Choose US health insurance

US health insurance is a monthly contract. You, and often your employer, pay a premium every month, and the insurer covers a negotiated share of your medical costs in return. Healthcare here is not funded through taxes the way it is in most countries. Coverage is split across private plans, employer plans, and government programs: Medicaid, Medicare, and the Children's Health Insurance Program (CHIP).

Four numbers define almost every plan. The premium is what you pay every month to hold coverage, whether you use it or not.

The deductible is what you pay yourself each year before the insurer starts sharing costs.

Copays and coinsurance are your share of each visit or prescription once you have met the deductible. A copay is a flat fee, such as $30 for a doctor visit. Coinsurance is a percentage, such as 20% of the bill.

The out-of-pocket maximum is a hard cap on what you spend in a plan year. For the 2026 plan year, healthcare.gov sets that cap at $10,600 for one person and $21,200 for a family. Once you reach it, the plan pays 100% of covered in-network care for the rest of the year.

A cheap plan with a $7,000 deductible can cost you more across a year than a pricier plan with a $1,000 deductible. Which one wins depends on how much care you use.

Which coverage fits you depends on your visa, your employer, your income, and your state. Five kinds cover almost every newcomer.

Employer-sponsored group plans are the default for full-time US employees. The employer pays a large share of the premium and the rest comes out of your paycheck before tax. This is the best value for most people who qualify.

Affordable Care Act (ACA) Marketplace plans are individual plans sold on Healthcare.gov or a state exchange. Most lawfully present immigrants can buy one. Premium tax credits still exist and are based on income, but they are much smaller since the enhanced credits expired on December 31, 2025.

Medicaid is free or low-cost government coverage for people with low income. Most non-citizens face a five-year waiting period, and the exemptions for humanitarian statuses end on October 1, 2026. The warning below covers both rules.

Student health plans are sold by universities to F-1 and J-1 students, and most schools require them. They cost less than a Marketplace plan and are simpler to enroll in.

Short-term and travel medical plans are cheap bridge coverage. They exclude pre-existing conditions, preventive care, and maternity. They work for a one-month gap. They are a poor substitute for a year-round plan.

Eligibility comes down to three things: your immigration status, your employment, and your household income.

H-1B, L-1, O-1, E-2, and TN holders qualify for employer coverage after a wait of 30 to 90 days, and can buy an Affordable Care Act (ACA) Marketplace plan.

F-1 and J-1 students carry the school's student health plan, which most universities require. The Marketplace is an option when the school plan is optional.

Green card holders can use employer plans and the Marketplace from day one. Federally funded Medicaid still carries a five-year wait.

Refugees, asylees, and humanitarian parolees lose Medicaid eligibility on October 1, 2026. Refugees, asylees, and people with Temporary Protected Status (TPS) also lose Marketplace premium tax credits on January 1, 2027. They keep the right to buy a Marketplace plan at full price.

H-4, L-2, J-2, and F-2 dependents join the primary visa holder's employer plan, or buy on the Marketplace.

Deferred Action for Childhood Arrivals (DACA) recipients lost Marketplace eligibility on August 25, 2025. A court order on December 11, 2025 restored Marketplace eligibility for certain other non-citizen statuses in every state.

People without lawful status cannot use the Marketplace or federal Medicaid. State-funded programs are closing: California stopped new enrollment for undocumented adults in January 2026, and Illinois ended its program for ages 42 to 64 in July 2025.

SettleKit works this out for your visa and your state.

Enrollment through an employer, the Marketplace, or Medicaid comes down to proving three things: who you are, that you are lawfully present, and what your income is.

For Marketplace and Medicaid applications you give your Social Security Number (SSN), which the Marketplace checks against Social Security Administration records. You give your immigration documents: I-94, visa stamp, Employment Authorization Document (EAD), green card, or your refugee or asylee papers, depending on your status. You give proof of income, which means recent pay stubs, a signed offer letter, or last year's tax return. If you have no US income yet, you enter an estimate. You give household information: the spouse and dependents you want to cover, and whether they file on the same tax return. And you say whether your employer offers you a plan, because that affects whether you can get a premium tax credit.

For employer enrollment, HR handles the immigration check. You fill in the benefits form and pick a plan.

A plan's network is the list of doctors, hospitals, and labs where it covers care. Go outside the network and you pay the full price or get nothing back. Network type matters more than most newcomers expect, especially before you have chosen a doctor.

A Health Maintenance Organization (HMO) has the lowest premium. You name a primary care doctor who refers you to specialists, and out-of-network care is not covered at all.

A Preferred Provider Organization (PPO) costs more. It needs no referrals and covers out-of-network care at a lower rate. It suits people who want choice or who travel often.

