How immigrants can obtain health coverage

Can immigrants select from any available health plans during ACA open enrollment?

Yes, as long as they're lawfully present in the U.S.¹ But starting with the 2027 plan year (coverage obtained during the open enrollment period in the fall of 2026), various immigrants, including refugees, asylees, people with Temporary Protected Status (TPS), and people with temporary work or student visas, will no longer qualify for Marketplace subsidies, which may limit the appeal of on-exchange plans.

This change stems from H.R. 1, which limits the immigration statuses that allow an immigrant to obtain Marketplace subsidies.² The law clarifies that as of 2027, the only immigrants who will qualify for Marketplace subsidies will be lawful permanent residents (LPRs), Compact of Free Association (COFA) migrants, and Cuban and Haitian entrants.³

DACA recipients were temporarily eligible for Marketplace coverage under a rule change that was finalized by the Biden administration. But that was reversed by the Trump administration, and DACA recipients became ineligible for Marketplace coverage (with or without subsidies) starting August 25, 2025.⁴

As discussed below, some states have established their own programs that provide health coverage to eligible applicants regardless of immigration status. But undocumented immigrants are never eligible for federally funded health coverage and cannot use the Marketplace unless a state-run Marketplace obtains federal approval for that.

Open enrollment for individual-market health insurance coverage runs from November 1 to January 15 in most states, although some states have different deadlines. During this window, any non-incarcerated, lawfully present U.S. resident can enroll in a health plan through the exchange in their state. (Depending on the state, this can be a state-run platform or the federally run HealthCare.gov.) It’s also an option to enroll outside the exchange during that window, although premium subsidies and cost-sharing reductions are not available outside the exchange.

Are immigrants eligible for health insurance premium subsidies?

You do not have to be a U.S. citizen to benefit from the ACA. If you're living in the U.S. legally – regardless of how long you've been here – you're eligible for subsidies in the exchange if your income is in the subsidy-eligible range and you don't have access to an affordable employer-sponsored plan that provides minimum value. (As discussed below, some states have programs that use state funds to subsidize health coverage for undocumented immigrants).

However, the OBBBA has changed the rules in terms of what immigration categories make a person subsidy-eligible. As noted above, various immigrants, including refugees, asylees, people with temporary visas, and individuals with TPS will no longer be eligible for ACA subsidies, starting with 2027 health plans.

The OBBBA also eliminates access to subsidies for recent immigrants whose income is below the federal poverty level. Premium subsidies are normally only available to exchange enrollees if their income is at least 100% of the federal poverty level (FPL). But under the ACA, subsidies also extended below the federal poverty level for recent immigrants who were ineligible for Medicaid because they’ve been in the U.S. for under five years.⁵

But that is no longer the case as of the 2026 plan year, due to H.R. 1. Starting with the 2026 plan year, recent immigrants must have an income of at least the federal poverty level in order to qualify for Marketplace subsidies.

Lawfully present immigrant status applies to a wide range of people, including those with “non-immigrant” status such as work visas and student visas. So even if you’re only in the U.S. temporarily – for a year of studying abroad, for example – you can purchase coverage in the health insurance exchange for the state you’re living in while in the U.S. Depending on your income, you might be eligible for a premium subsidy to offset some of the cost of the coverage. But as noted above, eligibility for subsidies will be more restricted starting with the 2027 plan year. At that point, immigrants will only be eligible for Marketplace subsidies if they're LPRs, COFA migrants, or Cuban or Haitian entrants.³

Can recent immigrants 65 and older buy exchange health plans?

Yes. Most individuals become eligible for Medicare when they turn 65 years old and, consequently, they no longer need individual-market coverage. However, recent immigrants are not eligible for Medicare until they’ve been lawfully present in the U.S. for five years, regardless of their age.

As a result of the ACA, policies in the individual market are available on a guaranteed-issue basis, regardless of health status, age, gender, or other factors necessary for medical underwriting. And if the plan is purchased in the exchange, subsidies are available based on income, just as they are for younger enrollees. ⁶

(As is the case for younger enrollees, subsidies for immigrants age 65+ will only be available in 2027 and future years for LPRs, COFA migrants, and Cuban and Haitian entrants, and subsidies are also only available for immigrants age 65+ if their household income is at least 100% of the federal poverty level.)

