Health insurance for green card holders, visa holders and non-citizens: the 2027 subsidy rules
Starting January 1, 2027, most lawfully present immigrants who are not green card holders will lose the ACA premium tax credit. That includes E-2 investors, H-1B workers, students, asylum seekers, refugees and people with a pending green card application. They can still buy a marketplace plan, but at full price.
On October 15, 2026, the IRS and Treasury published a proposed rule (REG-101576-26) explaining how they will apply these changes. The changes themselves come from the One Big Beautiful Bill Act, signed July 4, 2025. They are already law. The proposed rule only fills in the details.
Who keeps the subsidy and who loses it in 2027
From 2027, only citizens, U.S. nationals and three groups of “eligible aliens” can get the premium tax credit. Exchanges will check eligible-noncitizen status against DHS records before paying advance subsidies.
| Group | Subsidy in 2026 | Subsidy in 2027 | Can buy a plan at full price? |
|---|---|---|---|
| U.S. citizens and nationals | Yes | Yes | Yes |
| Green card holders, including conditional residents | Yes* | Yes | Yes |
| COFA migrants (Micronesia, Marshall Islands, Palau) | Yes* | Yes | Yes |
| Work and investor visas: E-1, E-2, E-3, H-1B, L-1, O-1, TN and dependents | Yes* | No | Yes |
| Pending green card application (I-485) | Yes* | No | Yes |
| Cuban or Haitian nationals with parole, pending asylum or in removal proceedings ("Cuban/Haitian entrants") | Yes* | Yes | Yes |
| Refugees, asylees, pending asylum, TPS, most parolees (other nationalities) | Yes* | No | Yes |
| Students and exchange visitors: F-1, J-1, M-1 | Yes* | No | Yes |
| T and U visa holders, VAWA self-petitioners, SIJ without a green card | Yes* | No | Yes |
| Undocumented immigrants and DACA recipients | No | No | No |
*In 2026, lawfully present immigrants qualify only if household income is at least 100% of the federal poverty line. The old exception for lower-income immigrants who couldn't get Medicaid because of their status ended this year.
Once a pending green card is approved, the person becomes an eligible alien. Report the approval to the marketplace right away so the subsidy can restart.
Cuban and Haitian nationals: you likely keep the subsidy.
The law names “Cuban/Haitian entrants” as eligible aliens, and that term is defined broadly (Refugee Education Assistance Act §501(e)). It covers any Cuban or Haitian national who was paroled into the U.S., has a pending asylum application, or is in removal proceedings without a final order. A Cuban with asylum pending stays eligible in 2027; a Venezuelan or Colombian with the identical case does not. Make sure the marketplace has your status recorded as Cuban/Haitian entrant, not as a generic asylum applicant.
Green card holders: nothing changes for you
Lawful permanent residents, including conditional residents with a two-year card, are “eligible aliens” under the new law. You qualify for the premium tax credit in 2027 on the same terms as a citizen: household income between 100% and 400% of the poverty line, no affordable employer coverage, and a marketplace plan. The five-year waiting period that applies to Medicaid does not apply to marketplace subsidies.
Two things still change for you in 2026 and 2027: the repayment cap on excess subsidy is gone, and from 2028 your eligibility must be verified before a month counts. Keep your income estimate current and upload documents when asked.
Sponsoring a relative? Using the premium tax credit is not considered a public charge, so it does not affect your sponsorship or their green card application.
Changes for everyone with a marketplace plan
Even if your immigration status isn't affected, three changes reach every subsidized enrollee.
1. No cap on paying back extra subsidy (2026 tax year)
If your income ends up higher than you estimated, you now repay the full excess advance subsidy at tax time (estimate yours). Before 2026, repayment was capped for households under 400% of the poverty line. Treasury estimates that in 2028 about 3.7 million returns will include a repayment of excess subsidy.
2. Income-only special enrollment periods no longer qualify
If you enroll mid-year only because your income is low, with no qualifying life event, that plan won't get the subsidy.
3. Stricter verification (2028)
A month won't count toward the subsidy unless the exchange verifies your residence and citizenship or lawful presence. For subsidized enrollees, it must also verify income, family size, other coverage and eligible-alien status. Exchanges must offer a pre-enrollment verification process starting no later than August 1 of the year before coverage. Life events like a birth, adoption, marriage, divorce or death get a waiver, so subsidies aren't held up. Treasury estimates about 50,000 families with newborns benefit from that waiver.
The practical rule: keep your income estimate current and answer document requests quickly.
States must start Medicaid work requirements by January 1, 2027. The proposed rule says that if an exchange finds you ineligible for Medicaid only because you did not meet the work requirement, you are treated as if you had Medicaid. Those months do not count toward the subsidy, so you would pay full price for a marketplace plan.
The block ends once you become ineligible for Medicaid for any other reason, such as your income rising above the Medicaid limit.
Florida is not affected. The work requirement applies only to the Medicaid expansion “adult group”, and Florida never expanded Medicaid, so there is no such group here. This matters in the 40 expansion states and DC.
