AOW, healthcare and tax in America: what comes along, what stops — and what works like this nowhere else

For the AOW and pension, America is better arranged than its reputation; for healthcare it's exactly as hard as the stories say. This is the honest overview.

Your AOW: fully along, thanks to a treaty from 1990

The Netherlands and the US have had a social-security treaty since 1990, and because of it America is on the list of countries where the AOW (the Dutch state pension) is simply paid out — without the reduction that hits single people in non-treaty countries. Accrual does stop on your departure day (every missed year costs 2%), and whoever wants to repair that has one year to sign up for the voluntary continuation — which, by the way, may last a maximum of ten years and at 17.9% of your income isn't cheap.

If you work in the US, you build up Social Security there. The treaty lets both systems exist side by side: each country will pay its own share, and if you fall short on the American side, your Dutch years count towards still obtaining a partial American benefit (from six American credits). And there's good news that older forums don't know yet: the notorious Windfall Elimination Provision — the American reduction of Social Security for whoever also received a foreign pension such as the AOW — has been abolished by law, retroactively to January 2024. Those scare stories can go in the bin.

The tax: here America is the exception

The tax treaty (1992) follows the familiar lines for wages and pensions: wages are taxed where you work, your company pension and annuity where you live. An ABP pension from government service stays taxed in the Netherlands — the familiar exception, with a tail of its own here: if besides a resident you also become an American citizen, that pension moves to the American tax authorities too (article 20, second paragraph). But for the AOW and other social-security benefits the US route deviates from all other destinations on this site: those remain taxed exclusively in the Netherlands (article 19, paragraph 4). So the Netherlands simply withholds on your AOW while your company pension is taxed in America — for the latter you apply for an exemption statement so that your pension fund stops Dutch withholding. One warning for whoever wants to be creative: a lump-sum surrender of pension or annuity within five years of emigration may still be taxed by the Netherlands — the treaty has closed that back door. And don't forget the American side: as soon as you're a tax resident (the substantial presence test), the US taxes your worldwide income.

Healthcare: no route, no safety net — but a plan

Here the story has to be strict for a moment. The US is not on the CAK's list of treaty countries: the S1 route that pensioners have to Germany, France or even the UK doesn't exist to America. Your Dutch health insurance ends on emigration, the healthcare allowance lapses, and what comes back for it you arrange entirely yourself: via your American employer (the usual route for employees), via the ACA marketplace, or with an international private insurance. American premiums and deductibles are of a different order than Dutch ones — put this in the family budget as a fixed item before you decide, not after. Crossing the ocean uninsured isn't an option: one hospital admission can cost a year's salary there.

The rest of the closing list

Child benefit stops on emigration (the quarter of departure is the last), housing allowance too. The M return for your emigration year is done online nowadays, and adjust your provisional assessment before departure. Deregister with the municipality (from five days before departure) and ask at that moment for the international proof of deregistration. Activate DigiD and the Berichtenbox before you go — applying from America is possible, but activating is then a hassle — and register once as a voter outside the Netherlands with the municipality of The Hague. America takes part in the apostille convention: have your marriage certificate and the children's birth certificates travel along as multilingual extracts with apostille, and count on American authorities wanting to see a certified English translation of every non-English document.