Getting covered: the Marketplace, Medicaid and enrolment windows

If you are new to the United States, health insurance is one of the first things you need to tackle. Unlike some countries with a national system, America relies on a mix of employer plans, government programs like Medicaid, and the federal Health Insurance Marketplace. The path you take depends on your job, income, immigration status, and where you live—but deadlines matter, and missing them can leave you uninsured for months.

Understanding the Open Enrollment Period

Every year, there is one main window when you can sign up for health insurance through the ACA Marketplace (also called the health insurance exchange). This is called Open Enrollment, and it runs each winter. For 2026, it began November 1, 2025, and ended on January 15, 2026, in most states that use the federal HealthCare.gov platform, though some states that run their own marketplaces had different deadlines—some extending to January 31. Outside of this window, you cannot buy a Marketplace plan unless you experience a major life change that qualifies you for a Special Enrollment Period.

If you miss the Open Enrollment deadline in your state, you will have to wait until the following year's window unless you qualify for a Special Enrollment Period. This is a key reason to act quickly if you are uninsured. Timing also affects when your coverage starts: if you enroll by December 15, your coverage begins January 1 of the following year. If you enroll after December 15, coverage typically starts on February 1.

Special Enrollment Periods: When You Can Enroll Outside the Window

If you experience certain major life events, you are eligible for a Special Enrollment Period (SEP). This is a limited-time exception to the annual window that allows you to enroll in Marketplace coverage or switch plans at any point during the year, as long as you act within 60 days of the qualifying event.

Qualifying Life Events

The following life changes open a Special Enrollment Period for you:

• Loss of health coverage (such as losing employer insurance or being dropped from Medicaid)
• Getting married
• Having a baby or adopting a child
• Moving to a new home in a different coverage area
• A significant change in household income
• Gaining a work visa, asylum, refugee status, or other lawful immigration status
• Aging out of a parent's coverage (e.g., turning 26 and no longer eligible for a family plan)

Importantly, simply becoming self-employed or starting a new business does not automatically trigger a Special Enrollment Period. However, if you lose health coverage as a result, that loss of coverage does qualify. Each state may have slightly different rules, and some states recognize additional events, so it is worth checking with your state's marketplace.

How the 60-Day Clock Works

Once a qualifying event occurs, your Special Enrollment Period begins immediately and runs for 60 days. You must enroll and select a plan within this window. If you miss the 60-day deadline, you generally cannot enroll until the next Open Enrollment period. However, if you lose Medicaid coverage, you may have up to 90 days in most states.

When you apply, you may be asked to send proof of your qualifying event—such as a marriage certificate, birth certificate, letter of employment, or notice from your previous insurance or Medicaid program. The Marketplace will ask you to attest (formally confirm) that your information is truthful. Keep these documents ready and submit them promptly so your coverage can take effect without delay.

Navigating Medicaid: Income Limits, Immigration Rules, and State Variation

Medicaid is a joint federal-state program that provides free or very low-cost health insurance to low-income residents. Unlike the Marketplace, you can apply for Medicaid any time of year—there is no annual Open Enrollment. However, Medicaid has strict rules about immigration status, and these rules vary significantly by state. Before you assume you are ineligible, research your state's specific requirements.

Immigration Status and Medicaid Eligibility

In general, only U.S. citizens and certain immigrants with qualified immigration status can enroll in federal Medicaid. Non-citizens must have a satisfactory immigration status, which includes lawful permanent residents (green card holders), refugees, asylees, and some visa holders with work authorization. To prove your status, you must provide documentation and pass a verification through the Department of Homeland Security's SAVE (Systematic Alien Verification for Entitlements) system.

There is a five-year waiting period for many qualified immigrants: if you obtained a qualified immigration status on or after August 22, 1996, you must wait five years before becoming eligible for federal Medicaid benefits, unless you fall into a specific exception category (such as refugees, who can enroll immediately). Some immigrants, like DACA (Deferred Action for Childhood Arrivals) recipients, are not eligible for federal Medicaid, though they may qualify for Emergency Medicaid. Some states offer state-funded coverage for groups that federal law does not cover, so check with your state Medicaid office.

Several states have elected to cover lawfully present immigrant children and pregnant women under an option called CHIPRA 214, which bypasses the five-year waiting period for these groups. If you have a child or are pregnant, ask your state Medicaid office if this applies.

