Health Insurance Options for Immigrants and Non-Citizens

Understanding Health Coverage for Immigrants in the U.S.

Navigating the U.S. health insurance system is challenging for anyone, but immigrants and non-citizens face additional complexity due to eligibility rules that vary based on immigration status, length of time in the country, and state of residence. The good news is that many immigrants have more coverage options than they realize. Whether you hold a green card, have refugee or asylee status, are a DACA recipient, or are still in the process of adjusting your status, there are pathways to affordable health coverage.

This guide breaks down every major coverage option available to immigrants and non-citizens, including ACA marketplace plans, Medicaid and CHIP, emergency services, community health centers, and state-funded programs. We also clarify common misconceptions about the public charge rule and explain what coverage undocumented individuals can access.

Who Is Considered Lawfully Present?

Your eligibility for health insurance in the United States depends primarily on whether you are classified as lawfully present. The term lawfully present covers a broad range of immigration statuses recognized by the federal government. Understanding which category you fall into is the first step toward finding coverage.

The following immigration statuses are considered lawfully present for the purposes of health insurance eligibility:

• Lawful Permanent Residents (LPRs): Green card holders who have been granted authorization to live and work in the U.S. permanently.
• Refugees: Individuals admitted to the U.S. after being screened abroad and determined to meet the definition of a refugee.
• Asylees: Individuals who applied for and were granted asylum after arriving in the U.S.
• DACA recipients: Individuals granted Deferred Action for Childhood Arrivals, who became eligible for marketplace coverage starting in November 2024.
• Temporary Protected Status (TPS) holders: Nationals of countries designated by DHS due to armed conflict, environmental disasters, or other extraordinary conditions.
• Work and student visa holders: Individuals present on valid nonimmigrant visas such as H-1B, L-1, F-1, J-1, and O-1 visas.
• Other categories: Cuban/Haitian entrants, individuals with withholding of deportation or removal, conditional entrants, individuals paroled into the U.S., battered immigrants with approved or pending VAWA petitions, and victims of trafficking.

ACA Marketplace Coverage for Lawfully Present Immigrants

Lawfully present immigrants are fully eligible to purchase health insurance through the ACA Health Insurance Marketplace. They can shop for plans, compare metal tiers, and enroll during open enrollment or a qualifying Special Enrollment Period just like U.S. citizens. Gaining lawfully present status itself qualifies as a life event that triggers a Special Enrollment Period, giving you 60 days from the date of your status change to enroll.

Premium Tax Credits and Subsidies

Lawfully present immigrants qualify for premium tax credits and cost-sharing reductions on the same terms as U.S. citizens. If your household income falls between 100% and 400% of the federal poverty level (FPL), you can receive premium tax credits that reduce your monthly insurance cost. Under the enhanced subsidies extended through the Inflation Reduction Act, people earning above 400% FPL can also qualify if their benchmark plan premium exceeds 8.5% of household income.

Lawfully present immigrants with incomes below 100% FPL receive a special benefit not available to U.S. citizens. If you are lawfully present but your income is below 100% FPL and you are ineligible for Medicaid (for example, due to the five-year waiting period), you can still qualify for marketplace premium tax credits and cost-sharing reductions. This is an important exception because U.S. citizens with incomes below 100% FPL in Medicaid expansion states are generally directed to Medicaid and do not qualify for marketplace subsidies.

How Much Does Marketplace Coverage Cost for Immigrants?

The cost of marketplace coverage for lawfully present immigrants is identical to what U.S. citizens pay. Plans are priced based on age, location, tobacco use, and plan tier — not immigration status. With subsidies, many enrollees pay less than $100 per month and some qualify for $0-premium plans. To understand the full range of costs, see our guide on how much health insurance costs in 2026.

DACA Recipients and Health Insurance

In a landmark policy change, the Biden administration finalized a rule in May 2024 that extended ACA marketplace eligibility to DACA recipients by reclassifying them as lawfully present for health coverage purposes. The rule took effect on November 1, 2024, and DACA recipients can now enroll in marketplace plans, receive premium tax credits and cost-sharing reductions, and access the same plan options available to other lawfully present individuals.

Before this change, DACA recipients were the only group with federal deferred action status explicitly excluded from the ACA's definition of lawfully present. This left approximately 580,000 DACA recipients without access to subsidized marketplace coverage unless they had employer-sponsored insurance or lived in a state that offered separate coverage programs. Now, DACA recipients can apply through HealthCare.gov or their state exchange using their Employment Authorization Document and valid Social Security number.

It is important to note that while DACA recipients now qualify for marketplace plans and subsidies, they remain ineligible for Medicaid and CHIP under current federal rules. However, some states may offer separate state-funded health programs that cover DACA recipients.

Green Card Holders: Full Marketplace Access

Lawful Permanent Residents, commonly known as green card holders, have full access to ACA marketplace plans from the day they receive their green card. They can enroll during open enrollment, qualify for premium tax credits and cost-sharing reductions, and choose from the same Bronze, Silver, Gold, and Platinum plan tiers available to citizens.

