September 27, 2026
Moving to the United States often creates an immediate health insurance problem. A new job may offer coverage, but the policy may not start on the first day. Marketplace coverage can fill the gap, but 2026 brought higher costs for many people after the expiration of enhanced ACA subsidies.
For immigrants arriving in the U.S., immigration status can also affect which coverage options are available. J-1 visitors face specific insurance requirements, while F-1 students are generally subject to school-specific rules.
The first few weeks are therefore less about finding the cheapest insurance and more about avoiding an uninsured gap.
The first question: When does employer coverage start?
Employer-sponsored insurance is often the simplest option when a new job provides it. However, coverage does not necessarily begin on the employee’s first day.
Federal rules generally prevent a group health plan from imposing a waiting period longer than 90 days after an employee becomes otherwise eligible for coverage. An employer can also use certain eligibility conditions, including a bona fide orientation period that can last up to one month.
That means the offer letter and benefits documents matter. The important date is not simply the employment start date. It is the date on which health coverage actually becomes effective.
A gap of several weeks can be significant in the U.S., where even routine medical care can generate substantial bills.
A move from another country can open a Marketplace window
A move to the United States from a foreign country can qualify for a Special Enrollment Period through the ACA Marketplace. HealthCare.gov specifically lists moving to the U.S. from a foreign country as a qualifying change in residence.
Special Enrollment Period rules generally provide a 60-day window around the qualifying event, although the exact rules depend on the type of event. Documentation may also be required to confirm the move and, in some cases, previous health coverage.
This can be particularly important when employer insurance has a waiting period. Marketplace coverage may provide an alternative rather than leaving the new arrival uninsured while waiting for employer benefits to begin.
Marketplace eligibility is also tied to immigration status. Lawfully present immigrants can generally use the Marketplace, including people with many work and student visas, lawful permanent residents and several humanitarian statuses. DACA recipients are currently not eligible for Marketplace coverage under the federal rules. See also: Who Among Non-Citizens Still Qualifies for Medicare After the 2026 Law?.
Marketplace coverage became more expensive in 2026
The cost calculation changed significantly this year.
The enhanced ACA premium tax credits that had been available since 2021 expired at the end of 2025. KFF estimates that average annual premium payments for subsidized Marketplace enrollees could rise from about $888 in 2025 to $1,904 in 2026, an increase of about 114%, if the enhanced credits were not renewed.
Actual premiums vary considerably by income, age, household size, location and plan.
The expiration also affected plan choices. KFF reported that the average Marketplace deductible increased from about $2,759 in 2025 to $3,786 in 2026, while more people shifted toward lower-premium Bronze plans with higher deductibles.
For someone arriving in the U.S. for the first time, comparing only the monthly premium can therefore give a misleading picture of the total cost.
Low-income green card holders face a separate issue
There is another important change for immigrants with lower incomes.
Before 2026, certain lawfully present immigrants with household income below 100% of the federal poverty level could qualify for Marketplace premium tax credits if they were excluded from Medicaid because of immigration rules, including the five-year Medicaid waiting period. See also: Green Card Holders and ACA Health Insurance: What Changes for 2027.
That changed on January 1, 2026. The 2025 federal reconciliation law eliminated Marketplace premium tax credit eligibility for lawfully present immigrants with incomes below 100% of the federal poverty level who fall into this category. KFF identifies immigrants in the five-year Medicaid waiting period as one of the groups affected.
The change is particularly relevant for newly arrived immigrants with very low income. Medicaid eligibility itself is also subject to the five-year waiting period for many qualified immigrants, although refugees, asylees and certain other groups are treated differently and states can provide additional coverage for some children and pregnant people.
There are also further Marketplace immigration changes scheduled for January 1, 2027, when subsidized Marketplace coverage will be restricted to a narrower group of lawfully present immigrants, including green card holders, certain Cuban and Haitian entrants and COFA migrants.
J-1 visitors have specific insurance requirements
J-1 exchange visitors cannot simply choose any health plan that looks inexpensive.
