Abstract: To assist cable manufacturers in addressing North American market access requirements and optimizing product design, a systematic interpretation of ICEA S-94-649—2021, the product execution standard for concentric neutral medium-voltage power cables (applicable voltage class 5–46 kV) issued by the Insulated Cable Engineers Association (ICEA), was conducted, accompanied by a layer-by-layer comparative analysis with the mainstream International Electrotechnical Commission standard IEC 60502-2: 2024. The technical requirements of the North American standard were elucidated with respect to conductor size systems and DC resistance calculation, conductor shield and insulation shield thickness and surface quality control, insulation level selection (100%, 133%, 173%), concentric neutral conductor cross-sectional design, and jacket type selection. The comparative analysis demonstrates that ICEA S-94-649—2021 specifies long-term aging assessment programs such as the Accelerated Water Treeing Test (AWTT) and the Thermomechanical Qualification Test (TMQT), and adopts a dual certification model of "material qualification plus manufacturing process qualification," whereas IEC 60502-2:2024 establishes a verification system comprising routine tests, sample tests, and type tests, with emphasis on short-term electrical performance verification. Significant differences exist between the two standards in conductor size systems (AWG/kcmil versus mm²), DC resistance calculation methods, quantitative indicators for shield structures, and long-term aging test requirements. Compatible designs satisfying both standards typically result in a 10%–15% increase in material consumption. Finally, differentiated design strategies targeting specific markets and recommendations for standard harmonization and unification are proposed, providing a reference for the international manufacturing and certification of medium-voltage cable products.