Green card holders should be aware that while marketplace coverage is immediately available, Medicaid eligibility is subject to the federal five-year waiting period in most states. During those first five years, the marketplace with subsidies is typically the most affordable option for green card holders who do not have employer-sponsored coverage.

Refugees and Asylees: Immediate Eligibility

Refugees and asylees hold a unique position in the health insurance landscape. Unlike most other immigrant categories, refugees and asylees are exempt from the five-year Medicaid waiting period. They are eligible for Medicaid and CHIP from the date they are granted refugee or asylee status, provided they meet their state's income and other eligibility requirements.

In addition to Medicaid, refugees often receive initial healthcare assistance through the Refugee Medical Assistance (RMA) program, which provides up to eight months of medical coverage for refugees whose incomes are too high for Medicaid. Asylees are also eligible for RMA benefits. After RMA coverage ends, refugees and asylees can transition to Medicaid if they qualify by income, or they can enroll in marketplace plans with full subsidy eligibility.

The Five-Year Medicaid and CHIP Waiting Period

One of the most significant barriers to coverage for lawfully present immigrants is the federal five-year waiting period for Medicaid and the Children's Health Insurance Program (CHIP). Under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, most qualified immigrants must wait five years from the date they obtain qualified immigrant status before they can enroll in federally funded Medicaid or CHIP.

The following groups are exempt from the five-year waiting period and can enroll in Medicaid or CHIP immediately upon meeting income requirements:

• Refugees (for their first seven years of refugee status)
• Asylees (for their first seven years of asylee status)
• Cuban and Haitian entrants
• Individuals granted withholding of deportation or removal
• Veterans, active-duty military members, and their spouses and dependents
• Victims of trafficking

Additionally, under the CHIPRA option enacted in 2009, states can choose to cover lawfully residing pregnant women and children in Medicaid and CHIP without the five-year waiting period using federal matching funds. As of 2026, more than 35 states plus the District of Columbia have elected to cover lawfully residing children, and a similar number cover lawfully residing pregnant women, without requiring the five-year wait.

Emergency Medicaid

Federal law requires that emergency Medicaid be available to all individuals who meet the income requirements for Medicaid, regardless of immigration status. This is one of the few health coverage provisions that extends to undocumented immigrants. Emergency Medicaid covers medical conditions that meet the federal definition of an emergency: acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any organ or body part.

Emergency Medicaid commonly covers emergency room visits, emergency labor and delivery (including prenatal care classified as emergency in some states), and emergency surgical procedures. It does not cover follow-up care, routine office visits, preventive screenings, or chronic disease management. The application process for emergency Medicaid varies by state, but hospitals typically help patients apply when they present for emergency treatment.

Community Health Centers and Free Clinics

Federally Qualified Health Centers (FQHCs) are a critical safety net for immigrants of all statuses, including undocumented individuals. There are more than 1,400 FQHCs operating nearly 15,000 service delivery sites across the United States. These centers receive federal funding and are required by law to serve all patients regardless of their ability to pay or their immigration status.

Services available at FQHCs include primary care, dental care, mental health and substance use treatment, pharmacy services, prenatal and maternity care, pediatric care, and chronic disease management. Fees are based on a sliding scale tied to household income, meaning many low-income patients pay little to nothing for care. You do not need insurance or identification documents to receive services at a community health center.

In addition to FQHCs, free clinics operated by nonprofit organizations and charitable groups provide healthcare services in many communities. While the range of services at free clinics varies, they often offer basic primary care, chronic disease management, prescription assistance, and referrals to specialists. You can find a community health center near you by visiting the Health Resources and Services Administration website or calling 1-800-318-2596.

State-Funded Health Programs for Immigrants

Several states have created their own health coverage programs that go beyond federal requirements, using state funds to cover immigrants who are not eligible for federal programs. These programs vary significantly in scope, eligibility, and benefits.

• California (Medi-Cal): Provides full-scope Medi-Cal coverage to all income-eligible residents regardless of immigration status. California completed the expansion to all age groups in January 2024, making it the first state to offer Medicaid-equivalent coverage to all undocumented residents who meet income requirements.
• Illinois: Offers the Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs, covering non-citizen adults and seniors who meet income requirements and are not eligible for federal Medicaid.
• New York: Provides state-funded Medicaid coverage to certain immigrants who do not meet federal eligibility criteria and offers the Essential Plan to lawfully present immigrants with incomes up to 200% FPL.
• Washington: Operates Apple Health, which provides coverage to certain immigrant populations not eligible for federal Medicaid, including undocumented individuals in specific age and income groups.
• Oregon, Colorado, Connecticut, and others: Several additional states have implemented or are expanding programs that cover undocumented children, pregnant women, or broader immigrant populations using state-only funds.

Eligibility rules and benefits differ from state to state, so check with your state's Medicaid agency or a local enrollment assister to determine what programs are available in your area.

