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How to Navigate the U.S. Healthcare System as an Immigrant

In the United States, health insurance helps you and your family access necessary care, and it protects you from unaffordable medical bills. But healthcare can be confusing for immigrants because there isn’t a single form of health insurance in the United States. Instead, the U.S. healthcare system is a combination of publicly and privately funded programs with different requirements and rules for eligibility, depending on factors like where you live, your immigration status, and your income.

The good news is that many resources exist to help you understand your insurance options so you and your family can be protected. This article will explain what you need to know about U.S. healthcare as an immigrant, including the difference between publicly and privately funded programs and the definitions of common terms like “primary care physician” and “PPO.”

Why You Want Healthcare as an Immigrant

Nobody plans to get sick or hurt, but unfortunately, it can happen to anyone — and when it does, it pays to be insured.

Think of health insurance as a contract between you and the insurance company. When you buy a plan, the company agrees to pay part of your medical costs. Health insurance helps cover the costs of care like emergency room visits, medicine, and regular check-ups with your doctor so you and your family can stay in good health.

The Affordable Care Act requires most U.S. citizens and lawfully present immigrants to a minimum level of coverage, but there isn’t a penalty if you don’t have health insurance.

However, uninsured adults in the United States are more likely to have poor health than insured adults. And according to the Kaiser Family Foundation, people of color are less likely to have health insurance than white people. That’s a problem because people without insurance have worse access to care than people who are insured, and when the uninsured do seek care, they often face unaffordable medical bills.

An Overview of Healthcare Options for Immigrants

Many people in the United States have health insurance through their employer, but not all employers offer insurance plans. Some insurance plans will not cover everything you and your family need or can afford. That’s why people enroll in public programs like Medicare or Medicaid, or they shop for private insurance plans. We’ll explain both below.

Am I eligible for health insurance?

Lawfully present immigrants are eligible for health coverage through the Health Insurance Marketplace, a service operated by the federal government that helps people shop for and enroll in health insurance.

“Lawfully present” means that you have:

Qualified non-citizen immigration status without a waiting period, such as a green card holder, asylee, or refugee
Humanitarian status or circumstances
A valid non-immigrant visa
Legal status conferred by other laws, such as temporary resident status
Or any of these immigration statuses

It’s important to know that you can find health insurance that you can afford. Through the federal Health Care Reform law, also known as the Affordable Care Act, ACA, or Obamacare, you may qualify for subsidies that make health insurance cheaper.

And if you don’t have eligible immigration status, you may still qualify for limited emergency services through Medicaid, depending on your state. Undocumented immigrants are not eligible for Medicaid or Marketplace coverage.

Publicly Funded Insurance Programs

If you are a lawfully present immigrant and meet your state’s income eligibility rules, you’re generally eligible for two government-funded programs: Medicaid and Children’s Health Insurance Program (CHIP).

Medicaid

As a state and federal program that provides health insurance for low-income individuals, Medicaid coverage can vary depending on where you live. It might be called something different, like Medi-Cal in California and Apple Health in Washington, and the services may vary from state to state.

Broadly speaking, Medicaid covers services like inpatient and outpatient hospital services, physician services, and laboratory and x-ray services. The income levels vary by state, but even if you don’t qualify based on income, you may be eligible for state programs based on factors like family status and disability.

CHIP

For families that earn too much money to qualify for Medicaid, CHIP provides low-cost coverage for children. Like Medicaid, CHIP is administered at the state level, so eligibility and coverage will vary depending on where you live. But every state offers CHIP benefits, which cover services like routine check-ups, immunizations, prescriptions, and emergency services.

You can apply for and enroll in Medicaid or CHIP any time of year. If you qualify, your coverage starts immediately. However, it’s important to note that some states require a five-year waiting period before you can enroll in these programs.

The best way to find out if you qualify is to fill out a Marketplace application. If you (or someone in your household) qualifies, you’ll be contacted by your state agency about enrollment.

It’s important to note that some states require a five-year waiting period for some lawfully present immigrants. That means you must maintain your qualified status for five years before you can enroll in Medicaid and CHIP.