The ACA also limits premiums for enrollees age 64 or older to three times the premiums charged for an enrollee in the same plan who is 21.⁷ (A few states limit that further,⁸ and two states – New York and Vermont – do not allow premiums to vary at all based on age.⁹) So there are essentially caps on the premiums that apply to elderly recent immigrants who are using the individual market in place of Medicare, even if their income is too high (or too low) to qualify for subsidies.

Are undocumented immigrants eligible for ACA coverage?

No, the ACA specifically prevents immigrants who are not lawfully present from enrolling in coverage through the exchanges.¹⁰ And they are also not eligible for Medicaid under federal guidelines.¹¹ So the two intended major cornerstones of coverage expansion under the ACA are not available to undocumented immigrants.

Some states – described in more detail below – have implemented programs to cover undocumented immigrants – particularly low-income children and/or people who are pregnant.

It’s important to understand that if you’re lawfully present, you can enroll in a plan through the exchange even if some members of your family are not lawfully present. Exchanges won’t ask family members who aren’t applying for coverage to provide details about their immigration status.

How are states making efforts to provide health coverage to undocumented immigrants?

Several states use their own funds to provide Medicaid or similar coverage to undocumented immigrants with low incomes.

But what about allowing undocumented immigrants to purchase coverage through a state-run exchange, either at full price or with state-funded subsidies?

That idea was first considered by California in 2016 (via legislation and a 1332 waiver submission to the federal government; the 1332 waiver would have needed federal approval in order to allow undocumented immigrants to use California’s exchange). But in January 2017, just two days before Donald Trump’s first inauguration, California withdrew its waiver proposal, citing concerns that the Trump administration might use information from Covered California to deport undocumented immigrants.

But other states have made this idea a reality:

• Colorado debuted a program (Omnisalud) in the fall of 2022 that allows undocumented immigrants to enroll in qualified health plans via a separate platform (instead of using the state-run exchange), so federal permission was not required. Colorado provided subsidies to the first 10,000 people who enrolled through that platform and reached that number within the first several weeks the program was available. For 2024, Colorado increased the number of subsidy-eligible spots to 11,000 and filled all of them within the first two days of open enrollment.¹² For 2025, the number of subsidy-eligible spots grew to 12,000.¹³ But funding for the program was reduced significantly for 2026, so only 6,700 subsidized spots were available.¹⁴ And starting in 2027, there will be a $15/month fee to enroll in Omnisalud.¹⁵
• Washington state received federal approval (via a 1332 waiver) to allow undocumented immigrants to enroll in coverage through the state-run exchange starting in the fall of 2023 (for 2024 coverage). State-funded subsidies are available for undocumented enrollees, but no federal subsidies.¹⁶ However, Washington plans to end the 1332 waiver early, at the end of 2026.¹⁷
• Maryland enacted legislation in 2024 directing the state to seek federal permission to allow undocumented immigrants to use the state-run exchange (but without any state or federal subsidies) starting in 2026. The federal permission was granted in January 2025,¹⁸ but Maryland opted to delay implementation until the fall of 2027, for coverage effective in 2028.¹⁹
  

How many undocumented immigrants are uninsured?

In terms of the insurance status of undocumented immigrants, the numbers tend to be rough estimates, since exact data regarding undocumented immigrants can be difficult to pin down. But according to Pew Research data, there were 10.5 million undocumented immigrants in the U.S. as of 2021.²⁰

According to a recent KFF analysis, undocumented immigrants are significantly more likely to be uninsured than U.S. citizens: as of 2023, almost half of undocumented immigrants were uninsured, versus about 6% of adults who had been born in the U.S.³

So about half of the undocumented immigrant population has some form of health insurance coverage. KFF’s Larry Levitt noted that “some are buying non-group, but I’d agree that it’s primarily employer coverage.” Undocumented immigrants also have the option to enroll in student health plans and individual (i.e., non-group) plans purchased off-exchange. (On-exchange, enrollees are required to provide proof of legal immigration status, but that is not the case off-exchange.)

