Haris Ashley
Healthcare.gov is a marketplace for health insurance options for individuals and families. To qualify for Marketplace coverage, one must be a U.S. resident for tax purposes, including U.S. citizens and non-citizen nationals. Those living in U.S. territories cannot get health coverage through the Marketplace unless they also qualify as a resident in one of the 50 states or Washington, D.C. Individuals and families may qualify for free or low-cost coverage from Medicaid, the Children's Health Insurance Program (CHIP), or the Essential Plan through the Marketplace, with savings based on income estimates.
| Characteristics | Values |
|---|---|
| Citizenship | U.S. citizen, non-citizen national, or lawfully present immigrant |
| Residency | Resident for tax purposes; if living in a U.S. territory, must also qualify as a resident in one of the 50 states or Washington, D.C. |
| Income | Savings and premiums are based on your income estimate for the year you want coverage |
| Incarceration status | Cannot be currently incarcerated |
| Nursing care | Cannot be applying for coverage of nursing home care |
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What You'll Learn
US residents for tax purposes
If you are a US resident for tax purposes, you are eligible for Marketplace coverage. The IRS defines a US resident as someone who is either a US citizen or owes permanent allegiance to the country. In most cases, non-citizen US nationals are people born in American Samoa or born abroad with one or more American Samoan parents.
If you live in a US territory, you cannot get health coverage through the Marketplace unless you also qualify as a resident of one of the 50 states or Washington, DC. You should contact your territory's government offices to learn about other health care options, such as Medicaid and the Children's Health Insurance Program (CHIP).
Your eligibility for Marketplace savings and premiums is based on your income estimate for the year you want coverage. You can use the income calculator to estimate your income and find out if you qualify for Medicaid or CHIP. You can include deductions for conventional IRA contributions, student loan interest, and more.
Additionally, you can apply for and enroll in Marketplace health coverage by creating an account and filling out an application. You can also get free, non-biased personal help and assistance in languages other than English. You can search for local organizations that can help you apply for coverage by entering your city, state, or ZIP code. Alternatively, you can apply through an approved enrollment partner, such as an insurance company or online health insurance seller.
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Non-citizen US nationals
If you are a "qualified non-citizen", you are generally eligible for free or low-cost coverage through Medicaid and CHIP if you meet state income and residency rules. You must have obtained your "qualified" immigration status five years ago—this is called the five-year waiting period. However, if you are a refugee, asylee, or lawfully permanent resident who used to be a refugee or asylee, you are exempt from the five-year waiting period. If you are a qualified non-citizen in your five-year waiting period, you may be able to get Marketplace coverage if you are otherwise eligible.
Additionally, if you are a citizen of the Marshall Islands, Micronesia, or Palau and are living in one of the US states or territories (referred to as Compact of Free Association or COFA migrants), you may qualify for Medicaid or CHIP. States have the option to remove the five-year waiting period for these programs.
Applying for or receiving Medicaid or CHIP benefits or getting savings for Marketplace health coverage will not affect your chances of becoming a Lawful Permanent Resident or US citizen. However, there is an exception for people receiving long-term care in an institution at government expense, such as in a nursing facility, who may face barriers in obtaining a green card.
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People living in US territories
If you live in a US territory, you can check with your territory's government offices to learn about other health care options, such as Medicaid, the Children's Health Insurance Program (CHIP), and other territory-specific programs. These programs offer health coverage for those who meet certain eligibility requirements, such as income level and family size.
It is important to note that Marketplace insurance covers health care services provided within the US. Therefore, if you live outside the US, including in US territories, you may not be able to use Marketplace coverage for local health care providers. However, if you qualify as a US resident for tax purposes, you may still be eligible for Marketplace coverage, even if you live in a US territory. You can refer to the IRS guidelines to understand the criteria for being considered a US resident for tax reasons.
Additionally, Open Enrollment for 2026 coverage starts on November 1. By enrolling during this period, you can explore your options and determine if you qualify for savings on Marketplace premiums or programs like Medicaid or CHIP based on your income and other factors.
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People with specific income levels
If you are a US resident for tax purposes, you are eligible for Marketplace coverage. This includes US citizens and those who owe permanent allegiance to the US (in nearly all cases, non-citizen US nationals are people born in American Samoa or born abroad with one or more American Samoan parents). If you live in a US territory, you cannot get health coverage through the Marketplace unless you also qualify as a resident in any of the 50 states or Washington, DC.
To qualify for low-cost Marketplace health care, you can use the income calculator to make an estimate. This estimate is based on your income for the year you want coverage, not the previous year. You can count yourself, your spouse (if you're married), and everyone you'll claim as a tax dependent, including those who don't need coverage. Your total (or "gross") income for the tax year can be adjusted by deductions for conventional IRA contributions, student loan interest, and more. Adjusted gross income appears on IRS Form 1040, line 11.
Additionally, individuals and families may qualify for free or low-cost coverage from Medicaid, Child Health Plus, or the Essential Plan through the Marketplace. The Marketplace is the only place to get financial assistance from the federal government to lower the cost of your health coverage.
In New York, for example, NY State of Health is the official health plan Marketplace, where individuals can shop for, compare, and enroll in health coverage. To qualify, you must live in New York and be a US citizen, national, or lawfully present immigrant. Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid or the Essential Plan based on your income.
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Lawfully present immigrants
To be considered "lawfully present," immigrants must have had their "qualified" immigration status for five years, unless they are a refugee or asylee. In that case, there is no five-year waiting period. During the five-year waiting period, qualified non-citizens may be able to get Marketplace coverage if they are otherwise eligible.
It's important to note that undocumented immigrants are not eligible for Marketplace health coverage, but they may apply for coverage on behalf of documented individuals.
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Frequently asked questions
If you are a US resident for tax purposes, you are eligible for Marketplace coverage. This includes US citizens and those who owe permanent allegiance to the US, such as people born in American Samoa.
If you live in a US territory, you cannot get health coverage through the Marketplace unless you also qualify as a resident in any of the 50 states or Washington, DC. Contact your territory's government offices to learn about other health care options.
You can apply for Marketplace health coverage by logging in or creating an account on the official website. You can also apply through an approved enrollment partner, like an insurance company or online health insurance seller.
Your plan costs are based on your income estimate for the year you want coverage. You can use the income calculator on the website to make an estimate.
You may qualify for free or low-cost coverage from Medicaid, the Children's Health Insurance Program (CHIP), or similar state-specific programs.
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