However, you may still be eligible for emergency Medicaid, or other insurance programs available on the Marketplace.

Private insurance programs

Private health insurance is any form of coverage that is offered by a company, rather than the state or federal government. Employer-sponsored plans are generally private insurance plans.

Just because an insurance plan isn’t government-funded doesn’t mean it’s less affordable; depending on your income, you may be eligible for subsidies that make some private plans cheaper. You may also be eligible for state-approved private health insurance plans, such as Qualified Health Plans available in the state of Washington.

You can find private health insurance on the Marketplace. As opposed to off-Marketplace plans, private health insurance on the Marketplace are required to cover health benefits deemed essential, such as emergency services, hospitalization, mental health and substance use disorder services, and prescription drugs.

Keep in mind that you can only enroll in private health insurance on the Marketplace during the Open Enrollment period. Certain life events, like moving or getting married, are considered qualifying life events that allow you to enroll in health insurance outside of the Open Enrollment period.

Eligibility for Government Heath Insurance Programs

Legal

Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act marketplaces have immigration-related restrictions that block many people from obtaining health coverage through these programs. These eligibility restrictions are complex, program-specific and in some cases vary by state. The questions and answers below seek to clarify these eligibility rules.

*Note, this FAQ includes information on changes to coverage programs (including effective dates) as a result of the One Big Beautiful Bill Act of 2025 (“reconciliation megabill”).

↓ Download PDF in English: Health Insurance Affordability Programs’ Eligibility Based on Immigration Status
↓ Download PDF in Spanish: Elegibilidad para programas de seguro médico asequible según el estatus de inmigración

1. What are the immigration-related eligibility requirements for Medicaid and CHIP?

The general rules related to eligibility based off immigration status for Medicaid and CHIP are grounded in the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. PRWORA restricted eligibility for many people who are immigrants by creating two categories of immigration statuses used in determining eligibility for public benefits: “qualified” and “not qualified.”

In general, people who are immigrants must be in a qualified status to be eligible for Medicaid and CHIP. However, even people with qualified immigration statuses may not be eligible because the law also created a five-year waiting period for many people who have qualified immigration statuses. There are some groups who are not in a qualified status but meet the eligibility standard due to exceptions granted by Congress. All other immigration statuses are considered not qualified for purposes of Medicaid and CHIP eligibility. See Table 1 for specific information about the eligible categories.

Starting October 1, 2026, the “One Big Beautiful Bill Act” of 2025 (the reconciliation megabill) ends federal matching funds for Medicaid and CHIP for most categories of qualified immigration statuses.

Hospitals and other medical providers can get payment from Medicaid when they provide life-saving medical care to individuals who are ineligible for Medicaid due to their immigration status but meet all other eligibility criteria.

Additionally, some states have adopted more inclusive immigration-related eligibility criteria for children and pregnant people under the lawfully residing state option and the from conception to end of pregnancy option. These options were not changed by the reconciliation megabill.

2. Are people with qualified immigration statuses eligible for Medicaid or CHIP immediately upon obtaining a qualified status?

In general, people with qualified immigration statuses who entered the U.S. on or after August 22, 1996, must wait five years after obtaining a qualified status before meeting the immigration-related eligibility requirements for Medicaid or CHIP. This is often referred to as the “five-year bar.” However, there are exceptions and some people with eligible immigration statuses and/or circumstances do not have to meet the five-year waiting period requirement. It is important to note that a few states restrict eligibility for some adults with a qualified immigration status even after the five-year wait.²

