Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants.
