There are various health insurance options available to recent immigrants – including those who become citizens or lawful permanent residents. Depending on the circumstances, they may be able to enroll in a plan offered by an employer or university, and they also have the option to enroll in an ACA-compliant individual/family plan obtained through the Marketplace/exchange (to clarify, all health insurance plans sold in the individual/family market are required to be ACA-compliant, but financial assistance is only available if the plan is obtained through the Marketplace).
A new citizen or an immigrant who is lawfully present in the U.S. can enroll in any Marketplace (exchange) plan available in their area, during the open enrollment period or when the person is eligible for a special enrollment period. Depending on their income, they may also qualify for Marketplace financial assistance (premium subsidies and cost-sharing reductions).[0]
Effective November 1, 2024, for coverage during plan year 2025, DACA recipients can use the Marketplace for the first time, and qualify for financial assistance under the same eligibility rules that apply to other Marketplace enrollees.[1]
The annual open enrollment period for individual-market health plans starts Nov. 1 and continues until Jan. 15 in most states. The same open enrollment period is used outside the Marketplace (off-exchange), but there are no subsidies available outside the Marketplace.
Special enrollment period due to new citizenship or lawfully present status
Becoming a U.S. citizen or gaining lawfully present resident status will give you a 60-day special enrollment period in your state’s Marketplace. During that window, you can enroll in any Marketplace plan available in your area, and potentially qualify for financial assistance depending on your income and your access to other coverage. (If you have access to employer-sponsored health insurance that’s considered affordable and that provides minimum value, you’re not eligible for Marketplace subsidies. You’re also not eligible for Marketplace subsidies if you’re eligible for Medicaid, CHIP, or premium-free Medicare Part A, but those are rarely available to recent immigrants).
There are a variety of other qualifying life events that trigger special enrollment periods for Marketplace coverage. Anyone eligible to use the Marketplace,[2] may have a qualifying event, so lawfully present immigrants and U.S. citizens alike may qualify for a special enrollment period.
Can immigrants get health insurance premium subsidies?
Yes, lawfully present immigrants can qualify for income-based Marketplace subsidies, including premium tax credits and cost-sharing reductions.[3]
And immigrants who have been in the U.S. for less than five years – and thus are not eligible for Medicaid in most states – can qualify for Marketplace premium tax credits with an income as low as $0.[4] Eligibility for premium tax credits normally begins at 100% of the federal poverty level,[5] but that’s not the case for recent immigrants who can’t qualify for Medicaid since they haven’t been lawfully residing in the U.S. for at least five years. For those first five years, when Medicaid isn’t available to them, recent immigrants can qualify for Marketplace premium subsidies even if their income is below the federal poverty level.
Note that some states do offer Medicaid to recent immigrants. Often, children and pregnant women[6] and some populations, such as refugees and asylees, don’t have to wait five years to qualify for Medicaid.[7] If a person is eligible for Medicaid, they are not eligible for Marketplace premium subsidies.
Can recent immigrants 65 and older buy coverage in the Marketplace?
Yes, immigrants can purchase Marketplace coverage if they’re 65 or older, and can qualify for income-based financial assistance if they’re not eligible for premium-free Medicare Part A.[8]
This access to Marketplace coverage and subsidies can be quite beneficial, since individuals cannot purchase Medicare until they’ve been in the U.S. for five years, and will always have to pay a premium for Medicare Part A if they (or their spouse) don’t have at least ten years of work history in the U.S.[9][10]
Most U.S residents become eligible for Medicare (premium-free Part A and Part B with a monthly premium) when they turn 65,[11] meaning they no longer need individual-market coverage. (It’s unlawful to sell individual-market coverage to anyone enrolled in Medicare Part A or Part B.)[12]
But for immigrants who either can’t enroll in Medicare at all or can’t qualify for premium-free Medicare Part A, Marketplace coverage – and subsidies, depending on income – can continue to be available regardless of age.
