Gained Citizenship or Lawful Presence? Your Health Insurance Options

Who qualifies for this SEP

You qualify for a 60-day Special Enrollment Period if you've recently gained one of these immigration statuses:

• U.S. citizen — through naturalization or derivation
• Lawful permanent resident (green card holder)
• Refugee or asylee
• Cuban/Haitian entrant
• Paroled into the U.S. for at least one year
• Conditional entrant (granted before 1980)
• Battered spouse, child, or parent with a pending or approved VAWA petition
• Victim of trafficking with a T visa or certification letter
• Granted withholding of deportation or removal

The key requirement: you must be "lawfully present" in the United States. The marketplace uses this specific legal definition, which covers a broad range of immigration statuses beyond just citizenship and green cards.

Being lawfully present lets you buy a marketplace plan. Getting help paying for it is a separate question, and the answer changed for 2027.

Who can get subsidies in 2027

Starting with 2027 coverage, premium tax credits and cost-sharing reductions are only available to:

• U.S. citizens and U.S. nationals
• Lawful permanent residents (green card holders)
• Cuban/Haitian entrants
• People lawfully living in the U.S. under a Compact of Free Association (COFA migrants from the Federated States of Micronesia, the Marshall Islands, and Palau)

If you are lawfully present but don't have one of those statuses (for example, a refugee or asylee who doesn't have a green card yet, a parolee, someone with Temporary Protected Status, or most visa holders), you can still enroll in a marketplace plan. You just pay the full price, with no premium tax credit and no cost-sharing reductions. DACA recipients are not eligible for marketplace coverage.

For citizens, nationals, and eligible green card holders, the subsidy is based on household income compared with the federal poverty level. A single person earning $35,000 is expected to pay about $220 a month for the benchmark Silver plan in 2027, with the tax credit covering the rest. At $25,000, that drops to about $95 a month, and Silver plans also come with cost-sharing reductions that lower deductibles and copays. There is no tax credit above 400% FPL ($63,840 for a single person).

One rule that used to help recent immigrants is gone. Lawfully present immigrants with income below 100% FPL ($15,960 for a single person) who couldn't get Medicaid because of their immigration status used to qualify for marketplace subsidies. Starting in 2026, they no longer do. They can still buy a plan at full price.

If you already have a marketplace plan and your status isn't one of the eligible ones, or the marketplace can't confirm it, you may be renewed into a 2027 plan without any financial help. Log in during Open Enrollment (November 1, 2026 through January 15, 2027 on HealthCare.gov) and update your application with your current immigration documents. If you have since gotten a green card or become a citizen, that update can restore your subsidy.

Medicaid: new limits and the 5-year waiting period

Medicaid rules for immigrants also changed. Since October 1, 2026, federal Medicaid and CHIP funding is generally limited to the same groups listed above: citizens and nationals, green card holders, Cuban/Haitian entrants, and COFA migrants. Refugees, asylees, parolees, and trafficking victims who don't also have one of those statuses generally no longer qualify for full Medicaid or CHIP. Some states may choose to cover them with state-only funds, so check with your state. Emergency Medicaid, which pays for treatment of an emergency medical condition, is still available regardless of status.

Most green card holders still have to wait 5 years before they can get full Medicaid, even if their income is low enough. This is often called the "5-year bar." During that waiting period, a marketplace plan with a premium tax credit is usually the most affordable option, as long as your income is at least 100% FPL.

Who is exempt from the 5-year bar:

• Cuban/Haitian entrants
• COFA migrants
• Green card holders who are veterans or active-duty service members, and certain family members
• Children and pregnant people who are lawfully residing in the U.S., in states that have chosen to cover them without the wait

The 5-year clock generally starts from the date you gained qualified immigrant status, which for green card holders is usually the date on your permanent resident card. If you were admitted as a refugee or granted asylum before getting your green card, ask your state Medicaid agency how the waiting period applies to you.