Uninsured undocumented immigrants do have access to some healthcare services, regardless of their ability to pay. The Emergency Medical Treatment & Labor Act (EMTALA), a federal law, requires Medicare-participating hospitals to provide screening and stabilization services for anyone who enters their emergency rooms, without regard for insurance or residency status.

The federal government provides Emergency Medicaid funding to reimburse hospitals for some of the cost of providing emergency care to people who aren’t eligible for Medicaid due to their immigration status.²¹ But under H.R. 1, the funding for this is being reduced in states that have expanded Medicaid. Emergency Medicaid will be provided at the state’s regular federal matching rate, rather than the ACA’s enhanced 90% Medicaid expansion matching rate, starting in October 2026.²²

Do ACA exchanges check the status of immigrants who want to buy coverage?

Yes. As part of the enrollment process, the exchanges are required to verify lawful presence. Applicants who are asked to provide documentation to verify citizenship or immigration status have 95 days in which to do so. If they don’t, their coverage and/or financial assistance can be terminated.²³

The details of how HealthCare.gov resolves immigration status data matching issues are explained here. There are enrollment assisters in your community who can help you with this process if necessary. But if you’re not lawfully present, you cannot enroll through the exchange in most states, even if you’re willing to pay full price for your coverage. You can, however, apply for an ACA-compliant plan outside the exchange, as there’s no federal restriction on that.

Should immigrants consider short-term health insurance?

Immigrants who are unable to afford ACA-compliant coverage might find that a short-term health insurance plan may fit their needs, although it is not a replacement for major medical health insurance, as discussed more below. Short-term plans are not available in all states. And where they are available, duration limits vary considerably from one state to another, after the federal government announced in August 2025 that it was no longer enforcing the Biden administration's four-month limit on short-term policy duration, leaving this issue up to the states.²⁴

Short-term plans are not sold through the health insurance exchanges, so the exchange requirement that enrollees provide proof of legal residency does not apply to short-term plans. However, proof of residency may still be required by an insurer that offers short-term plans.

Short-term plans provide coverage that’s less comprehensive than ACA-compliant plans, and for the most part, they do not provide any coverage for pre-existing conditions. The premiums for short-term plans are lower than the unsubsidized premiums for ACA-compliant plans because short-term plans are not required to provide comprehensive coverage like ACA-compliant plans, do not cover things like the ACA’s 10 essential health benefits or pre-existing conditions, and do not provide minimum essential coverage.

Immigrants who are eligible for premium subsidies in the exchange will likely be best served by enrolling in an ACA-compliant plan through the exchange. The coverage will be comprehensive, with no limits on annual or lifetime benefits and no exclusions for pre-existing conditions. But as noted above, immigrants who have been in the U.S. under five years are no longer eligible for subsidies if their household income is less than the federal poverty level.

With any insurance plan, it’s important to read the fine print and understand the ins and outs of the coverage. That’s particularly important with short-term plans, as they’re not subject to the same sort of insurance regulations that apply to ACA-compliant major medical coverage. Some states have extensive rules for short-term plans, so availability varies considerably from one state to another. (You can click on a state on this map to see how your state regulates short-term plans.)

Travel insurance plans are another option, particularly for people who will be in the U.S. temporarily and who don’t qualify for premium subsidies in the exchange. Travel policy details and plan durations vary, although some policies are marketed for those who need multi-year coverage. Some people, including those with work or student visas, may find that they have the option to enroll in either a travel policy or a Marketplace policy.²⁵ But as noted above, people with temporary work or student visas (as opposed to a lawful permanent resident status) will not be eligible for Marketplace subsidies starting in 2027.

Like short-term plans, travel insurance policies are not compliant with the ACA, so they generally won’t cover pre-existing conditions, tend to have gaps in their coverage (since they don’t have to cover all of the essential health benefits), and will come with limits on how much they’ll pay for an enrollee’s medical care. But if the other alternative is to go uninsured, a travel insurance plan is better than no coverage at all.