intimidating. Officers may ask about your travel plans, finances, accommodation, and return flight. Answer honestly and calmly. Having printed confirmation of your hotel and return flights helps.
ESTA & visa basics
- ESTA: Required for Visa Waiver Program countries (UK, Ireland, most EU, Australia, Japan, etc.). Apply at esta.cbp.dhs.gov at least 72 hours before travel. Now costs $40.27 (up from $21 under the FY2026 adjustment). Valid for 2 years or until your passport expires.
- B1/B2 Visa: Required for non-VWP countries. Apply at a US embassy/consulate. Since 1 October 2025 a Visa Integrity Fee of at least $250 applies on top of the normal visa fee — it does not apply to ESTA travellers, and although it is billed as refundable, the refund mechanism is not yet clearly operational.
- ESTA allows stays of up to 90 days — overstaying can result in a 10-year ban.
Social media checks
CBP officers can and do check your social media. In 2025, the ESTA application form now asks for social media handles. Posts about working in the US, overstaying, or immigration opinions can cause secondary screening or denial. Clean up your public profiles before you travel.
Sales Tax Surprises
Unlike most countries, prices displayed in US shops and restaurants do not include tax. Sales tax is added at the register and varies by state — from 0% (Oregon, Montana, Delaware) to over 10% (parts of California, Louisiana, Tennessee).
What this means in practice
A $100 item will cost $108–$110+ at checkout in most states. Restaurant bills will have tax added, and then you'll add a tip on top. A $50 dinner can easily become $65–$70 after tax and tip. Budget accordingly.
No nationwide VAT refund scheme exists. Unlike the EU, you cannot reclaim sales tax when leaving the country (Louisiana is the only state with a limited refund programme for international visitors).
Phone & Connectivity
Your home mobile plan likely charges extortionate roaming rates in the US. Many European plans that include "worldwide data" cap US usage or throttle speeds severely.
Best options
- eSIM: Buy an Airalo, Holafly, or T-Mobile eSIM before you arrive. Cheapest and easiest option.
- Prepaid SIM: T-Mobile and AT&T offer tourist prepaid plans ($30–$50/month). Available at airport kiosks and Walmart.
- Wi-Fi: Free Wi-Fi is widespread at Starbucks, McDonald's, hotels, airports, and many public spaces.
Note: The US uses different network bands than much of the world. Check that your phone supports US LTE/5G bands before relying on a local SIM.
Food, Water & Portions
American food portions are significantly larger than what most international visitors are used to. A "regular" drink at a US restaurant is often a "large" everywhere else. Don't be afraid to share plates, ask for a doggy bag, or order from the appetiser menu for a lighter meal.
Food tips
- Tap water is safe virtually everywhere and is served free at restaurants — just ask
- Free refills on soft drinks are standard at most casual restaurants
- US food labelling uses calories, not kilojoules
- Be aware of allergens — US food can contain high-fructose corn syrup, artificial colours, and additives banned in the EU
- Grocery stores: Trader Joe's, Whole Foods, and Aldi are great for affordable, quality food
Eating out is expensive in major cities ($15–$25 per casual meal before tip). Budget travellers should explore food trucks, diners, and ethnic restaurants for better value.
Safety & Situational Awareness
The vast majority of the US is safe for tourists. However, certain realities are different from what many international visitors are accustomed to.
Things to be aware of
- Firearms: Guns are legal and widespread. If you encounter law enforcement, keep your hands visible and follow instructions calmly.
- Jaywalking: Crossing the road outside of crosswalks can get you a fine in some cities ($50–$250).
- Drinking in public: Open containers of alcohol in public are illegal in most states. Don't walk around with a beer.
- Drinking age: Strictly 21+. You will be ID'd — carry your passport.
- Drug laws: Vary wildly by state. Cannabis is legal in some states, a felony in others.
Practical safety tips
- Avoid walking alone late at night in unfamiliar neighbourhoods
- Use well-lit, main streets — not shortcuts through alleys
- Keep valuables out of sight in your car (smash-and-grab theft is common in cities like SF, LA, Chicago)
- Register with your embassy before travelling (UK: FCDO, Ireland: DFA, Australia: Smartraveller)
Cultural Norms & Etiquette
Americans are generally friendly, open, and happy to chat — sometimes more than visitors expect. Small talk with strangers is completely normal. "How are you?" is a greeting, not a genuine question — the expected answer is "Good, thanks!"
Cultural norms to know
- Personal space: Americans value personal space. Keep about an arm's length distance in conversation.
- Queuing: Cutting in line is considered extremely rude. Always queue.
- Shoes indoors: Many Americans wear shoes inside their homes — don't assume you should remove yours unless asked.
- "How are you?": This is a greeting. Don't actually tell them how you are.
- Punctuality: Being on time is important for meetings and reservations. "Fashionably late" doesn't really exist outside parties.
- Imperial units: Miles, Fahrenheit, pounds, gallons. Download a converter app.
Americans are proud of their country and their state. Avoid making dismissive comparisons to your home country. Engaging with genuine curiosity will get you much further than criticism.