Mixed-status families: citizen kids still qualify
If a parent loses the subsidy but a child is a U.S. citizen or green card holder, the child keeps their own eligibility. The IRS proposal explains the math. The family's premium and the benchmark plan cost leave out the ineligible members, and the subsidy covers only the eligible members' share. The family can stay on one plan. Form 1095-A will also exclude premiums tied to family members who are not eligible aliens.
Florida families should check KidCare first. A citizen child's eligibility doesn't depend on the parents' status, though household income counts.
| Program | Who qualifies (approx.) | Cost |
|---|---|---|
| Children's Medicaid | Up to about 138–145% of the poverty line, depending on age | Free |
| Florida KidCare CHIP | Up to about 215% of the poverty line | $15 or $20 a month |
| KidCare full-pay | Above the subsidized limit | Full premium |
For a family of three, 215% of the poverty line is about $4,895 a month, or roughly $58,700 a year. Florida's planned expansion of KidCare to 300% has not taken effect. A child who qualifies for KidCare or Medicaid can't also get the marketplace subsidy, so it's one or the other.
Your options if you lose the subsidy
Losing the subsidy doesn't mean losing coverage. These options can bring the cost down.
Full-price plan finder →
Cheapest Bronze HSA, Silver and Gold for your ZIP.
Mixed-status calculator →
Who in your family still gets the credit, and how much.
Cover yourself through your business →
Small-group, ICHRA or the self-employed deduction, with a free broker.
Green card approval alert →
Restart the subsidy the month your I-485 is approved.
- 1Buy a marketplace plan at full price. Or buy the same plan directly from the insurer. Compare on total cost (premium plus deductible and copays), not premium alone.
- 2Consider a Bronze, HSA-eligible plan. Premiums are lower, and HSA contributions reduce your taxable income. Works best if you are healthy and can cover the deductible.
- 3Use your business, if you own one. E-2 investors and other business owners may be able to deduct premiums as self-employed health insurance, or offer a small-group plan or an individual-coverage HRA. Ask a CPA and a licensed broker to compare. Make sure a company plan does not cancel a child’s subsidy.
- 4Cover eligible family members separately. Enroll citizen children in KidCare or Medicaid if eligible, or claim the subsidy for their share of a family marketplace plan.
- 5Use sliding-scale care. Federally qualified health centers charge by income regardless of immigration status. Emergency Medicaid covers emergencies for people otherwise ineligible because of status.
- 6Be cautious with short-term plans and health-sharing ministries. They can exclude pre-existing conditions and are not ACA coverage.
Checklist before 2027 open enrollment
- Update your 2026 income estimate now. There is no longer a cap on repaying excess subsidy at tax time.
- Answer immigration status questions accurately. Claiming an eligible status you do not hold means repaying the full subsidy.
- Budget for your 2027 full-price premium. Run an estimate now so January is not a surprise.
- Check KidCare or Medicaid for citizen children. A child’s eligibility does not depend on the parents’ status.
- Ask your immigration attorney about benefits and a pending case. Public-charge rules are separate from this change, but ask before you rely on any program.
- Report a green card approval to the marketplace the day you get it. Your subsidy can restart for the months that follow.
Key dates
Jan 1, 2026 — Already in effect
Repayment cap ends; income-only enrollment periods lose the subsidy; the under-100%-of-poverty exception for immigrants barred from Medicaid ends.
Oct 15, 2026 — IRS proposed rule published
REG-101576-26 appears in the Federal Register, explaining how Treasury and the IRS will apply the new law.
Nov 30, 2026 — Public comment deadline
Comments and requests to speak at the hearing must be received by this date. File at regulations.gov.
Dec 4, 2026 — Deadline to request hearing attendance
Requests to attend the telephone hearing are due by 5 p.m. ET.
Dec 8, 2026 — IRS telephone public hearing
10 a.m. ET.
Jan 1, 2027 — Subsidy limited to citizens, nationals and eligible aliens
The new eligibility rules apply to every month of 2027 coverage. Also from 2027, if you are turned down for Medicaid only because you did not meet a state work requirement, you are treated as if you had Medicaid and cannot get the subsidy for those months.
Jan 1, 2028 — Exchange verification required
A month counts toward the subsidy only if the exchange has verified your eligibility. Exchanges must offer pre-enrollment verification starting no later than August 1.
Frequently asked questions
Sources
- IRS/Treasury proposed rule, Premium Tax Credit, REG-101576-26 (Federal Register, Oct. 15, 2026)
- Treasury press release announcing the proposed rule (Oct. 14, 2026)
- CMS guidance on noncitizen eligibility for APTC and CSR, plan year 2027
- Medicaid.gov BHP 2027 bulletin, eligible alien definition
- Health Affairs on the HHS final rule
- Florida Health Justice, 2026 KidCare eligibility levels
This article is general information, not legal, tax or immigration advice. Rules may change. Talk to a licensed broker, tax professional or immigration attorney about your situation.