Every prospective oleh asks for this comparison first, and it is reported wrong more often than any number in the aliyah conversation. The Israeli figure is not a flat percentage, it stops at a ceiling, and it ignores how many children are in the house.
To keep this concrete we built one family and moved it. Two parents in their late thirties, four children, employer coverage at a mid-size American firm, landing in Israel on 22,000 shekels a month. In America they cost $26,993 a year. In Israel, about $5,500.
Two figures need fixing before that comparison can be made. The health tax is quoted as 5.17 percent of income, which is its top marginal bracket rather than a rate anyone pays on a whole salary; the real range is 3.23 to 4.88 percent, which runs from about $800 a year on minimum wage to $10,130 at the ceiling. The $1,886 deductible printed beside it is the single-coverage average, and no family figure is published anywhere.
| This family's ledger, one year | America | Israel |
|---|---|---|
| Paid by the employer | $20,143 | none |
| Paid by the employee | $6,850 | $3,949 |
| Voluntary second layer | priced apart | $1,600 |
| Owed before cover begins | $1,886 | 22 to 35 NIS a quarter |
| What the household bears | $26,993 | $5,549 |
There is no Israeli income at which the health tax reaches the average American family premium. The ceiling arrives first.
What does an American family actually pay for health insurance?
Ask a covered worker and most will name the payroll deduction, which averaged $6,850 in 2025. The full premium averaged $26,993. The other $20,143 came from the employer, out of the same budget the salary comes from, so this family bears all of it.
The chart below draws that premium twice, both bars to the same scale. The narrow rust bar on the left is the deduction the family sees on a pay stub. The tall bar on the right is that same deduction with the employer's share stacked on top in pale rust. Notice how much of the tall bar sits above the short one.
Is the Israeli health tax really 5.17 percent?
Israel funds national health insurance through a payroll levy, דמי ביטוח בריאות (dmei bituach briut, health insurance contributions). For 2026 it runs at 3.23 percent on monthly earnings up to 7,703 shekels and 5.17 percent above that, with nothing owed above 51,910 shekels a month.
So 5.17 percent applies to the top slice of a salary. Below, gross monthly salary runs along the bottom and the share of it going to the tax runs up the side. The two dashed steps are the statutory rates, and the vertical dash where they meet is the threshold at 7,703 shekels. The solid teal curve underneath is what a worker actually hands over.
Follow the teal curve to its highest point.
At what Israeli salary does the health tax catch the American premium?
Because the rate is capped and so is the income it applies to, the tax has a maximum. At the 2026 ceiling, a salary of about $207,000, it comes to $10,130, and no Israeli earner pays more.
Below, Israeli gross monthly salary runs along the bottom and annual cost in dollars up the side. The teal line is the health tax. The three dashed rust lines running straight across are American benchmarks, lowest to highest: the payroll deduction, the deduction plus a deductible, the full family premium. Watch where the teal line crosses each, and where it does not.
So who is that tax actually charging, and for how many people?
In Israel residents under 18 are insured automatically and pay nothing, and a non-earning spouse married to an insured person is exempt. One earner supporting eight hands over what one earner supporting one hands over.
In America the premium is quoted per tier, and the tier is the household: $9,325 for employee-only coverage in 2025, $26,993 for family, a jump taken once at the first dependent.
Read the chart below the way you read the last one: rust is America, teal is Israel. Number of children runs along the bottom. Watch the rust line step up once and then go flat.
If the tax is that small, why does nobody in Israel call health care free?
Because almost everybody buys something on top of it. Supplemental cover from the funds themselves, שירותי בריאות נוספים (sherutei briut nosafim, additional health services, shortened to shaban), reaches 77 to 85 percent of members, and commercial policies a further 35 to 40 percent. The repeated claim that 88 percent of adults carry both cannot be squared with those two figures.
The second layer buys speed and choice. Israeli specialist waits averaged around 50 days for endocrinology and neurology in early 2024.
The chart below has two panels, with the same two households in both. Brass is the lowest-income group, teal the highest. Left, shekels a year. Right, share of disposable income. Watch the taller bar change sides.
Then why is Israeli out-of-pocket spending nearly twice the American share?
It is, and the fact gets produced as evidence that the Israeli system bills its patients out of sight. Israeli households cover about 19.9 percent of national health expenditure directly, against roughly 11 percent in America. Then look at what the percentage is a percentage of.
Israel spends $3,941 a person a year, America about $15,500: denominators that differ fourfold.
The chart below draws both readings side by side. The left panel is the share, in percent. In the right, each country's dashed outline is total health spending per person, and the solid block at its base is the out-of-pocket part. Read the left panel first, then the right, and watch the ranking reverse.
What does an oleh family have to do about health care, and when?
Coverage begins on registration at a health fund, with no waiting period for a new immigrant. The exemptions and the traps sit in the months right after, and none of them announce themselves.
| When | What happens | Why it matters |
|---|---|---|
| Day 1 to 2 | Register with a health fund | Cover starts on registration: no qualifying period, no medical questions |
| Month 1 to 6 | The contribution holiday | No health tax for six months, extendable to twelve, exactly when there is no Israeli income yet |
| Day 60 to 90 | The supplemental window | Supplemental cover added without underwriting. Miss it and pre-existing conditions can be excluded permanently |
| Month 3 onward | The commercial layer | A 90-day waiting period, twelve months for caesarean, pre-existing conditions excluded absent written agreement |
| Year 1 to 5 | Amendment 262 | American olim liable for US Social Security owe no national insurance for five years. The health tax is still owed |
So: a family pays $26,993 a year for health insurance in America. What do they pay in Israel?
About $5,500, a fifth of it, and the ceiling does most of the work. Even at the very top of the Israeli income distribution the figure stays under 40 percent.
Israel caps the levy and exempts children and non-earning spouses, so a large family on one salary is the household its design flatters most.
The framing to retire is that Israeli health care is free. What the numbers show is a system inexpensive at the point of contribution and stratified at the point of service, where the households that cannot buy past the queue spend nearly twice the income share on health that the wealthiest spend.
Israel's Central Bureau of Statistics blocks automated retrieval, so the per-capita spending and the 19.9 percent out-of-pocket figure reach this essay through the Commonwealth Fund and Israeli business press citing it. The supplemental prices come from Bizportal rather than the funds' own schedules.
The American figures are national averages across all firm sizes and plan types, and the family aggregate deductible is not published at all. The Israeli figures are statutory rates and posted prices: exact for the modeled family, no more representative of any real one. This essay prices two systems rather than comparing what they deliver. Conversions use 3.002 shekels to the dollar as of 25 August 2026, and the income gradient figures date from 2015.
Ḥeshbon
A data project on how Jewish life is paid for, published in full. Every figure comes from the underlying research, and where a chart simplifies a published result the piece says so.
Each piece here is published, with its own sources, sample sizes and limits stated in place. Percentages describe the samples observed, and several rest on small denominators, noted where they appear. Nothing here audits an individual institution. Aliyah figures are current as of August 2026, at roughly three shekels to the dollar, and Israeli tax and benefit rules move faster than that.