Health Insurance When You Are New to the United States
By Frank Caballero, licensed health insurance broker (NPN 21032307) · Updated
If you just moved to the United States, the health insurance system can be confusing even if you have bought insurance elsewhere for years. Eligibility depends on your immigration status, help with the cost depends on both status and income, and a major federal change takes effect in 2027. Here is a plain guide.
Private health insurance
Most people I help end up on a private plan, not a Marketplace plan. Private, medically underwritten health insurance is priced on your age, zip code and health instead of your income, so a strong year never raises your premium and there is no tax credit to pay back in April.
Why people leave the Marketplace
- Premiums keep climbing. Marketplace premiums are rising again for 2027.
- The subsidy cliff. Above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) you pay full price.
- Surprise tax bills. Underestimate your income and you repay the tax credit in April.
- Narrow networks. Many plans are local HMOs or EPOs that need referrals and cover little outside the area.
- High out-of-pocket costs. 2027 out-of-pocket maximums reach $12,000 per person and $24,000 per family.
- One window a year. Outside open enrollment you need a qualifying life event to enroll or switch.
What a private plan does differently
- Start any month. If approved, coverage can begin the first of next month, with no wait for open enrollment.
- Networks that travel. Many private plans use national PPO networks, which can give you in-network doctors outside your home state too. Networks vary by plan.
- Can cost less than full-price Marketplace plans for some healthy applicants above the subsidy line.
- Accident coverage the Marketplace does not offer. A private plan can be paired with accident coverage, a separate policy. What it includes varies by plan.
- Approval is based on health. You answer health questions, and acceptance is not guaranteed.
With a significant health condition, or income low enough for a large tax credit, a Marketplace plan can be the better fit, and I will tell you if it is. Either way you see both side by side.
Private plans are not ACA Marketplace plans. Benefits, exclusions and pre-existing condition rules differ by plan and by state, so review the plan details before you enroll.
Get a private plan quoteLearn more: coverage not based on income · how underwriting works · private vs Obamacare · PPO plans for individuals · switching from the Marketplace
First: you do not need prior U.S. coverage to enroll
Moving to the United States from abroad opens a 60-day special enrollment period on the Marketplace for people who are lawfully present, and unlike most moves, you do not need to have had coverage before. Private plans can be bought any month regardless.
Who can buy a Marketplace plan
Marketplace plans are available to U.S. citizens and nationals and to people who are lawfully present in the United States. Lawfully present includes, among others:
- Lawful permanent residents (green card holders).
- People on many work, student and other visas.
- Refugees and asylees.
- People with temporary protected status.
- Certain other humanitarian and pending statuses.
People who are not lawfully present cannot buy Marketplace coverage, even at full price, but they can buy private plans where carriers allow it, and they can use community health centers.
The 2027 change to tax credits for immigrants
Federal law passed in 2025 narrowed who can receive the Marketplace tax credit. Starting with 2027 coverage, among non-citizens, generally only these groups remain eligible for the credit:
- Lawful permanent residents.
- Cuban and Haitian entrants.
- Citizens of the Freely Associated States living here under a Compact of Free Association.
Many other lawfully present people, including refugees, asylees, people with temporary protected status and many visa holders, can still buy a Marketplace plan but generally cannot receive a tax credit for it starting in 2027. A separate change that started in 2026 also ended credits for lawfully present immigrants with income below the poverty line. Confirm your situation on HealthCare.gov before you enroll, because the details depend on your exact status.
For Florida, with its large Cuban and Haitian communities, the entrant category is important: many Cuban and Haitian entrants remain eligible for the credit.
If your income is very low
Medicaid eligibility for immigrants depends on status, how long you have held it and the state. Many lawful permanent residents must wait five years. Some groups, such as refugees, have different rules. Florida did not expand Medicaid, so most adults without dependent children do not qualify regardless of status. Children and pregnant women may have more options, including Florida KidCare for children.
Your options, by situation
Green card holder. You can buy a Marketplace plan and receive a credit if your household income is between 100 and 400 percent of the poverty level, up to $63,840 for one person and $132,000 for four for 2027 coverage. If your income is above that, or you are healthy, compare a private plan.
Work visa holder whose employer offers coverage. Your employer plan is usually the simplest choice. If your employer does not offer coverage, or not for your family, you can buy a Marketplace plan, but from 2027 you may not receive a credit. A private plan is often worth pricing.
Refugee or asylee. You can buy a Marketplace plan. From 2027, the credit is generally not available, so compare full-price Marketplace plans, private plans and any state or resettlement program support.