An Exclusive Provider Organization (EPO) sits between the two. No referrals, and no out-of-network coverage except in an emergency.

A High Deductible Health Plan (HDHP) is not a network type. It is a cost structure: a high deductible with a low premium, paired with a Health Savings Account (HSA). For 2026 the Internal Revenue Service defines an HDHP as a deductible of at least $1,700 for self-only coverage or $3,400 for family coverage, with out-of-pocket costs capped at $8,500 and $17,000.

Before you sign up, check that your hospital and any specialist you already see are in the plan's network. Search the insurer's directory by the doctor's exact name and by the facility name, because one doctor can be in-network at one hospital and out-of-network at another.

Affordable Care Act (ACA) plans come in four metal tiers. The tier tells you how the cost of a typical year splits between you and the insurer.

A Bronze plan pays about 60% of costs and leaves you about 40%. It has the lowest premium and the highest deductible, which suits a healthy person who wants protection against a disaster year. New for 2026, healthcare.gov confirms that Bronze and Catastrophic plans can be paired with a Health Savings Account (HSA).

A Silver plan splits costs 70/30. Cost-Sharing Reductions apply only at Silver, and only when household income is under 250% of the federal poverty level. When you qualify, a Silver plan gives you Gold-level coverage at close to a Bronze premium. Do not default to Bronze because its sticker price looks lowest.

A Gold plan splits costs 80/20. The premium is higher and the deductible is low, which suits someone who expects regular care.

A Platinum plan splits costs 90/10. It has the highest premium and the lowest out-of-pocket costs, and it pays off only for someone who uses a lot of care.

The 2026 federal poverty guidelines are $15,960 for a household of one and $21,640 for two in the 48 contiguous states, and the Marketplace uses them for 2027 coverage. Since the enhanced premium tax credits expired on December 31, 2025, there is no credit at all above 400% of the poverty level, which is $63,840 for one person and $86,560 for two.

An employer offers two or three choices: a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA), a Preferred Provider Organization (PPO) plan, and sometimes a second PPO tier. Four things decide which one is cheaper for you.

Total annual cost is the real comparison. Add twelve months of premium to a realistic estimate of the care you will use, rather than comparing premiums alone.

The deductible and the out-of-pocket maximum set your worst case. For 2026 the Internal Revenue Service defines an HDHP as a deductible of at least $1,700 for self-only coverage or $3,400 for family coverage, with out-of-pocket costs capped at $8,500 and $17,000.

An HSA and an FSA work differently. HSA money rolls over every year, stays yours when you change employer, and goes in and comes back out untaxed when you spend it on medical care. An FSA belongs to the employer, and you forfeit whatever you do not spend inside the plan year.

Network coverage decides whether the plan is useful at all. A generous plan is worth little when your hospital sits outside its network.

If you are healthy and earning well, the HDHP with an HSA is usually cheaper across a year. If you see specialists regularly, take ongoing medication, or are planning a pregnancy, the lower-deductible PPO wins even at a higher premium.

Marketplace enrollment is not open all year. Three windows exist.

The Open Enrollment Period is the annual window when anyone can enroll or switch plans. As of August 2026, healthcare.gov publishes it as November 1 to January 15. Enroll by December 15 and coverage starts January 1. Enroll between December 16 and January 15 and coverage starts February 1. Some state exchanges run a longer window than the federal one.

A Special Enrollment Period is a 60-day window opened by a qualifying life event. Gaining lawfully present status in the US is one of those events, so a newcomer has 60 days from that date to enroll on the Marketplace.

Medicaid and the Children's Health Insurance Program (CHIP) take applications on any day of the year. Employer plans run their own windows: your first 30 days on the job, then once a year after that.

For an employer plan, HR sends the enrollment link in your first week and the deadline is 30 days from your start date. Miss it and you wait for the company's annual enrollment or a qualifying life event.

The Marketplace is the main path for a newcomer who has no employer plan and does not qualify for Medicaid.

Start at Healthcare.gov and enter your ZIP code. If your state runs its own exchange, Healthcare.gov forwards you to it. That rule works from every state, so you never have to work out which exchange is yours, and starting anywhere else risks filing on the wrong site.

Create an account and start the application. You enter your household, an income estimate, your immigration status, and your ZIP code. The site works out your premium tax credit while you fill the form in.

Compare plans. You can filter by metal tier, network type, premium, deductible, and whether the doctors you already see are in network.

Enroll. Choose a plan, pay the first premium, and coverage starts on the first of the following month, or on January 1 or February 1 during Open Enrollment.

