Get health insurance

The United States has no universal health service. Medical care is billed at prices that have little relation to what anything costs elsewhere, and an uninsured emergency admission routinely produces a bill of tens of thousands of dollars. Insurance is not a luxury here.

Employer plan

Usually the cheapest, if offered

Marketplace

Subsidised by income; open enrolment each autumn

Medicaid

Free or near-free for low incomes; eligibility varies by state

Deadline

Moving to the U.S. opens a 60-day special enrolment window

The four routes

Through an employer. If your job offers a plan, this is normally the best value: the employer pays a large share of the premium. You have about 30 days from starting work to enrol, then must wait for the annual open enrolment period.

The Marketplace (healthcare.gov or your state's own exchange). Anyone lawfully present can buy a plan, and subsidies based on household income can reduce the premium substantially. Open enrolment runs each autumn — but arriving in the United States is a qualifying life event, giving you a 60-day special enrolment window from the date you arrive. Do not miss it.

Medicaid, for low incomes. Rules and names differ by state (Medi-Cal in California, MassHealth in Massachusetts). Many lawfully present immigrants face a five-year waiting period for federal Medicaid, but a number of states cover children, pregnant women, or all residents regardless of that rule, using their own funds.

Short-term travel or visitor policies, which cover emergencies but usually exclude anything ongoing. A stopgap, not a plan.

Deadlines are the thing that catches people

Missing a window usually means waiting until the next autumn with no coverage at all. The 60 days from arrival is the one most often lost, because it runs while you are occupied with everything else. Other qualifying events reopen it: marriage, a birth, losing employer coverage, or moving to a different state.

Medicaid and CHIP have no enrolment window — you can apply on any day of the year, and children are frequently eligible when adults in the same household are not.

Reading a plan

Term	What it means
Premium	What you pay monthly whether or not you use care
Deductible	What you pay yourself before the plan starts paying
Copay	A fixed amount per visit, e.g. $30 to see a doctor
Coinsurance	Your percentage share after the deductible
Out-of-pocket maximum	The most you can pay in a year — the number that matters most
Network	The doctors and hospitals the plan covers. Out-of-network costs far more.

A cheap premium with a $9,000 deductible is not cheap insurance. Compare the out-of-pocket maximum and the network before the monthly price. Choosing a plan and enrolling works through the comparison in detail.

If you have no coverage right now

You are not without options while you sort it out. Community health centres charge on a sliding scale and treat everyone regardless of insurance or status; emergency departments must stabilise you regardless of ability to pay; and Emergency Medicaid exists in every state to cover emergency treatment for people who meet the income rules but not the immigration ones. See where to go when you are sick.

Using public coverage and immigration status

Enrolling in Medicaid or Marketplace coverage does not, for most people, affect a future green card application. Under the rules in force until 17 September 2026, ordinary Medicaid, CHIP, emergency Medicaid and subsidised Marketplace plans are not counted against you — the public charge test is essentially limited to cash assistance for income maintenance and long-term institutional care.

The regulation setting out those definitions is rescinded from 18 September 2026 without a replacement, giving officers broader discretion. Public charge does not apply at all to refugees, asylees, U and T visa holders, VAWA self-petitioners or existing green card holders.

The fear of these rules keeps eligible families uninsured far more often than the rules themselves ever bite. Read will using benefits hurt my green card, and if your situation is at all uncertain ask an immigration lawyer or an accredited representative — not an insurance salesperson.