What You'll Need to Know When Moving to London from the USA

You’ll Love London — But There Are Some Things to Consider

There are some things we expected to love about life in London. Afternoon tea, big red buses and the prospect of meeting royals spring to mind. We knew there would never be a shortage of things to do in London.

The three years we spent living in London were some of our best. We fell in love with the city.

Last year, during a visit to the United States on an epic road trip that took us 3,800 miles, we bemoaned the fact that there were literally zero English pubs dotting the countryside where we could stop for lunch and a view of something other than a stretch of interstate.

Forget the abundance of McDonalds and truck stops with a million brands of beef jerky. We wanted an English pub, a pint and some bright green rolling hills, perhaps with a few sheep dotting the landscape.

Clearly, our life in London was starting to impact us.

But as with any place, there is an adjustment period, when you try to find your footing and come to grips with not only getting to know a new city, but an entirely new country and culture. While we now reflect fondly on our time as Americans living in London, our feelings were a little more mixed when we arrived, and began the process of understanding the logistics of being an expat.

Specifically, we thought we would tackle the three areas we get asked about most often by prospective expats moving to London from the U.S.: health care, taxes and housing.

Health Care

For most people moving abroad for the first time, health care is usually at the top of the list of concerns. And that’s fair, since the potential of dealing with a completely different medical system in a foreign country can be downright scary.

Basically, U.K. health care is all done through the National Health Service (NHS), which is the government-run health care system. When you arrive in London, you register with your nearest doctor’s office (locally called a “surgery”).

Once you are registered, you can then go to that office if you need to see one of the general practitioners (GPs).

Thanks to the NHS, health care is entirely free, including all visits to the GP and any procedures. Prescriptions are controlled by the NHS as well and all are priced at a flat rate of £8.60, no matter what type of medication is needed.

Even better, prescriptions are entirely free for anyone under 16 and anyone over 60.

Of course, all this “free” health care does come at a cost. Making a last-minute appointment with your GP is not usually possible, and you often need to go to the office in the morning to be given a time to return a few hours later.

If you need to see someone immediately, you have to visit an Urgent Care Center or go to A&E (hospital emergency room). This same frustration can occur with more serious procedures, like if you need an operation.

The most immediate and grave cases are handled first, so you could face delays of a few months in getting a date for an operation.

You can always go outside of the NHS system, and purchase private insurance (it is usually included with most U.S. expat packages). Private insurance is more akin to health insurance in the United States, and most are 80/20 plans (80% covered, you pay the remaining 20%) with modest deductibles.

The benefit is that it allows you to skip the NHS system, and speak directly with a specialist at any hospital or clinic without having to consult an NHS GP. Wait times are much lower and you can usually be seen quickly for an appointment.

The hospitals are top notch, and many prominent figures from around Europe come to London’s private hospitals for medical attention for that very reason. Of course, this all comes at a cost, and even basic visits with a specialist can run around £250 per session.


Taxes are a nightmare for American expats. The process of paying taxes in two different countries is a unique problem for us, as the United States is one of the few countries in the world to tax citizen on income earned overseas.

Trust us, the look on our European friends faces when we told them we still owed U.S. taxes was priceless!

The Foreign Tax Credit allows you to deduct any taxes paid to any country outside the United States from your taxable income in the United States. In a country like the United Kingdom, which has tax rates closer to the 50% level for the highest earners, it means that you usually end up owing very little U.S. tax.

That’s great, but dealing with the paperwork involved means most expats need to hire a tax professional each year, which can easily run $2,000 depending on the tax firm or accountant you use.

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Unless you are moving from a major city like New York City or San Francisco, the housing costs will be a major adjustment. The exchange rate between the dollar and the pound has improved for U.S. expats recently, but London still maintains its reputation as being an expensive city.

Apartments (known as “flats” in London) are incredibly expensive, and space comes at a premium. Many U.S. expats look for housing in areas like Chelsea, Kensington and Mayfair, which have a larger percentage of Americans.

However, those are also the most expensive neighborhoods in London, and the average two-bedroom flat will run around £3,400 (about $4,700) per month. And don’t get too excited if you see a much lower number when doing research, as most rents are advertised per week, not per month, so be careful!

Luckily, you can find more affordable apartments in the less popular neighborhoods for expats, and still close to Central London. Areas like Islington, Camden, Lambeth or Wandsworth are fun and exciting, and rental rates are closer to £2,000 for a two-bedroom flat.

Not exactly a bargain, but certainly more affordable.

Of course, the high rents don’t include utility expenses, or council tax (comparable to property tax, but renters are required to pay it as well) and the TV license (a yearly £147 fee for using a TV that helps fund the BBC). Utilities run from £50-200 per month on average for gas, electricity and water.

Broadband, phone and cable can add from £50-100 per month, with the council tax adding between £50-200 per month based on the size of your flat.

Taking the Leap

Living in London as a U.S. expat was one of the best decisions we made. Walking past historic sites like the Tower of London or the U.K. Parliament Building or St. Paul’s Cathedral while simply running errands or meeting friends for a pint, never got old.

And the city is constantly changing, with tons of new construction, upgrades to infrastructure, and a vibrant food and nightlife scene.

Moving to London in general requires a host of information to ensure you can make a smooth transition to the city. But throwing the added logistics of being an expat into the mix presents even more challenges. For example, you’ll need to make sure you do your research into the ways in which Brexit will impact expats so you can factor that into your plans.

There will be frustrations along the way, but by keeping an open mind and having a little patience, the experience can be incredibly rewarding. There are so many reasons to move abroad.

After our three years there, we now have a whole host of friends from around the world, thanks to the melting pot of cultures that is London. And most importantly, taking the plunge and living overseas gives you a deeper perspective not only of the world, but of yourself.

For more insight into expat life, check out Drive on the Left, where Drew and Julie are documenting their recent move to Shenzhen, China.

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