Health insurance options

There are five main ways to obtain health insurance in the U.S.: employer-sponsored insurance, the HealthCare.gov (or state) Marketplace, Medicaid and CHIP, Medicare, and student plans offered by schools. Which one you can access depends on your status, age, and income. On this page, you will find the requirements for each option, the change to premium assistance for immigrants beginning January 1, 2027, student and exchange visitor insurance, application methods, and phone numbers. For basic concepts such as premiums and deductibles, see 9.1 How the U.S. health system works.

• If you work at a job in the U.S.: first check the plan offered by your employer.
• If you do not have employer insurance or it is expensive: use HealthCare.gov or your state Marketplace.
• If your income is low: Medicaid or CHIP may be options; however, immigration-status requirements have been narrowed since October 1, 2026.
• If you are 65 or older: Medicare. If you have Medicare, you cannot buy a plan through the Marketplace.
• If you are an F-1/M-1 student or J-1 exchange visitor: use your school's plan or the mandatory insurance required by the J-1 program.
• If you are under 26: you may remain on your parent's plan.

• In most employer plans, the employer pays part of the premium. If you choose a Marketplace plan, the employer generally does not contribute to the premium.
• When you start a new job, your employer must provide notice about your health coverage options. Ask for these two documents:
  • Summary Plan Description (SPD)
  • Summary of Benefits and Coverage (SBC)
• The plan may have a waiting period. This period is generally no more than 90 days from the date you become eligible.
• You can add your spouse and children to the plan. Children can generally remain on a parent’s plan until age 26; marriage, leaving school, or moving out does not change this.
• When an employer offer is considered “affordable”: if the monthly premium you would pay for the employer’s lowest-cost plan is less than 9.96% of household income in 2026 and 10.22% in 2027, and the plan meets the minimum value standard, the offer is considered affordable.
  • If the offer is affordable for you, you cannot receive Marketplace premium assistance.
  • For family members, affordability is measured using the premium covering everyone. If the offer is affordable for you but expensive for your family, only family members may qualify for assistance.
• Some employers offer an account that helps pay your premiums instead of a plan (ICHRA or QSEHRA). This offer creates a special enrollment opportunity in the Marketplace; you enroll through the Marketplace call center.

• COBRA gives people who lose their job, have their work hours reduced, or lose coverage because of events such as divorce or death the right to temporarily continue their former employer’s plan.
• It generally applies to private-sector employers with 20 or more employees. Some states have their own rules covering smaller employers.
• Duration:
  • job loss or reduction in working hours: 18 months
  • employee’s death, divorce or legal separation, the employee becoming eligible for Medicare, or a child losing dependent status: up to 36 months
  • with a disability extension: up to 29 months total
• The premium is expensive: the plan may charge you up to 102% of the premium (up to 150% with a disability extension).
• You generally have 60 days to elect COBRA. After electing it, you have 45 days to make the first payment.
• COBRA is not mandatory. You can buy a Marketplace plan within 60 days after your employer coverage ends. If you voluntarily end COBRA early, you may have to wait until the next Open Enrollment Period to enter the Marketplace.

• Who can enroll:
  • Living in the U.S. If you are a U.S. resident for tax purposes, you meet this requirement (see 15.1 Tax residency).
  • Being a U.S. citizen or “lawfully present” person
  • Not being incarcerated
• Main statuses eligible to buy a plan: green card holders, refugees and asylees, people admitted to the U.S. under parole, Employment Authorization Document (EAD) holders, nonimmigrant visa holders including work and student visas (for example, H-1B, H-2A, and H-2B), Temporary Protected Status (TPS) holders, and certain other humanitarian statuses.
  • People whose green card applications (adjustment of status) are pending may also be eligible.
  • People covered by DACA cannot enroll in the Marketplace.
• Premium tax credit: if your annual income is between 100–400% of the federal poverty level (FPL), you may qualify for a tax credit that reduces your monthly premium.
  • For 2027 plans, the 2026 poverty guidelines are used to calculate assistance. This corresponds to approximately $15,960–$63,840 for a one-person household and $33,000–$132,000 for a four-person household. The limits are higher in Alaska and Hawaii.
  • Income is measured using modified adjusted gross income (MAGI). MAGI also includes untaxed foreign income. If you have income from Türkiye, include it in your application.
  • If you receive the credit in advance during the year (APTC), you reconcile it with your tax return at year-end by attaching Form 8962. If you received too much, you repay the excess through your taxes. See 15.3 Tax return.
• States with their own Marketplaces: in some states, applications are submitted through the state website instead of HealthCare.gov. For example, Covered California, Get Covered New Jersey, Get Covered Illinois, and Massachusetts Health Connector are official state Marketplaces. When you select your state on HealthCare.gov, you will be directed to the correct website.

• Since October 1, 2026, full Medicaid and CHIP coverage has generally been available only to U.S. citizens, green card holders, Cuban/Haitian entrants, and people covered by COFA.
• In some states, pregnant people and children who are “lawfully residing” may also qualify.
• Green card holders generally become eligible after a five-year waiting period. During this period, you can buy a Marketplace plan and remain eligible for premium assistance in 2027.
• You can apply for Medicaid and CHIP in any month of the year. For people without an eligible immigration status, Medicaid may cover treatment for an emergency medical condition if the state’s other requirements are met.
• For income limits, application steps, and effects on the green card process, see 16.3 Medicaid and CHIP and 16.5 “Public charge”.