Table 1: Immigration Categories Eligible for Medicaid and CHIP Coverage
Subject to Five-Year Waiting Period	Not Subject to Five-Year Waiting Period
“Qualified” Immigrants:People with lawful permanent resident status (LPR/green card holder)People with parole status in the U.S. for at least one yearCertain people who are domestic violence survivors and their children and/or parents	“Qualified” Immigrants:RefugeesAsyleesPeople with LPR status with 10 years’ credit for working in the U.S.People granted withholding of deportation or withholding of removalCuban/Haitian entrantsCertain victims of sex or labor traffickingCitizens of Compact of Free Association (COFA) nations residing in the U.S.People who are U.S. veterans or on active military duty and their spouses or childrenPeople who physically entered the U.S. before 8/22/96 and remained in the U.S. continuously until obtaining a qualified statusPeople with special immigrant visas from Iraq or AfghanistanChildren and pregnant people who are lawfully residing in the U.S. (at state option)People who are Amerasian immigrants
	Not Qualified but Meet Eligibility StandardMembers of a federally recognized Indian tribe or American Indians born in CanadaCertain people from Afghanistan or the Ukraine with parole status in the U.S.

3. Can states have less restrictive eligibility requirements for people who are immigrants?

Yes. States have the option to provide Medicaid and CHIP coverage to children and/or
pregnant people who are lawfully residing in the U.S. without a five year-waiting period. The term lawfully residing includes all qualified immigration statuses, as well as people with many other types of immigration statuses who have permission to live or work in the United States.

Under the CHIP from-conception-to-end-of-pregnancy option, states can use CHIP funding to provide pregnancy-related care to people who are otherwise ineligible for Medicaid and/or CHIP due to their immigration status. In addition, a growing number of states use state or local funds to provide Medicaid and CHIP to other groups, such as people who have not met the five-year bar, people with lawfully residing immigration statuses who do not have a qualified status, and people without a documented immigration status.

4. What are the immigration-related eligibility requirements to enroll in an ACA marketplace plan?

People must have a lawfully present immigration status to enroll in an ACA marketplace plan . In general, people permitted under the law to be in the U.S. if they meet all other requirements including state and/or marketplace service area residency requirements.

5. Are people with Deferred Action for Childhood Arrivals (DACA) eligible to enroll in an ACA marketplace plan?

The U.S. Department of Homeland Security can grant temporary administrative relief from deportation, which is referred to as deferred action, for a variety of reasons. Individuals granted deferred action are generally eligible to enroll in marketplace coverage. Beginning November 1, 2024, a Department of Health and Human Services (HHS) rule took effect that changed the “lawfully present” eligibility standard, making people with DACA newly eligible, allowing these individuals to enroll in ACA marketplace coverage. However, a new final rule subsequently issued by HHS bars people with DACA from ACA marketplace enrollment effective August 25, 2025. Any existing ACA coverage for DACA recipients will terminate as of October 1, 2025.

6. What are the immigration-related eligibility requirements for premium tax credits and cost sharing reductions in the ACA marketplaces?

People with a lawfully present immigration status are eligible to purchase ACA marketplace coverage and may also qualify for premium tax credits and cost sharing reductions if they meet all other requirements such as income, tax filing status, residence, etc. However, starting January 1, 2027, a far more limited group will be eligible for premium tax credits in the ACA marketplace. For additional information.

Currently, people who have a lawfully present immigration status but are ineligible for Medicaid based off immigration status can qualify for premium tax credits even with incomes below the poverty level. This provision was terminated by and starting January 1, 2026, no one will be eligible for premium tax credits in the ACA marketplace with income below the poverty level.

7. How are premium tax credits calculated for people with a lawfully present immigration status and household income below the poverty line?

Several states have created their own health coverage programs similar to Medicaid to offer coverage to certain groups who do not meet federal immigration-related eligibility criteria for Medicaid.⁴ These look-alike programs, which exist in 16 states and the District of Columbia, are primarily for children, but some also cover people who are pregnant and postpartum, older adults, people with specific statuses and/or other groups of adults. Because states do not receive federal matching funds for these Medicaid look-alike programs, coverage options may have narrower eligibility guidelines, provide fewer benefits than Medicaid and CHIP, or have enrollment caps.

Alternatively, Colorado and Washington states utilize Section 1332 State Innovation Waivers to operate state-funded programs that make private health plans accessible and affordable to people with low incomes who are ineligible for ACA marketplace plans due to their immigration status.

