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Starting Jan. 1, 2027, federal help with marketplace premiums will be limited to green card holders, Cuban and Haitian entrants and citizens of three Pacific nations. New CMS instructions show how everyone else will be moved to full-price coverage, often automatically, during the open enrollment that begins Nov. 1.
Hundreds of thousands of immigrants who are in the United States lawfully, including H-1B and other visa holders, refugees, asylees, TPS holders and people with pending green card applications, will lose the premium tax credits that lower the cost of Affordable Care Act marketplace plans beginning Jan. 1, 2027. The cutoff comes from Section 71301 of the 2025 tax and spending law known as the One Big Beautiful Bill Act, and the Centers for Medicare & Medicaid Services issued guidance on Oct. 5 telling the federal marketplace how to apply it when 2027 open enrollment starts on Nov. 1. Affected immigrants can still buy a marketplace plan, but at full price, and many who do nothing will be renewed into coverage that costs far more than they pay today.
The law was signed on July 4, 2025, so the change itself is not new. What is new is that it now has machinery. The CMS guidance spells out how HealthCare.gov will check each enrollee’s status, what happens to people who do not update their applications, and what notices they will get. With the National Immigration Law Center, an immigrant-rights advocacy group, warning on Oct. 9 that many families on automatic renewal “could be re-enrolled at a much higher monthly cost,” the next three months are the window in which affected households decide whether to keep, change or drop coverage.
Three groups keep the credit. Every other lawful status loses it
Since the ACA took effect, the premium tax credit has been open to citizens and to anyone “lawfully present,” a broad category that covers far more than permanent residents. Section 71301 narrows that for tax years beginning after Dec. 31, 2026. Under the CMS guidance, only these “eligible noncitizens” keep access to the credit and to the cost-sharing reductions that lower deductibles and copays:
- Lawful permanent residents (green card holders), including conditional residents
- Cuban and Haitian entrants
- Citizens of the Compact of Free Association nations (the Federated States of Micronesia, the Marshall Islands and Palau) living in the United States
Everyone else who is lawfully present stays eligible to enroll but loses the financial help. The National Immigration Law Center’s list of groups losing eligibility includes refugees, asylees and asylum applicants, people granted withholding of removal, TPS holders and applicants, green card applicants, U and T visa holders, VAWA self-petitioners, Special Immigrant Juvenile petitioners, people paroled for a year or more (including certain Afghan and Ukrainian parolees), and people with deferred action other than DACA. Because the statute names only three eligible groups, nonimmigrant visa holders such as H-1B, H-4, L-1, F-1, J-1, O-1 and TN workers and their families fall outside it as well. DACA recipients, according to KFF, had already been made ineligible for marketplace coverage by Trump administration regulatory changes in 2025.
For the readers of this site, two groups stand out. The first is people in the employment-based green card line. A worker whose I-485 adjustment application is pending holds no permanent residence yet, so a family relying on a marketplace plan while waiting, for example after a layoff, during a gap between employers or while one spouse is self-employed, will pay full price until the card is approved. The second is refugees and asylees, who become eligible again only once they adjust to permanent residence. Refugees must apply after one year in the country; asylees can apply after a year as asylees but often wait much longer for a decision.
People who get health insurance through an employer are not affected by this change. The credit has always been reserved for people buying their own coverage on the marketplace.
What HealthCare.gov will do with enrollees who don’t act
The CMS guidance applies to the federally facilitated marketplace that serves most states; state-run marketplaces use the same federal status-checking service and will handle their own enrollees. The federal process works like this:
- Enrollees are “strongly encouraged” to update their applications during open enrollment. The application on HealthCare.gov and on partner broker sites is being revised before Nov. 1 to ask the new questions.
- Status is checked through DHS’s SAVE system. If an enrollee claims an eligible status that SAVE cannot confirm, the marketplace opens a data matching issue and gives 95 calendar days to submit documents, such as a green card, an employment authorization document or a Form I-94. Coverage and subsidies continue during that period.
- An enrollee who does not update by the plan selection deadline keeps the subsidy only if existing or new SAVE data shows an eligible status. Otherwise, the marketplace will find the person ineligible for subsidies effective Jan. 1, 2027, and will generally auto re-enroll them in a plan without any help.
- Affected enrollees will receive an open enrollment notice warning that subsidies will end unless their status is confirmed, followed by an eligibility determination notice with appeal rights before the plan year begins. Anyone SAVE shows as no longer lawfully present will be told that coverage is ending altogether.
Two smaller details in the guidance could catch families off guard. People who lose the subsidy also lose the three-month grace period for late premium payments that subsidized enrollees get; their insurer’s own, usually shorter, grace policy will apply instead. And in mixed-status households, where a citizen child or green card holder still qualifies but a parent on a visa does not, the subsidy will be calculated only for the eligible members. Everyone on a 2027 marketplace plan will receive a Form 1095-A in January 2028, but the ineligible members’ premium and subsidy fields may show blanks or zeros.
The cost, in the government’s own estimates
The Congressional Budget Office has put numbers on the two marketplace provisions aimed at immigrants. Section 71302, which took effect for 2026, already removed subsidies from lawfully present immigrants with incomes below the poverty line who are barred from Medicaid because of their status. Section 71301 is the far larger change.
| Provision | Takes effect | Fewer people with insurance in 2035 | Federal savings, 2026-2035 |
|---|---|---|---|
| Sec. 71301: credits limited to green card holders, Cuban/Haitian entrants and COFA citizens | 2027 | 1.0 million | $91.4 billion |
| Sec. 71302: no credits for lawfully present immigrants below 100% of the poverty line | 2026 | 200,000 | $27.3 billion |
KFF, a nonpartisan health policy research organization, reported that nearly 550,000 people with incomes below the poverty line signed up for marketplace plans during the 2025 open enrollment, most of them likely lawfully present immigrants who could not get Medicaid because of their status. KFF also noted that a separate section of the same law ends Medicare for lawfully present beneficiaries who are not green card holders or in the other two protected groups, with current beneficiaries losing coverage by early January 2027.