If you just arrived with no US income, you enter an estimate. Earn more than you estimated and you repay part of the credit when you file your taxes. Earn less and you get the difference back. Tell the Marketplace whenever your income changes during the year, so the credit adjusts instead of building up a bill.

An employer plan is the simplest and cheapest path when you have one. In your first week HR gives you a benefits portal such as Workday, Gusto, or Zenefits. Pick a plan tier, add dependents, set your HSA or FSA contribution, and submit before the deadline, which is 30 days at most companies. Coverage starts on the first of the month after your waiting period, and that period is 30, 60, or 90 days depending on the employer. Your offer letter states which one applies. Your share of the premium comes out of every paycheck before tax.

Medicaid runs through your state Medicaid or health-and-human-services agency rather than Healthcare.gov, though Healthcare.gov forwards your application there when it looks like you qualify. Applications are taken all year. You submit income documents, immigration status, and household size.

Inside the five-year wait and not exempt, you cannot get Medicaid, and a Marketplace plan with a premium tax credit is the alternative. State-funded programs for immigrants outside federal Medicaid are closing: California stopped new enrollment for undocumented adults in January 2026, Illinois ended its program for ages 42 to 64 in July 2025, and Washington closed new enrollment in its expansion.

Your member ID card carries the plan name and the member services phone number, and the provider directory sits inside your online plan account. Search it by the doctor's exact name and by the facility name before you book, because a hospital that is in network can still send you an in-network surgeon and an out-of-network anesthesiologist in the same operation.

Most people need three things in their first months. A primary care doctor handles checkups, repeat prescriptions, and referrals, and an HMO plan requires you to name one. A dentist and an eye doctor sit outside medical insurance: dental and vision are separate add-ons through an employer or the Marketplace. A pharmacy matters because plans have preferred pharmacies, such as CVS, Walgreens, or a mail-order service, where the copay is lowest, and the plan's formulary lists what each prescription costs.

Before any non-emergency appointment, confirm three things with the insurer: that the provider is in network, that the specific facility is in network, and that any lab work goes to an in-network lab. Each of the three is billed separately.

Two documents arrive after a visit, usually a few weeks apart, and they are easy to confuse.

The Explanation of Benefits (EOB) comes from your insurer. It is not a bill. It shows what the provider charged, what the plan's negotiated rate was, what the insurer paid, and what is left for you.

The provider bill or statement comes from the doctor or the hospital. This is the document you pay.

Put the two side by side before you pay anything. If the bill arrives before the insurer has processed the claim, wait for the EOB rather than paying blind. If the bill asks for more than the EOB says you owe, call the provider's billing office, because the two systems often lag each other. If you see a service you did not receive, ask for an itemized bill and dispute each line. If you see an out-of-network charge nobody warned you about, read the next section on the No Surprises Act.

Ask for the itemized bill on any large amount. It lists every charge separately, which is the only version you can check line by line.

The No Surprises Act has protected patients from most out-of-network surprise bills since January 2022. It covers three situations.

Emergency care is covered. An out-of-network emergency room (ER), an out-of-network doctor treating you at an in-network hospital, and an air ambulance cannot balance-bill you for emergency treatment.

Planned care at an in-network facility is covered. If an in-network hospital treats you with an out-of-network anesthesiologist, radiologist, or pathologist, the protection applies.

Air ambulance services are covered whatever the network.

Ground ambulances sit outside the federal law. The No Surprises Act does not cover them, and any protection you have comes from your own state rules.

If a bill looks like it breaks the No Surprises Act, do not pay it yet. Call your insurer and the provider to dispute it. You can file a complaint with the Centers for Medicare and Medicaid Services (CMS) through the No Surprises Help Desk on 1-800-985-3059. The law also gives you an Independent Dispute Resolution process for certain billing disputes.

Coverage changes more often than people expect. Four things trigger a change.

Annual re-enrollment comes every autumn. Employers run their own Open Enrollment, in October or November, for the calendar year ahead. Check the new premium, the new plan options, and whether your doctors are still in network. The Marketplace runs its own Open Enrollment, which healthcare.gov publishes as November 1 to January 15 as of August 2026.

Qualifying life events open a 60-day Special Enrollment Period on the Marketplace. Marriage, divorce, a new baby, a job change, losing other coverage, moving to a new state, and a change in immigration status all count. Employer plans allow similar mid-year changes.

Income changes matter because your premium tax credit rests on an estimate. Update Healthcare.gov as soon as your actual income moves, otherwise the difference is settled when you file your taxes and you may owe it back.

Moving states means a new plan. Marketplace plans are sold state by state, so a move across a state line is itself a qualifying event and you enroll again on your new state exchange.

Set a calendar reminder for every October. The automatic renewal your employer applies is often not the plan you would choose.