CHIP and coverage for children

CHIP follows the same new federal limits as Medicaid. The big exception is a state option to cover lawfully residing children and pregnant people without the 5-year wait. That option was not changed, so in states that use it, lawfully present children and pregnant people can often enroll in Medicaid or CHIP right away. Rules vary a lot by state, so check your state's program.

Documents you'll need

The marketplace will verify your immigration status electronically in most cases. When you apply for financial help, you'll be asked whether you have one of the eligible statuses. Have these documents ready:

• Naturalization certificate(Form N-550 or N-570) if you're a new citizen
• Permanent resident card (green card, Form I-551)
• Employment Authorization Document (EAD) — Form I-766
• Arrival/Departure Record — Form I-94
• Refugee travel document or asylum approval letter
• Foreign passport with relevant visa stamp
• Document expiration date — the marketplace needs to know when your status expires (if applicable)
• Social Security number(if you have one — it's not required to apply, but it speeds up verification)
• Income documentation — pay stubs, tax return, or self-employment records for the subsidy calculation

If the marketplace can't verify your status electronically, it will send a notice asking you to upload documents. On HealthCare.gov you have 95 days to respond, and you can keep your coverage (and any subsidy you qualify for) while that check is open. Don't ignore the notice. If you don't send documents, you can lose your subsidy or your coverage.

Common mistakes to avoid

Assuming you need citizenship for marketplace coverage. You do not. Lawfully present immigrants can buy marketplace plans. For 2027, green card holders, Cuban/Haitian entrants, and COFA migrants can also get subsidies on the same terms as citizens. Other lawfully present immigrants can enroll but pay full price.

Missing the 60-day enrollment window.The SEP starts from the date you gain your new status (the date on your approval document). If you wait too long, you'll need to wait for Open Enrollment, which runs November 1 through January 15 on HealthCare.gov.

Not updating your application after a status change. If you get a green card or become a citizen while you're enrolled, report it. Moving from a status that pays full price to one that qualifies for subsidies can lower your premium a lot, but only if the marketplace knows.

Not checking Medicaid.If you're a Cuban/Haitian entrant, a COFA migrant, or a green card holder who is past or exempt from the 5-year wait, you can get Medicaid if your income qualifies. Medicaid is free or nearly free and covers more than many marketplace plans. Don't pay for marketplace coverage if you qualify for Medicaid.

Confusing household members' statuses.In a mixed-status household, each person's eligibility is determined individually. A citizen child may qualify for Medicaid, CHIP, or a subsidized plan while a parent with a different lawful status pays full price for their own coverage. The marketplace application handles this, but it helps to understand it.

Using an expired immigration document. Your marketplace coverage is linked to your immigration status. If your EAD or visa expires, you need to renew it and update your marketplace application. A lapse in status can result in loss of coverage.

Step-by-step action plan

1. Gather your immigration documents.You'll need your approval notice, card, or other proof of lawful presence with the effective date and any alien/USCIS number.
2. Check Medicaid eligibility first.If you're a citizen, a green card holder past or exempt from the 5-year wait, a Cuban/Haitian entrant, or a COFA migrant, and your income is below 138% FPL in a state that expanded Medicaid, apply for Medicaid through your state. If you have another status, ask your state whether it offers any state-funded coverage.
3. Start your marketplace application. Go to HealthCare.gov (or your state exchange) or ask Nora to help you compare plans. Select "gained lawful presence" or "became a citizen" as your qualifying event.
4. Estimate your annual income carefully.Include all household members' income. If you just started working in the U.S., project your expected earnings through December 31.
5. Enroll within 60 days of your status date. The effective date on your immigration document is day one. On HealthCare.gov, coverage starts the 1st of the month after you pick a plan, so enrolling early in your window gets you covered sooner.
6. Pay your first premium. Coverage does not start until you make the first payment. Set up autopay to avoid accidental lapses.
7. Respond to any verification requests.If the marketplace can't verify your status electronically, upload the requested documents within the deadline (95 days on HealthCare.gov).