8. Are there health coverage options for people who do not meet the immigration-related eligibility requirements for health insurance affordability programs?

People without a documented immigration status are not eligible to purchase health insurance through the marketplaces but may enroll in private coverage outside the marketplace.

People who do not meet the immigration-related eligibility requirements for Medicaid but meet all other eligibility standards may be eligible for having limited treatment for life-threatening medical conditions paid for by Medicaid (including labor and delivery).

There are no immigration-related eligibility requirements for certain public health services including immunizations as well as services provided by Federally Qualified Health Centers, migrant and rural health centers, and hospital charity care. The Administration has issued guidance attempting to restrict access to some of these programs, based on immigration status. However, further guidance is still required before these changes can be implemented, and multiple states and impacted groups have sued to prevent the guidance from going into effect. Please reach out directly to program providers for the latest information.

In addition, some states provide coverage of pregnancy services to people regardless of immigration status, and a few states and local governments provide health coverage to children without a documented immigration status and/or some adults that do not meet the immigration-related requirements for health insurance affordability programs. People without a documented immigration status also can sign up for employer-sponsored insurance if their employer offers it.

9. What changes did the reconciliation megabill make to immigration-related eligibility for health insurance programs?

The reconciliation megabill ends federal Medicaid matching funds for most categories of immigration statuses. Starting October 1, 2026, states can only get federal matching funds to cover a new narrow megabill group in Medicaid and CHIP. This group includes U.S. citizens, lawful permanent residents (after completing the 5-year bar, when applicable), people from Compact of Free Association (COFA) nations residing in the U.S., and Cuban/ Haitian entrants. If states are unable to fully cover the cost of Medicaid and CHIP for these groups, they may opt to stop providing coverage to them.

Additionally, the megabill ends eligibility for premium tax credits (PTCs) in the ACA marketplace for most categories of immigration statuses. Starting January 1, 2027, access to PTCs will be limited to the new narrow megabill group (although these individuals will remain eligible to purchase full-cost ACA marketplace coverage).

The reconciliation megabill also terminates the special PTC rule that allows people with incomes below the poverty level who are lawfully present but ineligible for Medicaid because of their immigration status to get PTCs. Starting January 1, 2026, this group will no longer be eligible for PTCs (although these individuals will remain eligible to purchase full-cost ACA marketplace coverage).

Finally, the reconciliation megabill ends eligibility for Medicare for most categories of immigration statuses, limiting access only to the new narrow megabill group. This provision goes into effect immediately after enactment for new enrollees. Individuals who are already enrolled will have an 18-month window, until January 4, 2027, to terminate benefits.

If you are an undocumented immigrant…

Undocumented

If you aren’t lawfully present in the United States, it’s hard to get health insurance. But, trying to get it is a good idea, so that you don’t have to cover the full cost of healthcare on your own.

Does your employer offer health insurance? If so, consider taking it. You usually save money with a job-based plan compared to buying a plan on your own.
Does your employer not offer health insurance? Then, the question is whether you can afford to buy your own.
- If you can afford to buy your own health insurance. Undocumented immigrants are not allowed to use the government’s Health Insurance Marketplace to buy health insurance. But, you can buy a health plan directly from an insurance company or through an insurance broker. If you’re a college student, you can generally enroll in your college’s student health plan without having your immigration status questioned.
- If you can’t afford to buy your own health insurance. In many states, undocumented immigrants aren’t ordinarily allowed to sign up for Medicaid or CHIP—government health insurance programs for people with low incomes. But, rules about Medicaid and CHIP differ from state to state and in certain states you may be able to sign up.

Some states permit a category of undocumented immigrants known as Permanently Residing under Color of Law (PRUCOL) to qualify for Medicaid or other healthcare benefits. Those are immigrants who don’t otherwise qualify for public benefits but who plan to stay in the United States. The US Citizenship and Immigration Service knows about their undocumented status but is not trying to deport them.

Some states offer low-income, pregnant women access to CHIP through a State Plan Amendment. That lets an undocumented immigrant enroll her unborn child in CHIP. That way, she can get coverage for pre-birth care and labor and delivery services. Those women also may be covered by other state or local programs. Some states and cities also offer coverage to undocumented children. Check in your own city or state to see what kind of help is available.

