Starting January 1, 2027, the federal premium tax credit and the cost-sharing reductions that lower deductibles on silver plans are limited to three groups of non-citizens: lawful permanent residents (green card holders), Cuban and Haitian entrants, and migrants living in the U.S. under the Compacts of Free Association. Everyone else who is “lawfully present” — refugees, asylees, people with Temporary Protected Status, and work and student visa holders — can still buy a marketplace plan, but at full price.
The change comes from the 2025 budget reconciliation law (H.R. 1), and open enrollment for 2027 coverage starts November 1, 2026. If your household includes anyone who isn’t a citizen or green card holder, the plan you have now may cost several hundred dollars a month more in January unless you act during open enrollment.
Status-by-Status: Who Gets Help in 2026 and 2027
| Immigration status | Subsidy in 2027 | Subsidy in 2026 | Can buy a marketplace plan? |
|---|---|---|---|
| U.S. citizen | Yes | Yes | Yes |
| Green card holder (lawful permanent resident) | Yes | Yes — except income under 100% FPL while barred from Medicaid | Yes |
| Cuban/Haitian entrant | Yes | Yes | Yes |
| COFA migrant (Micronesia, Marshall Islands, Palau) | Yes | Yes | Yes |
| Refugee or asylee | No | Yes (not under 100% FPL) | Yes |
| Temporary Protected Status (TPS) | No | Yes (not under 100% FPL) | Yes |
| Pending asylum applicant with work permit | No | Yes (not under 100% FPL) | Yes |
| Humanitarian parolee | No | Yes (not under 100% FPL) | Yes |
| Work visa: H-1B, H-4, L-1, L-2, E-1/E-2, O-1, TN | No | Yes (not under 100% FPL) | Yes |
| Student or exchange visa: F-1, J-1, M-1 | No | Yes (not under 100% FPL) | Yes |
| U visa, T visa, pending VAWA self-petition | No | Yes (not under 100% FPL) | Yes |
| DACA recipient | No | No | No (since August 2025) |
| Undocumented | No | No | No |
“Not under 100% FPL”: since January 1, 2026, lawfully present immigrants with income below the poverty line who are ineligible for Medicaid because of their status no longer get the premium tax credit. In 2026 the poverty line was $15,650 for a single adult. Sources: H.R. 1 §§ 71301–71302; Covered California and Kansas Health Institute summaries.
Two details catch people out. First, the list of people who keep eligibility is short and specific — a work permit, a pending green card application, or years of lawful residence on a visa does not put you in it. Second, the rule follows each person, not the household. A family can have members on both sides of the line.
What the Change Costs: An Example
The premium tax credit is the gap between a benchmark silver premium and the share of income you’re expected to pay. Losing it means paying the whole premium. Take a single 40-year-old earning $39,000 (about 250% of the poverty line):
| 2026 (with subsidy) | 2027 (no subsidy) | |
|---|---|---|
| Expected contribution at ~250% FPL | about 8.4% of income ≈ $275/month | — |
| Benchmark silver premium (illustrative) | $600/month | $600/month or more |
| Premium tax credit | about $325/month | $0 |
| What you pay for the benchmark plan | about $275/month | $600/month |
| Cost-sharing reduction on silver | Yes (lower deductible) | No |
Illustrative figures. Actual 2027 premiums are higher in most states — proposed increases were around 15% at the median — and vary by age and county.
For lower incomes the jump is larger, because the subsidy was doing more of the work. For someone near 150% of the poverty line who paid little or nothing for a silver plan in 2026, a full-price silver plan in 2027 can cost more than a fifth of their income.
Mixed-Status Families
If you have a spouse or children who are eligible — U.S.-citizen kids, a green card holder spouse — they can still get premium tax credits for their own coverage, based on the household’s income. The application asks about immigration status only for the people applying for coverage, and family members who aren’t applying don’t have to give their status. Practical consequences:
- An ineligible parent and eligible children may end up on separate plans, because the subsidy applies only to the eligible members’ share of the premium.
- Children in lower-income households may qualify for Medicaid or CHIP rather than a marketplace plan; check before assuming the marketplace is the only route.
