The USMLE Is Less Than Half the Bill: Every Fee Between an IMG and US Residency (2026)

Published 30 October 2026 · Luke, co-founder of OET BANK and USMLE BANK · 10 min read

Ask what the road to a US residency costs and most people add up the USMLE: $695 a Step, plus a regional fee outside the US and Canada. That comes to $1,835 for Step 1 and Step 2 CK. It is also less than half of the official fees you pay before your first day of training. ECFMG Certification, OET Medicine, residency applications, the Match and the J-1 visa make up the rest: between about $5,500 and $7,700 if everything goes right the first time. This article lists every fee in the order you meet it, what a setback adds, and what the total leaves out.

1. The total at a glance

The table assumes you graduated from a medical school outside the US and Canada, take Step 1 and Step 2 CK outside the US, pass every exam the first time, apply in one specialty, rank up to 20 programs and train on a J-1 visa sponsored by ECFMG. The only thing that changes between the columns is how many programs you apply to.

Step 1 and Step 2 CK together are $1,835 of that, between a quarter and a third. The rest goes to ECFMG, OET, the AAMC, the NRMP and the US government. The one figure that moves a lot is the number of programs you apply to, because residency application fees rise sharply after the 30th program.

2. The exams and ECFMG Certification

ECFMG Certification is what you need to start a US residency. It takes Step 1, Step 2 CK, a Pathway that includes OET Medicine, and your diploma and transcript verified with your school. Our article on ECFMG Certification explains each requirement; here is what each one costs.

• The USMLE fee is the same for 2026 and 2027: $695 for Step 1 and for Step 2 CK. The USMLE notes that the regional fee ($210 and $235) is not a USMLE fee.
• OET costs A$587 for the full test; we converted at the rate of 30 October 2026 (A$1 ≈ US$0.70). If you take OET on Computer at a venue in the US, or OET@Home in the US, it is US$455. ECFMG accepts only a full test with every score met in one sitting, so the cheaper single sub-tests do not help you.
• Small extras. If FSMB cannot match you to an existing record, identity verification costs $75, kept as credit for a later FSMB service. If you test in India, an 18% goods and services tax has been added to Steps 1 and 2 since 4 December 2024.

3. What a setback costs

The total above assumes nothing goes wrong. These are the fees that a failed exam, a change of plan or a missing document adds:

One more cost is easy to miss. A certificate based on a Pathway expires with its Pathway (2025 Pathways on 31 December 2027, for example) unless you have completed 12 months of US training or hold a US licence by then. To renew it you revalidate through Pathway 1 or Pathway 6: a new Pathway application, and a new OET Medicine if your passing score dates from before 1 January 2025.

4. Applying for residency: ERAS

Most residency programs take applications through the AAMC's Electronic Residency Application Service (ERAS). From the 2027 season, which opened in June 2026, the AAMC charges a new, simpler fee: $11 for each of your first 30 programs in a specialty, and $30 for each program after that. The count starts again for each specialty. The 31st program in a specialty costs almost three times as much as the 30th.

Thirty programs in each of two specialties cost $660; sixty in one specialty cost $1,230. Doctors trained outside the US often apply to many programs, so this is the part of the bill that grows fastest. ERAS gives no refunds for any reason, including applications sent to a program that turns out not to be taking them.

Two more fees come with ERAS:

• The ERAS token, $185. ECFMG acts as the dean's office for graduates of schools outside the US and Canada. You buy one token from ECFMG per season, through MyIntealth, and it covers as many specialties and programs as you like that season. It is non-refundable and does not carry over to the next season.
• Your USMLE transcript, $70. Since 4 June 2026 it is requested through FSMB, once per application season. Our article on Step 2 CK explains how it reaches ERAS.

Emergency medicine and obstetrics and gynaecology programs use a different service, ResidencyCAS, with its own application fees. ECFMG charges $185 to support a ResidencyCAS application, as it does for the ERAS token.

Interviews are often held online now. The internal medicine program directors' association (AAIM) recommends that programs interview every applicant online, and the paediatrics association (APPD) strongly recommends online-only interviews for 2026–27. Other specialties leave the choice to each program, so check every invitation.

