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Health Insurance for Green Card Holders and New Immigrants
Moving to the United States comes with a long to-do list, and health insurance is easy to put off. Don’t. One emergency room visit can cost more than a month’s rent, and the rules for immigrants changed a lot in 2026 and 2027.
Here’s what green card holders and other new arrivals need to know right now.
The big change for 2027
The One Big Beautiful Bill Act narrowed who can get help paying for marketplace coverage. Starting with 2027 coverage, only these non-citizens can get premium tax credits and cost-sharing reductions (CMS):
- Lawful permanent residents (green card holders)
- Cuban and Haitian entrants
- People living in the U.S. under a Compact of Free Association (from Micronesia, the Marshall Islands and Palau)
Refugees, asylees, people with temporary protected status (TPS), most visa holders and many others can still buy a marketplace plan, but at full price. Some states, such as Virginia, offer their own state help on top (Virginia’s Insurance Marketplace).
Green card holders: your options
Marketplace plans (Obamacare)
Green card holders can buy a plan on HealthCare.gov or a state exchange and qualify for premium tax credits based on income. There’s no waiting period for marketplace coverage.
One catch: since January 2026, lawfully present immigrants with income below the federal poverty level who can’t get Medicaid because of their immigration status no longer qualify for tax credits (Georgetown CHIR). This mainly hits newer green card holders with very low income.
Medicaid and the 5-year bar
Most adult green card holders must hold their card for five years before they qualify for full Medicaid. Some people are exempt, including those who got their green card after being a refugee or asylee, and certain veterans and military families.
Since October 1, 2026, full federal Medicaid for immigrants is limited to green card holders who meet or are exempt from the 5-year bar, Cuban and Haitian entrants, and COFA migrants (Missouri DSS). Emergency Medicaid still covers true emergencies for people who otherwise qualify. Some states also cover children and pregnant people sooner.
Job-based coverage
If you work for an employer that offers health insurance, you can enroll the same way any worker does. Immigration status doesn’t change your eligibility for a work plan.
Medicare at 65
Green card holders can usually get Medicare after living in the U.S. for five years in a row. Premium-free Part A generally requires about 10 years of work in the U.S.; otherwise you can buy in.
Newly arrived? You don’t have to wait for open enrollment
Gaining lawful presence in the U.S., such as getting your green card or arriving with a visa that allows you to live here, is a qualifying life event. You get a special enrollment period, usually 60 days, to sign up for a marketplace plan.
Otherwise, open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027 in most states.
Quick tips
- Keep copies of your immigration documents. The marketplace will ask you to verify your status, often by uploading your card or I-94.
- Update your status when it changes. If you go from a visa or refugee status to a green card, your subsidy eligibility may change too.
- Use free help. Navigators and certified assisters help in many languages at no cost. Find one at localhelp.healthcare.gov.
- Ask an immigration lawyer if you’re worried about how benefits could affect a future visa or citizenship application.
FAQ
Can green card holders get Obamacare? Yes. Green card holders can buy marketplace plans and still qualify for premium tax credits in 2027.
Do green card holders have to wait 5 years for Medicaid? Most adults do, unless they fall into an exempt group.
Can refugees and asylees still get marketplace coverage in 2027? Yes, they can still enroll, but most will no longer get federal tax credits to lower the price.
What’s the best health insurance for new immigrants? For green card holders it’s usually a subsidized marketplace plan or a job-based plan. Others should compare full-price marketplace plans, job-based coverage and any state programs.
General information, not legal or insurance advice. Immigration and benefit rules change often and vary by state.
Sources: CMS: noncitizen eligibility for 2027 · Georgetown CHIR: marketplace changes for immigrants · Missouri DSS: H.R.1 Medicaid FAQs · Virginia’s Insurance Marketplace: federal changes · HealthCare.gov
