Health Insurance in the USA for Immigrants: 2026–2027 Guide

Back home, a doctor's visit might have been free or cost the price of a meal. In the US, one ambulance ride can cost more than a month's rent, so health insurance is often the first real money decision you face after landing. The good news is that most newcomers have a route to coverage. The catch is that your immigration status decides which route, and several of those routes change between October 2026 and January 2027.

This guide takes it one step at a time: what your status allows, what the 2025 federal law changes and when, and how to pick a plan without overpaying. Everything here reflects the rules at the time of writing (September 2026), so check HealthCare.gov or your state before you commit.

The three places US health insurance comes from

For most immigrants, coverage comes from one of three places:

1. An employer. This is the most common source for working adults and their families.
2. The Health Insurance Marketplace. This is the government-run shop for individual plans, reached through HealthCare.gov or your state's own website. It's also called the exchange.
3. Public programmes. Medicaid covers people on low incomes, and CHIP (the Children's Health Insurance Program) covers children in families that earn too much for Medicaid.

Undocumented people, and anyone who falls outside all three, usually rely on community health centres, emergency care and any programmes their state pays for itself.

If your job offers health insurance

Employer coverage is often the best-value option, because your employer usually pays part of the premium, and your share comes out of your pay before tax.

Two things catch newcomers out. The first is the waiting period. Many plans make new hires wait before coverage begins, but federal rules generally stop a waiting period based only on time from running longer than 90 days. So work out how you'll cover the gap, whether that's a Marketplace plan or short-term travel medical cover bought before you fly.

The second is family coverage. Adding a spouse or children can cost far more than covering yourself alone. Ask HR for the price of each tier (employee only, employee plus spouse, family) before you sign.

If you're coming on a work visa, our guide to working legally in the United States explains how employer sponsorship works. Benefits are part of that negotiation, so it pays to ask about them early.

Who can use the Marketplace, by immigration status

HealthCare.gov says Marketplace plans are open to people who are "lawfully present". That covers a wide range of statuses, including green card holders, refugees and asylees, most parolees, people with work permits (employment authorisation documents), nonimmigrant visa holders such as H-1B, H-2A, H-2B and student visas, and people with Temporary Protected Status (TPS).

Buying a plan is one thing. Getting help to pay for it is another, and that's where 2027 brings a big change. The table below shows the general picture. Individual cases vary, so treat it as a starting point.

A household with mixed statuses can still apply for the members who qualify. HealthCare.gov says relatives who aren't applying for coverage won't be asked about their own immigration status.

What the 2025 law changes, and when

In July 2025, Public Law 119-21 became law. CMS (the Centers for Medicare & Medicaid Services, which runs the Marketplace and oversees Medicaid) calls it the Working Families Tax Cut legislation. You'll also see it called the One Big Beautiful Bill Act. For immigrants, three parts of it matter most, and they start on different dates.

COFA migrants are citizens of the Marshall Islands, Micronesia and Palau who live in the US under the Compacts of Free Association.

The practical effect is simple. If you're on a work visa or TPS and you get a tax credit today, plan for your 2027 premium to cost the full price. When open enrollment opens, update your application and compare plans again rather than letting it roll over automatically.

Medicaid, CHIP and the five-year bar

Medicaid and CHIP are cheap or free, but immigrants face much tighter eligibility rules than they do for the Marketplace.

The five-year bar. Under a 1996 federal law, many qualified noncitizens, including many green card holders, have to wait five years before they can get full Medicaid or CHIP. Some groups have always been exempt.

The state option for children and pregnant people. Federal law lets each state choose to cover lawfully residing children and pregnant people without the five-year wait. CMS guidance confirms that the October 2026 changes don't remove this option, so in states that use it, a refugee child or a pregnant asylee may still qualify for full coverage.

The October 2026 change. After 1 October 2026, federal Medicaid funding generally no longer covers people who aren't citizens, green card holders, Cuban and Haitian entrants or COFA migrants. Refugees and asylees who haven't yet become green card holders are among those affected, unless a state option covers them. States must send notice before they end anyone's coverage.

Emergency Medicaid. People who can't get full Medicaid because of their status may still get emergency Medicaid if they meet their state's income rules. It pays for treatment of an emergency medical condition only.

Some states also run programmes with their own money for residents who don't qualify for federal ones. Your state Medicaid agency is the only reliable place to check.

Special enrollment: you don't have to wait until November

Open enrollment for 2027 plans on HealthCare.gov runs from 1 November 2026 to 15 January 2027. Enroll by 15 December and your coverage starts on 1 January. Enroll between 16 December and 15 January and it starts on 1 February, provided you pay your first premium.