- Report each person’s status accurately. Since the 2026 tax year, there is no cap on repaying excess advance credits, so subsidy paid for someone who wasn’t eligible comes back in full at tax time.
Medicaid and Medicare Are Changing Too
The same law narrows the other programs on a different schedule. Federally funded Medicaid and CHIP for non-citizens was limited to the same three groups on October 1, 2026, with states required to recheck status, and lawfully present people who aren’t green card holders begin losing Medicare in early 2027. Emergency Medicaid remains, and states can still cover lawfully residing children and pregnant people. We cover the timeline and the options in health coverage for refugees, asylees and TPS holders.
When You Get Your Green Card
Becoming a lawful permanent resident puts you back in the eligible group. If you’re already on a full-price marketplace plan, report the change to the marketplace as soon as the card is approved: a change that makes you newly eligible for financial help generally lets you start receiving the advance credit from the following month and opens a special enrollment period to switch plans — for example, from a bronze plan you chose to keep the premium down to a silver plan with cost-sharing reductions. If you aren’t enrolled, gaining eligible status can also qualify you for a special enrollment period; ask the marketplace when you report it.
What to Do During Open Enrollment (November 1, 2026 – January 15, 2027)
- Update your application before auto-renewal. Marketplaces will remove the subsidy for people outside the eligible groups, and you want to see the real 2027 price before January, not on your first bill.
- Compare at full price. Without cost-sharing reductions, silver plans lose much of their advantage. A bronze plan — which since 2026 can be paired with a health savings account — or a gold plan priced close to silver may be better value.
- Check employer coverage for every working adult. An employer plan that looked expensive next to a subsidized marketplace plan may now be the cheaper option, especially for family coverage.
- Ask about state programs. A few states fund coverage or premium help for some immigrants with state money; your state marketplace or Medicaid agency will know what applies.
- Enroll by December 15 for coverage starting January 1 on HealthCare.gov. State-run marketplaces set their own deadlines.
If you are on a work visa or run a business on an E-2 visa, the choices are different — employer plans, ICHRAs, and self-employed tax deductions matter more than the marketplace. See health insurance for H-1B, E-2 and other work visa holders. For the 2027 premium picture in your state, start from our state health insurance guides.
A note on immigration consequences: Covered California advises anyone planning to apply for a green card to talk to an immigration attorney before taking financial assistance, and public charge rules have been under revision. That’s a question for a qualified immigration lawyer, not an insurance site.
Frequently Asked Questions
Can green card holders still get ACA subsidies in 2027?
Yes. Lawful permanent residents remain eligible for premium tax credits and cost-sharing reductions in 2027, on the same income rules as citizens. The one exception, in effect since 2026, is that a green card holder with income below 100% of the poverty line who is barred from Medicaid by the five-year waiting period no longer gets the premium tax credit.
Can H-1B visa holders get marketplace subsidies in 2027?
No. From January 1, 2027, work visa holders, including H-1B, H-4, L-1 and E-2, are not eligible for premium tax credits or cost-sharing reductions. They can still enroll in a marketplace plan at full price during open enrollment or with a special enrollment period.
Do refugees and asylees lose ACA subsidies?
Yes, starting in 2027. Refugees, asylees, TPS holders, parolees and other lawfully present immigrants outside the three eligible groups lose premium tax credits on January 1, 2027. Eligibility returns once the person becomes a lawful permanent resident.
Can I still buy a marketplace plan if I lose the subsidy?
Yes, if you are lawfully present. Losing the subsidy does not bar you from enrolling; you pay the full premium. DACA recipients and undocumented immigrants cannot buy marketplace coverage at all, even at full price.
What happens when I get my green card in the middle of 2027?
Report the change to the marketplace right away. Becoming newly eligible for financial help generally lets you start receiving the advance premium tax credit from the following month and opens a special enrollment period to change plans, for example from bronze to a silver plan with cost-sharing reductions.
This content is for informational purposes only and does not constitute legal, immigration, tax, or insurance advice. Eligibility rules are being implemented through federal and state guidance that may change; confirm your situation with HealthCare.gov, your state marketplace, or a certified enrollment assister, and consult an immigration attorney about immigration consequences.