Health insurance for newcomers: how U.S. coverage works

Step 1 — Learn the basic words

HealthCare.gov lists several sources of coverage: a job, Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). If you have none of these, you can find a plan in the Health Insurance Marketplace (HealthCare.gov).

Whatever the source, these words come up all the time:

• Premium: what you pay for your insurance every month (HealthCare.gov glossary).
• Deductible: what you pay for covered care before your plan starts to pay (HealthCare.gov glossary).
• Copayment (“copay”): a fixed amount you pay for a covered service, usually after your deductible (HealthCare.gov glossary).
• Coinsurance: a percentage of the cost of a covered service that you pay after your deductible (HealthCare.gov glossary).
• Out-of-pocket maximum: the most you pay in a plan year for covered, in-network care. Your premiums and out-of-network care don’t count toward it (HealthCare.gov glossary).
• Network: the doctors, hospitals and other providers your plan has a contract with (HealthCare.gov glossary). HMO and EPO plans generally don’t cover care outside the network, except in an emergency. PPO plans do, for an extra cost (HealthCare.gov).

Remember the trade-off: plans with lower monthly premiums generally have higher deductibles (HealthCare.gov glossary).

Step 2 — Ask about coverage through your job

If you have a job, ask your employer about health insurance early. Job-based plans can have their own enrollment periods (HealthCare.gov glossary).

If your job offers insurance that counts as “affordable” and meets minimum standards, you won’t get savings on a Marketplace plan. HealthCare.gov says most job-based plans meet these standards (HealthCare.gov).

Step 3 — Check the Marketplace, and what changes in 2027

The Marketplace (also called the “exchange”) is where you shop for and enroll in a plan. HealthCare.gov runs it for most states; some states run their own website (HealthCare.gov glossary). To enroll, you must live in the U.S., be a U.S. citizen or national or be “lawfully present,” and not be incarcerated (HealthCare.gov).

“Lawfully present” covers many statuses. HealthCare.gov’s list includes green card holders, refugees, asylees, people with a work permit or Temporary Protected Status, and people with nonimmigrant visas, such as work and student visas (HealthCare.gov). The same page says Deferred Action for Childhood Arrivals (DACA) recipients aren’t eligible. Undocumented immigrants can’t get Marketplace coverage, but they may apply on behalf of people who are documented (HealthCare.gov). Read the full official list, not a summary.

From January 1, 2027, because of a change in the law, only three groups of immigrants can get savings on Marketplace plans: green card holders, Cuban or Haitian entrants, and Compact of Free Association (COFA) migrants (HealthCare.gov). “Savings” means the premium tax credit, which lowers your monthly premium, and discounts on your share of costs (same source). Other lawfully present people may still enroll. CMS, the federal agency behind HealthCare.gov, says they “will have to pay full price.” Its guidance covers states that use HealthCare.gov; states with their own Marketplace give their own instructions (CMS).

The premium tax credit is based on the income you estimate on your application. If you use more of it than your final income allows, you pay back the difference when you file your federal tax return (HealthCare.gov glossary).

Step 4 — Check Medicaid and CHIP, which also changed

Medicaid and CHIP give free or low-cost coverage to eligible people with low incomes, including children, pregnant women, older people and people with disabilities. Income limits, benefits and costs differ by state, and you can apply at any time of year (HealthCare.gov).

HealthCare.gov now says that, because of a law change, the only immigrants eligible for full Medicaid or CHIP are green card holders, Cuban or Haitian entrants and COFA migrants. Depending on the state, “lawfully residing” children and pregnant women may also be eligible (HealthCare.gov). CMS guidance to the states says these limits began on October 1, 2026 (CMS). Two more rules:

• The 5-year waiting period. Many people become eligible for Medicaid and CHIP only 5 years after getting a “qualified non-citizen” status, such as a green card. Some don’t have to wait — for example, green card holders who were refugees or asylees before. States can also remove the wait for “lawfully residing” children and pregnant people (HealthCare.gov).
• Emergencies. Medicaid may cover treatment of an emergency medical condition for someone who meets the state’s other rules, like income and residency, but doesn’t have an eligible immigration status (same source). CMS says the 2026 change did not change this emergency coverage (CMS).

You can apply through the Marketplace or directly to your state Medicaid agency (HealthCare.gov). In “mixed-status” families, you can apply for the members who are eligible. Family members who aren’t applying won’t be asked about their immigration status (HealthCare.gov).

Step 5 — Sign up at the right time

• Open Enrollment is the yearly window for Marketplace plans. On HealthCare.gov it runs from November 1 to January 15. Enroll by December 15 for coverage from January 1, or by January 15 for coverage from February 1. Either way, you must pay your first premium (HealthCare.gov). If your state has its own Marketplace, check its dates.
• A Special Enrollment Period (SEP) lets you enroll at other times after certain life changes, such as moving to the U.S. from a foreign country, getting married, having a baby or losing other coverage (HealthCare.gov). Gaining a newly eligible immigration status can count too (HealthCare.gov).
• SEP deadlines. Depending on the type, you usually have 60 days before or 60 days after the event to enroll (HealthCare.gov glossary). You may have to send documents, and you can appeal if you’re turned down (HealthCare.gov).
• Medicaid and CHIP take applications all year (HealthCare.gov).

Step 6 — Compare plans and enroll safely

• Look beyond the premium. For each plan, HealthCare.gov links to a summary of benefits, a provider directory and a list of covered drugs. You can check whether your doctors and prescriptions are covered in network (HealthCare.gov).
• Read the Summary of Benefits and Coverage (SBC). Insurers and job-based plans must give you this short, plain-language summary. You may be able to get it in another language if you ask (HealthCare.gov).
• Know your protection. A Marketplace plan can’t reject you or charge you more because of a health condition you had before. Pregnancy is covered from the day the plan starts (HealthCare.gov).
• Have your documents ready, such as your green card, Form I-94, work permit, foreign passport, Form I-20 or DS-2019 (HealthCare.gov). If the Marketplace can’t confirm your status electronically, it can ask you for documents by a deadline (CMS). Answer on time.
• Know who is helping you. Assisters (including Navigators) are certified by the Marketplace and must give fair, impartial information. Agents and brokers are certified too, but they’re generally paid by the insurance companies whose plans they sell (HealthCare.gov).
• Pay the insurer directly. Your first premium goes to the insurance company, not to the Marketplace (HealthCare.gov glossary).

Step 7 — Applying for a green card or a visa? Ask about “public charge” first

HealthCare.gov says that if you’re applying for a visa, for entry to the U.S. or for a green card, there is new guidance on how the Department of Homeland Security decides if someone is likely to become a “public charge.” It suggests learning about this update before you apply for Marketplace, Medicaid or CHIP coverage (HealthCare.gov).

USCIS says its updated guidance applies to green card applications (Form I-485) submitted on or after September 18, 2026. It also lists groups that aren’t subject to public charge, such as refugees and asylees (USCIS). The answer depends on your case, so talk to a licensed immigration attorney or a DOJ-accredited representative first — see our guide to free immigration legal help.