The Department of State requires J-1 participants and their J-2 dependents to maintain insurance meeting specific minimum standards during the exchange program. The policy must provide at least:
- $100,000 in medical benefits per accident or illness
- $50,000 for medical evacuation to the home country
- $25,000 for repatriation of remains
- A deductible of no more than $500 per accident or illness
The requirements come from the federal Exchange Visitor Program regulations.
A normal health insurance policy may not automatically satisfy every J-1 requirement. Exchange visitors therefore need to check the policy against the federal requirements and any additional rules imposed by the program sponsor.
F-1 students have a different situation
F-1 students do not have the same federal insurance requirements that apply to J-1 exchange visitors.
Instead, insurance requirements often come from the university or educational institution. Some schools require students to enroll in a university health plan, while others allow students to waive that plan if their existing insurance meets specific requirements.
The school’s international student or student health office is therefore an important source for the exact requirements.
What about a short-term health plan?
Short-term, limited-duration insurance can appear attractive because it may be cheaper than comprehensive coverage.
But federal rules changed the maximum duration for new short-term policies. For policies sold or issued on or after September 1, 2024, the federal definition generally limits the initial term to no more than three months and the total coverage period to no more than four months, including renewals or extensions. State rules can impose additional restrictions.
Short-term insurance also does not have to provide the same protections as ACA-compliant Marketplace coverage.
That can make a major difference when a medical problem appears. Before choosing a short-term policy, the exclusions, deductible, maximum benefits, prescription coverage and treatment limitations need to be examined carefully.
For someone waiting only a few weeks for employer coverage, a short-term policy may look like a simple bridge. But the lower premium does not necessarily mean lower financial risk.
Is there a federal penalty for going uninsured?
The federal penalty for not having health insurance has been reduced to $0 since 2019.
That does not mean being uninsured is financially harmless. Medical treatment in the U.S. can be extremely expensive, and several states have their own individual health insurance mandates or penalties.
The practical issue is therefore not simply whether a federal tax penalty applies. The larger issue is exposure to medical bills during the uninsured period.
The main options for a new arrival
| Situation | Potential option | Main issue |
|---|---|---|
| Employer coverage starts immediately | Employer plan | Compare deductible, network and out-of-pocket maximum |
| Employer coverage starts later | Marketplace or other temporary coverage | Avoid an uninsured gap |
| Recently moved to the U.S. | Marketplace Special Enrollment Period | Enrollment deadlines and documentation |
| Lawfully present immigrant | Marketplace, if eligible | Immigration status and income affect eligibility |
| J-1/J-2 | Compliant health insurance | Must meet federal J-1 insurance requirements |
| F-1 student | University plan or qualifying alternative | School-specific requirements |
| Short gap before employer insurance | Short-term plan may be available | Limited benefits and federal/state restrictions |
What should happen during the first week?
The benefits department or HR team should first confirm the exact employer coverage start date. The summary of benefits should also be reviewed for the deductible, out-of-pocket maximum, network and prescription coverage.
If employer insurance does not begin immediately, the Marketplace should be checked rather than assuming there is no option outside the annual enrollment period. A move to the U.S. can create a Special Enrollment Period, subject to the applicable eligibility and documentation rules.
Immigration status should also be checked before relying on a Marketplace subsidy. The rules are different for green card holders, work-visa holders, students, refugees, asylees and other categories, and additional changes are scheduled for 2027.
For people arriving near the end of 2026, the next annual Marketplace Open Enrollment period begins November 1, 2026, and runs through January 15, 2027. See also: Medicare Enrollment Ends December 7: What Changes for 2027, Plus the Part A Bill Immigrants Do Not Expect.
The most important point is simple: health insurance should be treated as part of the relocation plan, not as something to figure out after arriving. The gap between the first day of work and the first day of coverage can be expensive, and immigration status can affect which alternatives are available.
Sources
- HealthCare.gov: Special Enrollment Periods
- HealthCare.gov: Immigration status and Marketplace eligibility
- HealthCare.gov: Coverage for lawfully present immigrants
- U.S. Department of Labor: 90-day employer health plan waiting-period rule
- U.S. Department of State: J-1 insurance requirements
- CMS: Short-Term, Limited-Duration Insurance rule
- KFF: 2026 Marketplace premiums and expired enhanced tax credits
- KFF: Health coverage changes affecting immigrants