Supporters and critics of the law frame the change in very different terms. House Ways and Means Committee Republicans, who wrote the tax provisions, presented the change in June 2025 as ending “taxpayer funded handouts” and argued that eligibility for these benefits had been “expanded and abused” under the Biden administration. Immigrant-rights groups such as NILC note that the people affected are in the country lawfully, many on humanitarian protection, and that premiums for unsubsidized coverage “can exceed $1,000 a month for a family of four.” As a matter of law, the groups losing the credit are all ones the government itself classifies as lawfully present; the policy question Congress settled was whether that status alone should qualify for taxpayer-funded premium help, or only permanent residence.
Answers for families comparing plans this fall
I’m on an H-1B (or H-4, F-1 OPT, L-1) and buy my own marketplace plan. Do I lose my subsidy in 2027?
Yes, unless you become a green card holder. Nonimmigrant visa holders are lawfully present but are not among the three groups the law still covers. You can keep buying a marketplace plan at full price. If you can get coverage through an employer or a university plan, compare that cost before Dec. 15, the usual deadline for coverage starting Jan. 1.
My I-485 is pending and I have an EAD. Does that count?
No. A pending adjustment application and the work permit that comes with it do not make you a permanent resident, and NILC lists green card applicants among the groups losing the subsidy. Once your green card is approved, update your marketplace application with the new status right away, since eligibility for help depends on the status on file.
I already have a green card. Do I need to do anything?
Your eligibility does not change, but you should still log in during open enrollment and confirm your status. If the marketplace cannot verify it through SAVE, you will get a request for documents and 95 days to respond. Missing that deadline can cost you the subsidy even though you qualify.
What if I do nothing and my plan renews automatically?
If you are not in an eligible group, you will most likely be renewed into a 2027 plan with no subsidy and billed the full premium starting in January. If you do not want that coverage, the CMS guidance says you can cancel it. If you keep receiving advance payments you are not entitled to, for example because your status was recorded incorrectly, expect to repay them when you file your 2027 taxes. The same 2025 law also removed the caps on how much excess advance credit must be paid back, starting with 2026 tax years.
Can my U.S. citizen children still get help?
Yes. Citizens and eligible family members in a mixed-status household keep their subsidy. The CMS guidance says the credit will be calculated only for the members who qualify, so the household’s total bill will rise by the share attributed to the ineligible members.
Is anyone challenging this in court?
Immigration Analytics has not found a pending lawsuit against Section 71301. Because the limit is written into the tax code by Congress, rather than set by agency rule, it is harder to attack in court than the regulatory changes that have been blocked in recent months. A reversal would most likely require new legislation.
Our read: the real effect shows up in January bills, not in November
Auto re-enrollment is designed to prevent gaps in coverage, but here it means many affected families will not feel the change until a January premium bill arrives far larger than December’s. Some will drop coverage at that point, which is the behavior behind CBO’s estimate of one million fewer insured people. Others, especially families with ongoing medical needs, will keep paying, and that cost will weigh most heavily on people in long waits for permanent residence, including employment-based applicants from India and China and asylees with pending adjustment cases. For them, the green card has always carried legal stability; from 2027 it also unlocks health insurance subsidies, which raises the practical stakes of every month a case sits pending.
Employers and universities may feel it too. Sponsored workers between jobs, dependents not covered by an employer plan and international graduates on OPT who buy their own insurance will all face higher costs, which may lead more of them to ask their employers for coverage or help with premiums.
Dates to keep in view
- Nov. 1, 2026: Open enrollment for 2027 coverage begins on HealthCare.gov, with the revised application.
- Dec. 15, 2026: Usual HealthCare.gov deadline to choose a plan for coverage starting Jan. 1.
- Jan. 1, 2027: Section 71301 takes effect; subsidies end for lawfully present immigrants outside the three eligible groups.
- Jan. 15, 2027: End of open enrollment on the federal marketplace, according to NILC. State-run marketplaces set their own end dates.
- January 2028: Forms 1095-A for tax year 2027 arrive, the first tax season under the new rule.
Immigration Analytics will update this story as state marketplaces publish their own instructions and as enrollment data for 2027 becomes available. This article is for general information and is not legal advice. The situation is changing quickly, so please consult an immigration attorney about your specific case.
Sources
- Centers for Medicare & Medicaid Services: Guidance on noncitizen eligibility for APTC and CSRs, plan year 2027 (Oct. 5, 2026)
- HealthCare.gov: Health coverage for lawfully present immigrants
- Congressional Budget Office: Letter on the effects of repealing health provisions of Public Law 119-21 (Sept. 18, 2025)
- KFF: 1.4 Million Lawfully Present Immigrants Are Expected to Lose Health Coverage due to the 2025 Tax and Budget Law (Sept. 25, 2025)
- National Immigration Law Center: What Immigrants Need to Know About the New ACA Eligibility Restrictions (Oct. 9, 2026)
- House Ways and Means Committee: statement on the bill’s health benefit provisions (June 2, 2025)
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