5. The Match

To be matched to a program, you register with the National Resident Matching Program (NRMP) and submit a rank order list. For the 2027 Main Residency Match, the deadline for that list is 3 March 2027.

Ranking 30 programs therefore costs $85 plus $300. Every NRMP fee is non-refundable, and the extra-rank fees are charged when you certify your list: once certified, the list cannot be shortened to remove them.

6. The J-1 visa

ECFMG is the sponsor for J-1 physicians in clinical training. If your program offers a J-1, these are the fees for the first year, applying through a US embassy or consulate:

• ECFMG's fee is annual. Sponsorship is renewed every year of training, so a three-year residency in internal medicine means $1,110 to ECFMG.
• The "visa integrity fee". A US law of July 2025 adds a fee of at least $250, charged when a visa is issued. The State Department's fee schedule, as captured in July 2026, did not list it, and reports since then disagree on whether embassies collect it. Ask the embassy that will issue your visa.
• H-1B instead of J-1. Some programs sponsor an H-1B. The hospital files the petition and pays most of its costs, but you generally need to have passed Step 3 first, which brings its fee and a trip to the US forward. H-1B fees, including the $100,000 payment now held up in the courts, are covered in our article on J-1 and H-1B visas for residency.

7. After the Match

• Step 3, $955 (2026 and 2027). It is given only in the US and its territories, and you need ECFMG Certification to apply.
• J-1 renewal, $370 for each further year of training.
• Your medical licence. Each state sets its own fees and rules, and ECFMG charges $70 to send a state board a report of your certification status. Licensing will have its own article later in this guide.

8. What the total leaves out

• Preparation. The official sample questions are free. NBME self-assessments start at $62 a form, and a practice session at a Prometric centre outside the US costs $155. Commercial courses and question banks are extra and vary widely.
• Travel. Getting to a test centre, and to the US for Step 3 or a visa appointment in another city.
• Documents. Certified translations and copies, unless your school sends English documents.
• US clinical experience. Some programs ask for it, and observerships can charge fees. It gets its own article later in this guide.
• Moving. Flights, a rental deposit and living costs until your first salary.
• Exchange and card fees. Almost every fee is charged in US dollars by card, so your bank's exchange rate and foreign transaction fees apply.

One kind of help is not open to most readers. NBME's USMLE fee assistance program pays $695 towards Step 1 or Step 2 CK, but only for US citizens, permanent residents and DACA recipients enrolled at an accredited US medical school or a designated school in the Caribbean.

Frequently asked questions

How much does the USMLE cost for an international medical graduate?

Step 1 is $695 plus a $210 regional fee if you test outside the US and Canada, and Step 2 CK is $695 plus $235. Step 3 is $955 and is given only in the US. That is $2,790 for all three, passing each the first time, with the same fees in 2026 and 2027.

How much does ECFMG Certification cost in total?

$3,690 in ECFMG and USMLE fees: MyIntealth $110, the application $580, credential verification $220, a Pathway $945, Step 1 $905 and Step 2 CK $930 outside the US and Canada. OET Medicine adds A$587, or US$455 for the computer test in the US.

How much does it cost to apply for residency through ERAS in 2027?

$11 for each of the first 30 programs in a specialty and $30 for each program after that, counted separately for each specialty: 60 programs in one specialty cost $1,230. Graduates of schools outside the US and Canada also pay ECFMG $185 for the ERAS token and FSMB $70 for the USMLE transcript.

How much is the NRMP Match fee?

$85 for the 2027 Main Residency Match, which includes up to 20 programs on your primary rank order list. Each program after the 20th costs $30, registering after 29 January 2027 adds $50, and none of it is refundable.

How much does a J-1 visa for residency cost?

ECFMG charges $370 a year to sponsor you, the SEVIS fee is $220 for a first application and the visa application fee is $185, plus any issuance fee for your nationality. A fee of at least $250 written into US law in 2025 may also apply when the visa is issued: check with your embassy.