If you arrive at another time of year, you usually don't have to wait. HealthCare.gov lists moving to the US from a foreign country or a US territory as a qualifying life event. Losing other health coverage and becoming a US citizen are qualifying events too. For most events, you have 60 days to choose a plan.

Keep evidence of your arrival date, such as your I-94 record or your passport entry stamp, in case the Marketplace asks you to prove it.

Emergencies: what EMTALA does and doesn't do

EMTALA (the Emergency Medical Treatment and Labor Act) is a 1986 federal law. CMS says hospitals that take part in Medicare and offer emergency services must give anyone who comes in with an emergency a medical screening exam. If there is an emergency, including active labour, they must stabilise the patient or arrange a proper transfer. They have to do this regardless of the person's ability to pay.

What EMTALA doesn't do is make emergency care free. You'll get a bill afterwards, and without insurance it can be very large. Before it goes to collections, ask the hospital's billing office about financial assistance, charity care and payment plans. Unpaid medical debt can also get in the way of the credit history you're trying to build, which our guide to building credit in the USA covers.

For care that isn't an emergency, urgent care clinics usually cost much less than an emergency room. Community health centres charge on a sliding scale based on income, and HealthCare.gov points people who can't use the Marketplace towards them.

Public charge: the basics

Public charge is a test USCIS (US Citizenship and Immigration Services) uses on many green card applicants. It asks whether a person is likely to become mainly dependent on the government.

USCIS guidance says a new rule applies to adjustment of status applications (Form I-485) postmarked or submitted electronically on or after 18 September 2026. For benefits received before that date, officers consider only cash assistance for income maintenance and long-term care in an institution at government expense. For benefits received on or after it, officers can look at means-tested public benefits much more broadly. Refugees, asylees and more than 20 other groups are exempt from the test.

Buying private insurance or a Marketplace plan with your own money isn't receiving a public benefit. Whether a particular benefit such as Medicaid could count for you depends on your status, your application and when you received it. Before you apply for, or cancel, a public benefit, speak to a licensed immigration attorney or a DOJ-accredited representative. If a green card is in your plans, our overview of employment-based green cards explains the main routes.

How to compare plans and enroll, step by step

A low monthly premium can hide a very expensive plan. Look at the whole year's cost instead.

1. List your likely care. Include regular prescriptions, ongoing conditions, a planned pregnancy and children's check-ups.
2. Check the network. Make sure the doctors, hospitals and pharmacy near you are in network. Care outside the network can cost far more, or may not be covered at all.
3. Compare four numbers. These are the monthly premium, the deductible (what you pay before the plan starts sharing costs), your copays and coinsurance, and the out-of-pocket maximum (the most you'll pay for covered care in a year).
4. Work out a bad-year cost. Multiply the premium by 12 and add the out-of-pocket maximum. That's roughly the most a serious illness could cost you.
5. Gather your documents. You'll need your green card, visa and I-94, or work permit, and an estimate of your household income for the year.
6. Enter details exactly as they appear on your immigration documents. Mismatches are a common reason the Marketplace asks for extra paperwork.
7. Pay the first premium. Coverage doesn't begin until you do.
8. Upload any requested documents before the deadline, or you could lose your savings or your coverage.

Costs to budget for

• Premiums every month, even in months you don't use care.
• Deductible and copays when you do use care.
• Prescriptions, which vary widely in price. Ask for generics.
• The gap between arriving and your coverage starting.
• Dental and vision, which are often separate from medical plans for adults.

Health insurance scams aimed at newcomers

Newcomers get targeted because the system is unfamiliar. Look out for:

• Calls or social media messages offering "free government health insurance" in return for your Social Security number or bank details. Hang up and go directly to HealthCare.gov or your state marketplace yourself.
• Plans that aren't insurance. Some discount cards and membership programmes look like insurance but pay very little. If a policy doesn't show a deductible and an out-of-pocket maximum, ask exactly what it covers.
• Agents who switch your plan without asking. Only work with licensed agents or brokers, and check their licence with your state insurance department.
• Anyone who promises the policy will help your visa or green card. No insurance product guarantees any immigration outcome.

Free, trained help is available through the local assisters listed on HealthCare.gov's Find Local Help tool.

Your health insurance checklist

• Find out whether your job offers insurance, when it starts and what family coverage costs.
• Arrange cover for any gap between arriving and your plan starting.
• If you're using the Marketplace, apply within 60 days of arriving.
• Check how the 1 January 2027 tax credit change affects your household, and compare plans again from 1 November.
• If you have children or are pregnant, ask your state Medicaid agency whether it uses the lawfully residing option.
• Keep your immigration documents and proof of your arrival date together.
• Get immigration advice before applying for or dropping any public benefit.
• If you'll be driving, sort out cover for the car too. Our guide to car insurance in the USA for immigrants explains how.