Parents visiting family. Visitors are generally not eligible for Marketplace plans. Visitor or travel medical insurance purchased before the trip is the usual solution.
Student. Many universities require and offer a student health plan. Compare it with Marketplace and private options if you are eligible.
Understanding U.S. insurance if you are used to another system
- Networks matter. Plans cover doctors and hospitals in their network; going outside it can cost much more.
- Deductibles and coinsurance. You often pay the first part of costs each year, then a percentage.
- Out-of-pocket maximum. A yearly limit on what you pay for covered in-network care.
- Open enrollment. Most Marketplace changes happen once a year, November 1 to January 15 for 2027 coverage.
- Emergency care. Emergency rooms must treat you regardless of insurance, but the bill can be very large without coverage.
Documents you may need
Your immigration documents, a Social Security number if you have one, proof of address and an income estimate. HealthCare.gov checks status electronically and may ask you to upload documents. Answer every request by the deadline.
Florida's large immigrant communities
Florida is home to large Cuban, Haitian, Venezuelan, Colombian, Puerto Rican, Brazilian and many other communities, and Tampa Bay is no exception. Several situations come up often:
- Cuban and Haitian entrants generally remain eligible for the Marketplace tax credit in 2027, and many qualify for meaningful help.
- Venezuelans and others with temporary protected status can still buy Marketplace plans, but from 2027 generally cannot receive the credit. A private plan or a full-price Marketplace plan are the main options, and children may qualify for programs adults do not.
- Puerto Ricans moving to Florida are U.S. citizens. Moving from Puerto Rico is treated as moving from outside the Marketplace area, which opens a special enrollment period.
- Green card holders in their first five years can buy Marketplace coverage with a credit even though they may not yet qualify for Medicaid.
Mixed-status families
Many families include members with different statuses: a citizen child, a green card holder parent, a parent with temporary status. Each person's eligibility is determined separately. A family can apply for eligible members without putting ineligible members at risk; HealthCare.gov only asks for immigration information for people who are applying for coverage. Children who are citizens may qualify for Medicaid or Florida KidCare even if their parents do not.
Employer coverage on a work visa
If your employer offers coverage, it is usually the simplest choice, and it is unaffected by the 2027 tax credit changes. Check whether the employer's family coverage is affordable for your spouse and children. If you change employers, losing coverage opens a 60-day Marketplace special enrollment period, and if approved, private plans can start any month.
A quick checklist
- Identify each family member's immigration status.
- Check who is eligible for Marketplace coverage and who is eligible for the credit in 2027.
- Check Medicaid and Florida KidCare for children and pregnant family members.
- Compare Marketplace and private plans for adults who lose the credit.
- Keep immigration documents ready to upload if HealthCare.gov requests them.
Help in English and Spanish
Many of my clients are new to the United States, and I work with them in English or Spanish by phone and video. I will check which options your status allows, price them and explain how each plan works in practice. No fee. Get a quote or call or text (786) 218-2384. Spanish speakers can also start in the Spanish section of the site.
Frequently asked questions
Can immigrants buy health insurance on the Marketplace?
People who are lawfully present in the United States can buy Marketplace plans. People who are not lawfully present cannot, but may be able to buy private plans or use community health centers.
Who loses the ACA tax credit in 2027?
Starting with 2027 coverage, non-citizens generally keep eligibility only if they are lawful permanent residents, Cuban and Haitian entrants or Compact of Free Association migrants. Many others, including refugees, asylees and people with temporary protected status, can buy a plan but generally cannot get the credit.
Do I need prior health insurance to enroll after moving to the U.S.?
No. Moving to the United States from abroad opens a 60-day special enrollment period without the prior-coverage requirement that applies to most moves.
Can green card holders get Medicaid right away?
Often not. Many lawful permanent residents must wait five years for Medicaid, and Florida did not expand Medicaid for most adults without children. Children and pregnant women may have more options.
What insurance should visiting parents have?
Visitors are generally not eligible for Marketplace plans. Visitor or travel medical insurance, bought before the trip, is the usual coverage.
Are Cuban and Haitian entrants still eligible for the ACA tax credit in 2027?
Generally yes. Cuban and Haitian entrants are one of the groups of non-citizens that remain eligible for the premium tax credit starting with 2027 coverage.
Can my citizen child get coverage if I am not eligible?
Yes. Each family member's eligibility is determined separately. A citizen child may qualify for Medicaid, Florida KidCare or a Marketplace plan even when a parent does not.
Related guides
Last updated 2026-10-21. General information, not tax or legal advice.