Rules for immigrants changed a lot in 2025 and 2026 because of a federal law passed in July 2025. Here is the picture as of November 2026.
You can buy a plan on healthcare.gov or your state's Marketplace if you live in the US and are lawfully present. That includes green card holders, refugees, asylees, people with TPS, and people with a valid nonimmigrant visa such as H-1B, L-1, F-1 or J-1.
Buying a plan is different from getting savings (the premium tax credit that lowers your monthly payment).
Savings: what changes on January 1, 2027
For plans starting January 1, 2027, only these noncitizens can get Marketplace savings: green card holders (lawful permanent residents), Cuban or Haitian entrants, and COFA migrants (citizens of Micronesia, the Marshall Islands and Palau living in the US).
Others who are lawfully present, such as H-1B, L-1, F-1, J-1 and their families, refugees, asylees and people with TPS, can still buy a plan but pay the full price.
Savings also depend on income, usually between 100% and 400% of the federal poverty level.
The larger "enhanced" savings of 2021 to 2025 ended on December 31, 2025, so many people pay more in 2026.
If you are choosing a plan for 2027, compare the full price with your job or school plan.
Since August 25, 2025, DACA recipients cannot get Marketplace coverage. Some states run their own programs. This differs by state; see In your state below.
Since October 1, 2026, federal Medicaid and CHIP cover only citizens, green card holders, Cuban or Haitian entrants and COFA migrants (plus a few smaller groups), if they meet the income rules.
Refugees and asylees without a green card lost federal Medicaid on that date. Once they get a green card, they usually do not have to wait five years.
The five-year bar: many green card holders must wait five years after getting their status before Medicaid or CHIP. During the wait, you can use the Marketplace.
States may cover children and pregnant people who are lawfully living in the US without the five-year wait, and some states pay for coverage with their own money. This differs by state.
Emergency Medicaid pays hospitals for emergency care, including labor and delivery, for people who meet income rules but not the status rules. Ask the hospital's financial office.
Write down your exact status and the date you got it.
Open healthcare.gov (or your state's site) and answer the questions. It checks your status with DHS automatically.
If it asks for documents, upload them before the deadline in your account.
Before applying for Medicaid or CHIP, read the guide on public benefits and public charge.
Thinking "I can't get savings" means "I can't buy a plan". You usually can.
Not reporting a new green card. It can change what you qualify for.