Can Undocumented Immigrants Get SNAP or Medicaid?

Undocumented

Amid widespread misinformation about immigrants, SNAP, Medicaid, and government benefits, it’s critical to know the facts:

Undocumented immigrants are not eligible for federal benefits such as Medicaid, Medicare, SNAP, Social Security, or Affordable Care Act Marketplace health insurance.
Some lawfully present immigrants can qualify for benefits, but eligibility is severely limited. Green card holders must wait five years before qualifying for SNAP, and new federal restrictions have narrowed eligibility for Medicaid and SNAP beginning in 2026.
Undocumented immigrants can still receive emergency medical care. Federal law requires hospitals to provide emergency treatment regardless of immigration status.

Do undocumented immigrants qualify for federal healthcare benefits?

No. Undocumented immigrants do not have access to federally funded healthcare coverage, including Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP).

They are also unable to purchase health insurance coverage from the Affordable Care Act (ACA) Marketplace.

Are there any exceptions where undocumented immigrants could still get healthcare benefits?

Federal law mandates that hospitals provide emergency care to everyone, regardless of their immigration status.

Low-income noncitizens who don’t qualify for Medicare because of their immigration status can receive emergency treatment under the 1986 Emergency Medical Treatment and Active Labor Act. The federal Emergency Medicaid program then reimburses hospitals for emergency medical services, limited only to those needed to stabilize an individual who is at risk of permanent injury or death. Noncitizens do not receive any direct benefits from Emergency Medicaid, only hospitals.

However, due to new restrictions in President Trump’s OBBBA, states will receive less federal funding for these emergency services beginning October 1, 2026.

New Medicaid restrictions for lawful immigrants

Beginning October 1, 2026, OBBBA will restrict Medicaid eligibility to green card holders, certain Cuban-Haitian entrants, and people living in the United States under a Compact of Free Association, known as COFA citizens.

Previously qualified noncitizens will also lose access to Medicaid coverage under OBBBA, including but not limited to people granted asylum or refugee status, humanitarian parolees, and some survivors of domestic violence and human trafficking who have been granted immigration status.

Do undocumented immigrants qualify for SNAP benefits?

No, undocumented immigrants are not eligible to receive federal benefits under Supplemental Nutrition Assistance Program (SNAP), formerly known as the food stamps program.

However, SNAP benefits are provided to households rather than individuals. If, for example, the head of a household is undocumented, they may still apply for SNAP benefits for their U.S. citizen children. But benefits are calculated based on the number of eligible people in the household, so the assistance would only cover the U.S. citizen children—not the entire household.

Can other immigrants receive SNAP benefits?

Yes, but the majority must wait years before they can qualify. After obtaining a green card, eligible immigrants are subject to a five-year waiting period before they may apply for SNAP assistance, with limited exceptions.

Since the passage of OBBBA, only green card holders, Cuban-Haitian entrants, and COFA citizens can apply for SNAP benefits. Under the Act’s new restrictions, certain categories of noncitizens—asylees, refugees, parolees, and trafficking survivors—are no longer allowed to apply.

Many immigrants avoid applying for benefits even when they are eligible. The “public charge” rule of the first Trump administration saw families in mixed-status households unenrolling from public benefits for which they were entitled. Many feared it would impact their chances of obtaining a green card or visa in the future.

The Trump administration has since revived the public charge rule. If history repeats itself, we will see more people in mixed-status households go without the food assistance they need due to this climate of fear.

Do undocumented immigrants receive Social Security benefits?

No. Like most federal programs, Social Security is limited to U.S. citizens and specific groups of immigrants with lawful status.

While undocumented immigrants paid $26.2 billion into the Social Security Trust Fund in 2023—just one part of the estimated $89.8 billion they paid that year in combined federal, state, and local taxes—most undocumented immigrants will never collect these benefits.