Income Limits and Expansion States

Medicaid eligibility is also based on income, but the threshold depends on whether your state has expanded Medicaid. States that have expanded Medicaid under the Affordable Care Act cover most individuals earning up to 138 percent of the federal poverty level. States that have not expanded have much lower income limits. This is one of the biggest sources of variation between states—a family that qualifies for Medicaid in one state may not in another. Check your state's Medicaid office website to learn your state's specific income limit and eligibility rules.

The Marketplace, Income, and Subsidies

If your income is above your state's Medicaid threshold, the Marketplace may be your next option. You can receive federal financial help (called a premium tax credit or subsidy) to reduce your monthly premium if your household income is between 100 and 400 percent of the federal poverty level. For 2026, that range is roughly $15,650 to $62,600 for a single person, and $32,150 to $129,200 for a family of four in the continental United States.

However, important changes took effect in 2026. The enhanced subsidies that had been in place since 2021 expired at the end of 2025. As a result, premiums have risen significantly for many enrollees, and the income-based cap on what you pay for a benchmark plan has increased from 8.5 percent to higher levels. This means many people who bought coverage in 2025 will pay more in 2026 for the same level of coverage. A handful of states (including California, Colorado, Connecticut, Maryland, Massachusetts, and New Mexico) have created their own state-funded subsidy programs to help offset these increases, so check whether your state offers any additional help.

For Immigrants and Non-Citizens: Documentation and Identification Numbers

If you are a noncitizen, the application process requires you to verify your immigration status. You will need to provide a USCIS number (A-number) or other immigration document numbers to confirm your eligibility. Do not provide an Individual Taxpayer Identification Number (ITIN) in response to a request for a Social Security Number (SSN). If you do not have an SSN, leave the SSN field blank. The Marketplace will verify your information using government databases; this verification is not used for immigration enforcement.

If you are lawfully present but do not have an SSN, you can still apply for Marketplace coverage. Some household members who are not seeking coverage themselves do not need to provide an SSN, but including their information helps with income and household size calculations. If you have an ITIN and file taxes with it, you can use it on state-based marketplace applications in some states to verify your income, but the federal marketplace (HealthCare.gov) does not accept ITINs for income verification.

Since early 2027, most noncitizens (except for certain qualified immigrants) are no longer eligible for federal premium tax credits (subsidies) in the Marketplace, though they can still purchase unsubsidized plans. Some states offer their own assistance for noncitizens, so check what your state provides. Additionally, Medicaid eligibility for noncitizens depends on immigration status and varies greatly by state.

Starting Work and Changing Jobs

Many newcomers to the United States start working within their first few months. When you take a job, your employer may offer health insurance. If you lose coverage from a previous job or employer, that loss triggers a Special Enrollment Period, giving you 60 days to enroll in a Marketplace plan. If your new employer offers coverage and you decline it, you cannot enroll in the Marketplace until the next Open Enrollment unless you qualify for another life event (such as losing your employer coverage later).

If your new job offer includes a waiting period before health benefits begin, you may be able to use a Marketplace plan temporarily and switch to your employer plan when it becomes available. When you do, you can submit documentation of the waiting period to satisfy your Special Enrollment Period verification.

Practical Steps: Getting Covered

1. Visit healthcare.gov if you live in most states, or your state's marketplace website if your state runs its own.
2. Check your state's Open Enrollment dates and confirm the deadline in your state.
3. Create an online account with your email address.
4. Gather documents: proof of citizenship or immigration status (passport, green card, visa, USCIS documents), Social Security Number or ITIN (if applicable), and recent income information (tax return, pay stubs, or a written statement of estimated income).
5. Complete the application, answering questions about household size, income, immigration status, and current coverage.
6. If you qualify for a life event Special Enrollment Period, be ready to provide documentation.
7. Compare plans based on premiums, deductibles, copays, and which doctors and hospitals are in-network for your needs.
8. Select a plan and complete your enrollment.
9. Pay your first month's premium directly to the insurance company to activate your coverage.
10. For Medicaid, apply through your state Medicaid office or state marketplace website—apply any time, no deadline.

Key Takeaways

• Open Enrollment runs once a year (usually November through mid-January); dates vary by state.
• If you miss Open Enrollment, you need a qualifying life event to enroll outside the window—you have 60 days from that event.
• Medicaid is available year-round and has no Open Enrollment, but immigration status and income rules are set by state.
• Marketplace subsidies are smaller in 2026 than they were in 2021–2025, so compare your costs carefully.
• As a noncitizen, verify your immigration eligibility for both the Marketplace and Medicaid—rules vary widely.
• Provide correct identification numbers (SSN or USCIS number) and gather documents early to avoid enrollment delays.