You can seek a discounted hip-pain visit at a health center now, then compare a college plan and Marketplace insurance—but whether a new plan is affordable depends on its actual costs, your household income and when you can enroll.

Chapter 9

The health center must operate in a manner such that no patient shall be denied service due to an individual’s inability to pay.

Chapter 9

A full discount is provided for individuals and families with annual incomes at or below 100 percent of the current FPG, unless a health center elects to have a nominal charge, which would be less than the fee paid by a patient in the first sliding fee discount pay class above 100 percent of the FPG.

Chapter 9

Health center patients who are eligible for sliding fee discounts and have third-party coverage are charged no more for any out-of-pocket costs than they would have paid under the applicable SFDS discount pay class. Such discounts are subject to potential legal and contractual restrictions.

If your school offers a student health plan, enrolling in it can be an easy and affordable way to get basic insurance coverage. But, even if you have access to a student health plan, you can still apply for coverage through the Marketplace.

Individual with Non-immigrant Status including workers visas (such as H1, H-2A, H-2B), student visas, U-visa, T-visa, and other visas

Ambulatory patient services (outpatient care you get without being admitted to a hospital)

No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.

36B(c)(1)(A)

The term "applicable taxpayer" means, with respect to any taxable year, a taxpayer whose household income for the taxable year equals or exceeds 100 percent but does not exceed 400 percent of an amount equal to the poverty line for a family of the size involved.

§ 71302(a)

(a) IN GENERAL.—Section 36B(c)(1) is amended by striking subparagraph (B).

§ 71302(b)

(b) EFFECTIVE DATE.—The amendments made by this section shall apply to taxable years beginning after December 31, 2025.

No cost-sharing reduction shall be allowed under this section with respect to coverage for any month unless the month is a coverage month with respect to which a credit is allowed to the insured (or an applicable taxpayer on behalf of the insured) under section 36B of such title.

§ 71301(a)

Section 36B(e)(1) is amended by inserting ‘‘or, in the case of aliens who are lawfully present, are not eligible aliens’’ after ‘‘individuals who are not lawfully present’’.

§ 71301(e)

The amendments made by this section (other than the amendments made by subsection (c)) shall apply to taxable years beginning after December 31, 2026.

Overview

Beginning October 1, 2026, sections 1903(v)(5) and 2107(e)(1)(R) of the Social Security Act (the Act), as added and amended, respectively, by section 71109 of the WFTC legislation, generally limit federal financial participation (FFP) for medical assistance (Medicaid) and child or pregnancy-related health assistance (CHIP), with limited exceptions, to U.S. citizens and U.S. nationals, lawful permanent residents (LPRs), Cuban/Haitian entrants, and Compact of Free Association (COFA) migrants.

CHIPRA 214 option

If an applicant, who is not an FFP-eligible noncitizen, is a lawfully residing child or pregnant woman (e.g., a refugee) and meets all other eligibility requirements in the state, the applicant can be determined eligible for full Medicaid or CHIP benefits under the state’s CHIPRA 214 option.

Loss of qualifying coverage

Consumers also are not eligible for this SEP if the coverage they lost did not qualify as minimum essential coverage. For example, if the consumer lost short-term limited duration insurance (STLDI), they would not qualify.

**December 15:** Last day to enroll in or change plans for coverage to start January 1.

Usually, if you aren’t using health insurance to pay for your care, your health care provider must give you a good faith estimate of expected charges if you request one or schedule services at least 3 business days in advance.

62.14(a)

Sponsors must require that all exchange visitors have insurance in effect that covers the exchange visitors for sickness or accidents during the period of time that they participate in the sponsor's exchange visitor program.