Your rights to Healthcare Insurnace

Immigrant

You have the right to get healthcare no matter your immigration status or ability to pay, even if you do not have health insurance.

Under federal law, if you need emergency medical services, hospitals with emergency rooms must screen and treat you regardless of your immigration status, how much money you have, or whether you have insurance. Similarly, you can seek primary and preventive health care at community health centers regardless of your immigration status, your ability to pay, or whether you are insured.
You are not required to have U.S. citizenship, lawful immigration status, or a Social Security number (SSN) to receive health care services under federal law. Doctors, hospitals, clinics, health centers, or other medical providers may ask for this information to find out if you may be eligible for public health insurance, like Medicaid. But they cannot deny medical treatment based solely on your immigration status—or based on assumptions they make about your immigration status because of the language you speak, your accent, what you look like, or whether you have an SSN. In fact, doing so may violate federal civil rights laws.
Some states require hospitals to ask patients about their immigration status. If you are asked for your immigration status, you do not have to provide it, and a health care provider cannot refuse to treat you because you declined to share your immigration status information.

If you apply for health insurance, your personal information, including immigration status, is supposed to be kept private.

Federal privacy rules protect families applying for health insurance, including families whose members have different immigration statuses. The information you provide to apply for Medicaid, CHIP, or an ACA Marketplace plan may be used only for the operation of that program—not for immigration enforcement purposes. Government workers, enrollment assisters, and people who help with insurance applications are required by law to keep your information private and secure.

You should not be refused healthcare services because you don’t have identification.

Hospitals and health care providers may ask for photo identification, but not for purposes of immigration enforcement. Health care providers ask for identification to make sure that the person getting care is the same person whose name is on the medical record or prescription. You should not be refused health care because you do not have a photo ID.

You have the following health care options regardless of your immigration status or whether you have health insurance:

Basic emergency room treatment for serious medical emergencies, including labor and delivery.
Health care services from community health centers, migrant health centers, and free clinics.
Services from state or local departments of public health (including immunization, screening and treatment for communicable diseases).
Programs providing health services necessary to protect life or safety: including emergency medical, food or shelter programs; mental health crisis services; assistance for people experiencing domestic violence; crime victim assistance services and disaster relief.
Financial assistance or “charity care” programs at community health centers and most public and safety-net hospitals.
Note that some states provide free or low-cost public health insurance to children, pregnant individuals or other low-income residents regardless of their immigration status.

You do not need a Social Security number to apply for health insurance.

Whether you are applying for health insurance for yourself or on behalf of another person, your health insurance application may not be delayed or denied because you don’t have an SSN. Only people who have a valid SSN issued by the Social Security Administration are required to provide one.

You have a right to receive services in your language when you apply for health insurance and obtain health care.

You have a right to receive language assistance services at no cost when you seek health care at a hospital or community health center or are applying for Medicaid, CHIP, or a Marketplace plan. Hospitals, community health centers and government offices may use bilingual staff, telephone interpretation services, or qualified in-person interpreters to provide language assistance services. Children should not be asked to interpret for their family members, especially in health care settings.

What is health insurance?

Immigrant

Health insurance, or medical insurance, is a contract between you and a health insurer. It covers some or all of your healthcare costs in exchange for a monthly payment. The monthly cost of the insurance you pay is called the premium.

Having health insurance can be referred to as being covered or being insured. Health insurance can protect you from having to pay large medical bills. It is often better to pay the premium every month than suddenly get a huge bill from a hospital.

Health insurance plans typically pay for the following services:

Medical visits and screenings
Labs, imaging, and immunizations
Mental health services
Urgent care and emergency services
Prescription drugs

Health insurance companies offer multiple plans for different premiums. Each plan has specific coverage and conditions for a set monthly premium. Some health insurance providers also pay for vision and dental care.

Often, the insurance company does not pay for all of the expenses. You might have to pay a deductible when you get care. A deductible is an amount you have to pay before your insurance starts paying for your healthcare.

You may also have to make co-payments for certain medical services and prescriptions. Each plan also specifies which doctors and healthcare facilities you can visit.