Coverage Options for Undocumented Immigrants

Undocumented immigrants face the most limited set of coverage options. They are not eligible for ACA marketplace plans, premium tax credits, regular Medicaid, or CHIP. However, they are not entirely without options.

• Emergency Medicaid: Covers emergency conditions for individuals who would qualify for Medicaid by income.
• Community health centers: Serve all patients regardless of immigration status or ability to pay, with sliding-scale fees.
• State and local programs: Some states and counties offer health coverage or services to undocumented residents using non-federal funds.
• Free clinics and charitable care: Nonprofit clinics offer basic medical services free of charge in many communities.
• Short-term health insurance: While not ACA-compliant and not a substitute for comprehensive coverage, short-term health insurance plans may be available to some individuals as a temporary bridge. These plans do not require proof of immigration status in most states, though coverage is limited and they can deny coverage for pre-existing conditions.
• Employer-sponsored insurance: Some employers offer group health insurance that does not require verification of immigration status, though employment eligibility verification (I-9) is a separate requirement.

The Public Charge Rule: What Immigrants Need to Know

One of the most significant sources of confusion and fear among immigrants seeking health coverage is the public charge rule. The public charge ground of inadmissibility has existed in immigration law for more than a century, but a 2019 rule under the Trump administration attempted to expand the definition to include the use of certain public benefits like Medicaid, SNAP, and housing assistance. That rule was vacated by the courts and replaced with the current 2022 final rule from the Biden administration.

Under the current rule, the following health-related benefits are explicitly excluded from public charge determinations and will NOT negatively affect your immigration case:

• Medicaid (except for long-term institutionalization at government expense)
• ACA marketplace coverage and premium tax credits
• Children's Health Insurance Program (CHIP)
• Emergency Medicaid
• Medicare Part D Low Income Subsidy
• Disaster relief and pandemic-related assistance

The public charge rule only applies to individuals seeking admission to the United States or applying for adjustment of status to become a lawful permanent resident. It does not apply to refugees, asylees, VAWA petitioners, T-visa holders, U-visa holders, special immigrant juveniles, or anyone applying for naturalization (citizenship). If the public charge rule applies to your situation, the determination is based on the totality of your circumstances, including age, health, income, education, and family status. Using health coverage for yourself or your family members does not make you a public charge.

Mixed-Status Families

Many immigrant households are mixed-status families where some members are U.S. citizens, some are lawfully present, and some may be undocumented. The ACA marketplace and Medicaid are designed to handle these situations. When a mixed-status family applies for marketplace coverage, each household member's eligibility is determined individually. Eligible family members can enroll in marketplace plans and receive subsidies while ineligible members are simply excluded from the coverage application.

Critically, the marketplace application does not ask about the immigration status of household members who are not applying for coverage. You can apply for your eligible children or spouse without providing information about non-applicant family members' immigration status. Information provided on the application is used solely for determining health coverage eligibility and is not shared with immigration enforcement agencies. Federal law prohibits the use of marketplace application data for immigration enforcement purposes.

How to Enroll: Step-by-Step for Immigrants

If you are a lawfully present immigrant ready to enroll in marketplace coverage, follow these steps:

1. Gather your documents. You will need your immigration document (green card, Employment Authorization Document, I-94, or other proof of lawful presence), Social Security number (if you have one), employer and income information, and tax return data.
2. Visit HealthCare.gov or your state exchange. Create an account and begin the application. The application is available in multiple languages and includes prompts for immigration status documentation.
3. Complete the eligibility determination. The system will verify your immigration status through the SAVE database and determine whether you qualify for marketplace plans, premium tax credits, Medicaid, or CHIP.
4. Compare plans and enroll. Review the available plans, compare premiums, deductibles, and provider networks, and select the plan that best fits your needs and budget.
5. Get help if you need it. Free enrollment assistance is available through Navigators, certified application counselors, and community organizations that specialize in helping immigrants access coverage. Many offer services in languages other than English. Call 1-800-318-2596 for help in over 150 languages.

The Bottom Line

Health insurance options for immigrants and non-citizens are more extensive than many people realize. Lawfully present immigrants, including green card holders, refugees, asylees, DACA recipients, TPS holders, and visa holders, have full access to ACA marketplace plans and financial assistance. Refugees and asylees can access Medicaid immediately, while most other immigrants face a five-year waiting period that many states have chosen to waive for children and pregnant women.

Even undocumented immigrants have access to emergency Medicaid, community health centers, free clinics, and an expanding number of state-funded programs. The public charge rule should not deter anyone from enrolling in health coverage for which they are eligible, as current policy explicitly excludes most health programs from public charge considerations.

If you or a family member need help understanding your options, reach out to a Navigator, a community health center, or the marketplace call center at 1-800-318-2596. Trained assistors can explain your specific eligibility in your preferred language and help you enroll in the coverage you qualify for. No one should go without healthcare because of confusion about the rules, and the resources exist to help you find affordable coverage regardless of your circumstances.