• Medicare is a federal health program for people age 65 and older, certain younger people with disabilities, and people with end-stage renal disease.
• For enrollment periods, premiums, requirements for green card holders, and the immigration rule introduced by the 2025 law, see 17.6 Medicare.

• F-1 and M-1 students: according to the U.S. Department of Homeland Security, students are responsible for obtaining health insurance for themselves and their families. Schools’ insurance requirements and fees vary. Ask your school’s international student officer (DSO) about the requirements and costs.
• If your school offers a student health plan, it is an easy way to obtain basic coverage. You may still apply through the Marketplace; however, beginning in 2027, F-1 status will not qualify for premium assistance.
• J-1 exchange visitors: federal regulations (22 CFR 62.14) require insurance throughout the program. Your spouse and children must also be insured. The policy must include at least:
  • $100,000 in medical coverage per accident or illness
  • $25,000 for repatriation of remains in the event of death
  • $50,000 for medical evacuation to your country
  • a maximum deductible of $500 per accident or illness
  • the policy may require coinsurance of up to 25% of covered expenses and may impose a reasonable waiting period for pre-existing conditions.
  • Your program sponsor must inform you that you may also be subject to ACA rules.
• For other J-1 program rules, see 2.3 Exchange visitor (J-1); for F-1, see 2.2 Student visa (F-1).
• Students under 26 may remain on their parents’ plan. If your parent is in another state, check the plan’s network in the state where you study.

• Marketplace plans are for people living in the U.S. and cover services provided by U.S. providers. The Marketplace may not be an option for relatives visiting for a short time; research private travel health insurance options before travel.
• Short-term limited-duration health plans and health care sharing ministry plans are outside the federal protections against surprise bills under the No Surprises Act. Do not confuse these plans with Marketplace plans.

1. Use the screening tool to see options that fit your situation.
2. Prepare documents using HealthCare.gov’s checklist: information for everyone in the household, immigration documents (such as a green card or EAD), estimated income, and the employer’s insurance offer.
3. Create a HealthCare.gov account or go to your state Marketplace and complete the application.
4. Read your Eligibility Notice. If documents are requested, upload them by the deadline.
5. Select your plan and pay the first premium to the insurance company. Coverage does not begin until the first premium is paid.
6. Update your application if your income, household, or address changes during the year.

You can also apply by phone or with a paper form. Use the Find Local Help tool for local assistance.

• HealthCare.gov Marketplace Call Center — applications, plan selection, special enrollment
  • Phone: +1 800 318 2596 (TTY: +1 855 889 4325)
  • Hours: 24 hours a day, 7 days a week (except federal holidays)
  • Marketplaces established under the ACA are also required to provide free interpreters. When you call, say “Turkish” to request an interpreter.
  • Questions and documents cannot be submitted by email; upload documents through your account.
• Marketplace Appeals Center — appeals of eligibility decisions
  • Phone: +1 855 231 1751 (TTY: 711)
  • Hours: Monday–Friday, 7:00 a.m.–8:30 p.m. (U.S. Eastern Time)
• U.S. Department of Labor EBSA — employer plans and COBRA rights
  • Phone: +1 866 444 3272
  • Web: askebsa.dol.gov
• 1-800-MEDICARE — Medicare questions
  • Phone: +1 800 633 4227 (TTY: +1 877 486 2048)
• Local application assistance: Find Local Help

• Budgeting on the assumption that you will receive premium assistance with a visa such as H-1B or F-1 without knowing about the 2027 change.
• Failing to report income from Türkiye on the Marketplace application.
• Failing to report an income increase during the year and having to repay advance assistance at the end of the year.
• Voluntarily ending COBRA early and having to wait for the Open Enrollment Period for a new plan.
• Buying a cheap policy for a J-1 program that does not meet the minimum coverage requirements.

• I work with an H-1B visa, but my employer does not offer insurance. What can I do? You can buy a plan through the Marketplace. For 2026 plans, you may qualify for assistance based on your income; beginning January 1, 2027, you can buy a plan but cannot receive assistance.
• I just received my green card. I cannot get Medicaid. What should I do? You can buy a Marketplace plan during the five-year waiting period. Green card holders will remain eligible for income-based premium assistance in 2027.
• My green card application (I-485) is pending. Can I enroll in the Marketplace? People with pending adjustment-of-status applications may qualify for Marketplace coverage. Enter your status and document information accurately in the application.
• I am a student. Is school insurance mandatory? For F-1 and M-1 students, the school determines the requirement; ask your school’s international student office. For J-1 visitors, insurance is mandatory under federal regulations.
• I left my job. COBRA or Marketplace? Compare both. You can choose a Marketplace plan within 60 days after your employer coverage ends. With COBRA, you pay the entire premium plus an additional fee of up to 2%.

• HealthCare.gov – Screening tool
• HealthCare.gov – List of eligible immigration statuses
• HealthCare.gov – Application checklist (PDF)
• CMS – Paper application form: Application for Health Coverage & Help Paying Costs (PDF)
• U.S. Department of Labor – Job changes and health options (PDF)
• U.S. Department of Labor – Life changes and health options (PDF)
• IRS – Form 8962, Premium Tax Credit (PDF) · Form 8962 instructions (PDF)
• eCFR – 22 CFR 62.14 J-1 insurance requirement