I’m a legal U.S. resident, but not a citizen. What are my health insurance options?

Coverage, with subsidies based on income, is available to lawfully present U.S. residents

Legal U.S. residents have the same eligibility as citizens to receive subsidies for health insurance purchased in the exchange.¹ If you don't have an option for coverage through your employer, you may be eligible to receive a subsidy to help pay your premiums (on any metal-level plan) and reduce the out-of-pocket costs (Silver plan only) for your policy. Eligibility for subsidies is based on your household income. (Here's how household income is calculated under the ACA.)

But starting with the 2027 plan year (coverage obtained during the open enrollment period in the fall of 2026), Marketplace subsidies will no longer be available to refugees, asylees, and people with Temporary Protected Status (TPS). This is due to H.R. 1, which limits the immigration statuses that will allow a person to obtain Marketplace subsidies.²

In most states, DACA recipients were temporarily eligible for Marketplace coverage and subsidies, between November 1, 2024 and August 25, 2025. But starting August 25, 2025, DACA recipients can no longer utilize the health insurance Marketplace, and those who are enrolled at that point will be disenrolled from their Marketplace health insurance plans. This is due to a rule change that was finalized by HHS in June 2025.³

Changes to subsidy eligibility for eligible recent immigrants

The ACA included a provision to assist lawfully present recent immigrants who have incomes below the federal poverty level, even though premium subsidies aren't normally available in that case. Since most legal permanent residents are not eligible for Medicaid until they have been in the U.S. for five years, many lawfully present individuals would have found themselves in a situation where they earned too little (less than the federal poverty level) to qualify for exchange subsidies but were also not eligible for Medicaid – even in states that expanded Medicaid – based on the amount of time they had been in the United States.

So lawmakers included a provision in the ACA that allows recent immigrants with household incomes under 100% of the federal poverty level to receive exchange subsidies at the level they would if their income was equal to 100% of FPL. (See page 113.)

But that provision is being eliminated as of the 2026 plan year, due to H.R. 1. Starting January 1, 2026, recent immigrants will need to have income of at least the federal poverty level to qualify for Marketplace subsidies, even during the five years when they’re ineligible for Medicaid.⁴

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.