The Affordable Care Act (ACA), landmark health care reform legislation enacted in 2010, has a 3:1 age rating ratio, which means premiums (before subsidies are applied) for enrollees age 64 or older can’t be any more than three times as high as the premium for a 21-year-old.[13] So even for those who don’t qualify for subsidies, a Marketplace plan will have the same premium regardless of whether they’re 64 or 104.
Can undocumented immigrants enroll in Marketplace coverage?
Under the ACA, undocumented immigrants cannot use the health insurance Marketplace,[14] [15] But as we’ll discuss in a moment, it’s possible for a state that runs its own Marketplace to obtain federal permission to allow undocumented immigrants to use its Marketplace.
The Marketplace is required to verify applicants’ lawfully present status. If an applicant is asked to provide documentation to prove their citizenship or immigration status, they have 95 days in which to do so. If they don’t provide the necessary documentation, their coverage and/or financial assistance can be terminated.[16]
But Washington state, which runs its own Marketplace, obtained federal permission to allow undocumented immigrants to enroll in Marketplace coverage and qualify for income-based state subsidies (qualified health plans like Cascade Care).[17] And Colorado created a separate platform to allow undocumented immigrants to enroll in the same plans that are available in the Colorado Marketplace, with state-funded subsidies.[18]
Maryland also plans to allow undocumented immigrants to enroll in Marketplace coverage starting in 2026.[19] Maryland enacted legislation in 2024 that directs the state to begin the process of obtaining federal permission to allow undocumented immigrants to use the Marketplace.[20] and [21]
Undocumented immigrants are significantly more likely to be uninsured than U.S. citizens. A KFF analysis found that as of 2023, about 50% of undocumented immigrants did not have health insurance, versus about 8% of citizens.[22]
Can undocumented immigrants qualify for Medicaid?
In most cases, no, undocumented immigrants cannot qualify for Medicaid, and even lawfully present immigrants cannot qualify for Medicaid until they’ve been in the U.S. for at least five years. But there are some exceptions to this.
Medicaid is jointly funded by the state and federal government. States can choose to use only state funds to provide Medicaid to various undocumented immigrants. And states can access federal Medicaid funding to provide coverage for lawfully-present immigrant children and pregnant women who haven’t yet been in the U.S. for five years.[23]
A dozen states use state funds to provide Medicaid to low-income children, regardless of their immigration status (meaning they can be undocumented), and two of those states also provide coverage for low-income pregnant women regardless of immigration status.[24] In addition, California uses state funds to provide Medicaid to anyone who meets the income requirements, regardless of age or immigration status.[25]
Although lawfully present immigrants generally cannot qualify for Medicaid until they’ve been in the U.S. for five years, more than half of the states provide Medicaid (jointly funded by the state and federal government) to low-income immigrant children and pregnant women without a five-year waiting period.[26]
Should immigrants consider short-term health insurance?
Immigrants who are unable to enroll in Medicaid or ACA-compliant coverage might wonder if they should consider short-term health insurance instead.
It’s important to understand that short-term health insurance is not a substitute for ACA-compliant major medical health insurance. The coverage is not comprehensive, does not have to cover the ACA’s essential health benefits, and generally excludes coverage for pre-existing medical conditions. And short-term health plans effective in September 2024 or later are limited to total durations of no more than four months, including renewals.
So recent immigrants who are eligible for Marketplace premium subsidies will likely find that a Marketplace plan will better fit their needs (keeping in mind that ACA-compliant individual-market plans can only be purchased during open enrollment or a special enrollment period). The coverage will be comprehensive and the plan will provide full-year coverage as opposed to terminating after a few months.
Travel insurance plans are another coverage option. These can be useful for people who will be in the U.S. temporarily and who don’t qualify for Marketplace premium subsidies. (You need to be a U.S. resident to use the Marketplace.)[27]
Like short-term plans, travel insurance policies are not regulated by the ACA. So they typically do not cover pre-existing conditions and do not provide comprehensive coverage. But if the only other alternative is to be uninsured while in the U.S., a travel insurance plan may be a better option depending on your circumstances.
