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. Most newcomers have a route to coverage, but your immigration status decides which one, and several of those routes change between October 2026 and January 2027.

This guide covers what your status allows, what the 2025 federal law changes, how to bridge your first weeks and how to use a plan without overpaying. It reflects the rules as of October 2026, so check HealthCare.gov or your state before you commit.

The three places US health insurance comes from

1. An employer. The most common source for working adults and their families.
2. The Health Insurance Marketplace. The government-run shop for individual plans, reached through HealthCare.gov or your state's own website.
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.

Anyone who falls outside all three usually relies on community health centres, emergency care and programmes their state pays for itself.

Your first weeks: bridging the gap

Coverage rarely starts the day you land. Employer plans may have a waiting period, and a Marketplace plan picked after a move usually starts on the first of a later month.

Check what you already have. A policy from home or a card-linked travel policy may cover little in the US. Read the US terms, payout limit and exclusions.

Travel medical and short-term plans are sold to new arrivals as a bridge. Unlike Marketplace plans, they don't have to cover pre-existing conditions or a full set of benefits, and they can cap what they pay. A 2024 federal rule limited short-term plans to four months, but in August 2025 the federal departments said they would not prioritise enforcing it while they reconsider. States set their own limits, so what's on sale varies.

If your job offers health insurance

Employer coverage is often the best value, 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: federal rules generally stop a waiting period based only on time from running longer than 90 days. The second is family coverage, which can cost far more than covering yourself. Ask HR for the price of each tier before you sign.

Every plan also comes with a standard Summary of Benefits and Coverage, the quickest way to compare two options. If you're coming on a work visa, our guide to working legally in the United States explains how sponsorship works.

Who can use the Marketplace, by immigration status

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

Getting help to pay is another matter, and 2027 brings a big change. Treat this table as a starting point.

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

What the 2025 law changes, and when

Public Law 119-21, signed in July 2025, is called the Working Families Tax Cut legislation by CMS (the Centers for Medicare & Medicaid Services). Its changes for immigrants start on different dates.

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

If you're on a work visa or TPS and get a tax credit today, budget for the full 2027 price, and compare plans again at open enrollment rather than letting yours roll over.

Medicaid, CHIP and the five-year bar

Medicaid and CHIP are cheap or free, but immigrants face much tighter eligibility rules.

The five-year bar. Under a 1996 federal law, many green card holders and other qualified noncitizens wait five years for full Medicaid or CHIP. Some groups are exempt.

The state option. Each state can cover lawfully residing children and pregnant people without the wait. CMS confirms the October 2026 changes don't remove this option.

The October 2026 change. Federal Medicaid funding now generally covers only citizens, green card holders, Cuban and Haitian entrants and COFA migrants. Refugees and asylees without green cards are affected unless a state option covers them. States must give notice before ending coverage.

Emergency Medicaid may still pay for treating an emergency condition if you meet your state's income rules. Some states also fund programmes of their own; your state Medicaid agency is the place to check.

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

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

Arriving at another time? HealthCare.gov lists moving to the US from a foreign country or a US territory as a qualifying life event, and for most events you have 60 days to choose a plan. Keep your I-94 record or passport entry stamp as proof of your arrival date.

Low-cost care: community health centres

Community health centres funded by HRSA (the Health Resources and Services Administration) are the main safety net for everyday care, and HealthCare.gov points people who can't use the Marketplace towards them.

• Fees follow income. Centres must offer a sliding fee discount based only on income and family size. You don't have to apply for Medicaid or insurance first to get it.
• No one is turned away because they can't pay, and centres must say so publicly.
• Insured patients use them too. Many accept Medicaid and private plans.

Search by address on HRSA's Find a Health Center tool, then call to ask about services and what proof of income to bring.

Emergencies: what EMTALA does and doesn't do

Under EMTALA (the Emergency Medical Treatment and Labor Act), hospitals that take part in Medicare and offer emergency services must screen anyone with an emergency, including active labour, and stabilise or properly transfer them, regardless of ability to pay.

It doesn't make care free. Ask the billing office about financial assistance and payment plans before a bill goes to collections, which can hurt the credit you're building in the USA. For non-emergencies, urgent care usually costs much less than an emergency room.

Surprise bills. Since 1 January 2022, the No Surprises Act has protected insured patients from most surprise out-of-network bills for emergency care, and for some care at in-network hospitals. If you're uninsured or paying yourself, providers generally have to give you a good faith estimate for scheduled care, and you can dispute a bill that comes in at least 400 dollars above it.

Public charge: the basics

Public charge is a USCIS test of whether a green card applicant is likely to become mainly dependent on the government. New guidance applies to adjustment of status applications (Form I-485) filed on or after 18 September 2026. For benefits received before that date, officers consider only cash assistance for income maintenance and long-term institutional care at government expense. For benefits received after it, they can look much more broadly. Refugees, asylees and more than 20 other groups are exempt.

Paying for your own coverage isn't receiving a public benefit. Before you apply for, or cancel, something like Medicaid, speak to a licensed immigration attorney or a DOJ-accredited representative. Our overview of employment-based green cards explains the main routes.

Using your plan: networks, drug lists and approvals

Four terms decide how much a plan actually pays.

• In network. Doctors and hospitals with a contract with your plan. Out-of-network care can cost far more or not be covered, so check the provider directory before each new appointment.
• Formulary. The plan's list of covered drugs. If your medicine isn't on it, ask your doctor about a listed alternative or a generic.
• Prior authorization. Approval some plans need before a service or prescription. Without it, the plan may refuse to pay.
• Explanation of benefits. The insurer's statement after care. It isn't a bill, but check the bill against it, and ask for an itemised bill if anything looks wrong.

If a claim is denied, you can file an internal appeal with the insurer within 180 days of the denial notice, then ask for an independent external review if they still say no. Urgent cases must be decided faster.

How to compare plans and enroll, step by step

A low monthly premium can hide an expensive plan, so compare the whole year's cost.

1. List your likely care, including prescriptions, ongoing conditions and a planned pregnancy.
2. Check the network and formulary for your doctors, hospital, pharmacy and medicines.
3. Compare four numbers: premium, deductible (what you pay before the plan shares costs), copays or coinsurance, and the out-of-pocket maximum.
4. Work out a bad-year cost: 12 months of premiums plus the out-of-pocket maximum.
5. Gather your documents: green card, visa and I-94, or work permit, plus an income estimate.
6. Enter details exactly as they appear on your immigration documents, to avoid paperwork requests.
7. Pay the first premium. Coverage doesn't begin until you do.
8. Upload any requested documents before the deadline.

Adult dental and vision cover is often sold separately.

Health insurance scams aimed at newcomers

The FTC flags these warning signs:

• Calls claiming to be from the government. Agencies don't ring out of the blue asking for money or personal details. Go to HealthCare.gov or your state marketplace yourself.
• A quote that needs your Social Security number or bank details.
• Discount plans sold as insurance. Anyone selling insurance must be licensed by your state insurance department, so check.
• Fees for Marketplace help. Assisters on HealthCare.gov's Find Local Help tool are free.
• Promises about your visa or green card. No insurance product guarantees any immigration outcome.

Report scams at ReportFraud.ftc.gov and to your state attorney general.

Your health insurance checklist

• Find out whether your job offers insurance, when it starts and what family coverage costs.
• Arrange cover for the gap between arriving and your plan starting, and read what it excludes.
• If you're using the Marketplace, choose a plan within 60 days of arriving.
• Note your nearest community health centre and urgent care clinic.
• 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.