Health Insurance for Immigrants in Tennessee

The core fact: lawfully present immigrants can still shop for health insurance on the federal marketplace at HealthCare.gov (1-800-318-2596). What changed is who can get premium tax credits to help pay for it. Starting with 2027 coverage, federal law limits those credits to a shorter list of immigration statuses.

What changed for 2027 (federal law, now in effect)

The 2025 budget reconciliation law (Public Law 119-21, sometimes called the "One Big Beautiful Bill Act") made two changes that affect immigrants buying marketplace coverage:

• Starting January 1, 2027, premium tax credits and cost-sharing reductions are limited to: lawful permanent residents (green card holders), certain Cuban and Haitian entrants, and people living in the U.S. under a Compact of Free Association (COFA migrants from Micronesia, the Marshall Islands, and Palau). Many other lawfully present immigrants — including refugees, asylees, people with Temporary Protected Status, and most visa holders — lose eligibility for tax credits in 2027. They can still buy a marketplace plan, but at full price.
• Since January 1, 2026, lawfully present immigrants with income below 100% of the poverty level who can't get TennCare because of their immigration status no longer qualify for marketplace tax credits. Before 2026, this group could get credits; that exception is gone.

The general income rules still apply on top of the status rules: tax credits are for household incomes from 100% to 400% of the federal poverty level, with a hard cliff at 400%. Cost-sharing reductions require 100%–250% and a Silver plan.

Who this affects most

• Green card holders: still eligible for tax credits in 2027 if income rules are met.
• Refugees and asylees: marketplace tax credits end in 2027. Check TennCare eligibility separately, since Medicaid has its own immigration rules, and talk to a navigator before open enrollment.
• People with TPS or work/student visas: marketplace tax credits end in 2027. Compare full-price marketplace plans with any employer or school coverage you can get.
• Mixed-status families: eligibility is decided person by person. A citizen child or spouse can still qualify for TennCare, CoverKids, or tax credits even if another household member doesn't.

Paths that don't depend on marketplace tax credits

• CoverKids for pregnant women: CoverKids (Tennessee's CHIP program) covers pregnant women up to 250% of the federal poverty level with no immigration documents required.
• CoverKids and TennCare for children: citizen and qualified-immigrant children may qualify based on household income. See CoverKids and TennCare.
• Emergency care: hospitals with emergency departments must screen and stabilize anyone with an emergency medical condition, regardless of immigration status or ability to pay.
• Community health centers: federally qualified health centers charge on a sliding scale based on income and serve patients regardless of insurance.
• Standard marketplace protections still apply to anyone who buys a plan: guaranteed issue (no denial or higher price for a pre-existing condition) and essential health benefits.

What we're not stating

We don't cover marketplace eligibility for undocumented immigrants beyond this: people who aren't lawfully present can't buy marketplace plans. Anything specific to your status should come from HealthCare.gov or a trained navigator. Immigration rules are complicated, and a free one-on-one conversation is worth it.

FAQ

Can I buy a marketplace plan if I'm a green card holder? Yes, and you can still get premium tax credits for 2027 if your household income is between 100% and 400% of the poverty level and you don't have access to other qualifying coverage.

I'm a refugee (or asylee). Can I still get help paying for a marketplace plan in 2027? Not through marketplace tax credits. Starting in 2027, federal law limits them to green card holders, certain Cuban and Haitian entrants, and COFA migrants. You can still enroll at full price. Check TennCare eligibility and talk to GetCoveredTenn (1-866-475-7879) about your options before you enroll.

I have TPS. What happens to my marketplace subsidy? Tax credits for people with Temporary Protected Status end with 2026 coverage. For 2027, you can keep a marketplace plan but would pay the full premium. Compare it with employer coverage if you have that option.

Do I need a Social Security number to apply? HealthCare.gov's application asks for immigration and household information; the exact documents depend on your status. Household members who aren't applying for coverage generally don't need to provide their immigration status. A navigator at GetCoveredTenn (1-866-475-7879) can walk you through what's needed at no charge.

Is there coverage for my pregnant family member regardless of immigration status? CoverKids covers pregnant women up to 250% of the federal poverty level with no immigration documents required. Apply through TennCare Connect (tenncareconnect.tn.gov, 855-259-0701).

Where can I get help in my language? HealthCare.gov (1-800-318-2596) offers help in many languages, and GetCoveredTenn serves all 95 Tennessee counties by phone and video. Call 1-866-475-7879 or visit getcoveredtenn.org.

Sources

• Public Law 119-21 (2025), sections 71301 and 71302 — premium tax credit eligibility for lawfully present immigrants (congress.gov)
• Kansas Health Institute, "What's Changing – and What Hasn't Changed – on the ACA Marketplace? Part 1: H.R. 1" — provision-by-provision effective dates
• Marketplace eligibility for immigrants — HealthCare.gov
• CoverKids pregnancy coverage without immigration documents — tn.gov / TennCare
• 2027 open enrollment dates — HealthCare.gov and CMS

Related

• The marketplace explained
• Premium tax credits in detail
• When you can enroll
• Coverage for low-income households
• How we verify our information

Your next step

1. Check your status against the 2027 list above. If you're a green card holder, Cuban/Haitian entrant, or COFA migrant, the usual subsidy rules apply.
2. If you lose tax credits in 2027, compare before December 15. Look at full-price marketplace plans, employer or school coverage, and TennCare/CoverKids for eligible family members.
3. Talk to a navigator before you enroll. GetCoveredTenn (1-866-475-7879, getcoveredtenn.org) gives free help across all 95 counties.