Medicare and Medicaid for Immigrants: What Changes in 2026

The access of immigrants to U.S. federal health programs is undergoing the biggest transformation in decades. The One Big Beautiful Bill Act (H.R. 1), enacted in 2025, fundamentally redesigns the eligibility rules for Medicare and Medicaid for non-citizens, with changes taking effect from October 2026. Immigrants who currently rely on these programs or plan to use them in the future urgently need to understand the new landscape.

Before the new legislation, the main obstacle for legal immigrants was the five-year waiting period as a permanent resident before accessing Medicaid in most states. Now, the restrictions go further: entire categories of immigrants who previously had access-including refugees and asylees-will lose eligibility. This is a structural change that affects millions of people and requires immediate planning.

Understanding the differences between Medicare and Medicaid, who remains eligible under the new rules, and what alternatives exist is essential for any immigrant in the United States in 2026.

Medicare: How It Works

Medicare is the federal health insurance program primarily for people aged 65 and older, as well as individuals with certain disabilities or end-stage renal disease. The program is divided into parts with distinct coverages:

• Part A (Hospital Insurance): covers hospital stays, care in skilled nursing facilities, and hospice. Most beneficiaries pay no premium for Part A if they have accumulated at least 40 quarters (10 years) of contributions to the system. For those with between 30 and 39 quarters, the monthly premium in 2026 is $311. Those with fewer than 30 quarters pay the full amount of $565 per month.
• Part B (Medical Insurance): covers doctor visits, lab tests, medical equipment, and outpatient services. The standard monthly premium in 2026 is $202.90, with higher amounts for beneficiaries with higher incomes.
• Part D: prescription drug coverage, offered by private plans approved by Medicare.

The deductible for Part A in 2026 is $1,736 per benefit period, with copayments of $434 per day for hospital stays between the 61st and 90th day, and $868 per day for lifetime reserve days.

Medicaid: How It Works

Medicaid is a joint federal-state program that provides health coverage for low-income people, including families, children, seniors, and people with disabilities. Unlike Medicare, which is exclusively federal, Medicaid varies significantly from state to state-each state sets its own income and coverage criteria within federal guidelines.

Medicaid covers a wide range of services: doctor visits, hospitalizations, tests, medications, long-term care, and in many states, mental health services and substance abuse treatment. For low-income immigrants, it has historically been the main mechanism for accessing medical care in the United States.

Changes from H.R. 1 in 2026

The One Big Beautiful Bill Act introduces the most significant restrictions on immigrant eligibility for health programs since the 1996 welfare reform. The changes take effect on October 1, 2026 and affect both Medicaid and Medicare.

New Medicaid Rules

Starting in October 2026, only three categories of non-citizens remain eligible for Medicaid:

1. Lawful Permanent Residents (LPRs) – green card holders
2. Certain Cuban and Haitian entrants – under specific humanitarian programs
3. Citizens of the Freely Associated States (COFA) – Palau, Marshall Islands, and Micronesia

Categories that lose eligibility include refugees, asylees, humanitarian parolees, holders of Special Immigrant Visa (SIV), victims of trafficking, and survivors of domestic violence with status under the Violence Against Women Act (VAWA). This exclusion represents a reversal of the historic U.S. policy of guaranteeing immediate health access to populations admitted for humanitarian reasons.

The same restrictions apply to the CHIP (Children’s Health Insurance Program), affecting children from immigrant families who rely on this coverage.

New Medicare Rules

Medicare also faces eligibility restrictions under Section 71201 of H.R. 1. Only U.S. citizens, lawful permanent residents, Cuban and Haitian entrants, and COFA citizens remain eligible. Refugees and asylees who previously could access Medicare are excluded.

For immigrants already enrolled in Medicare at the date the law is enacted, there is an 18-month transition period during which coverage is maintained. After this period, eligibility ends for those who do not fall into the newly permitted categories.

By July 4, 2026, the Commissioner of the Social Security Administration must identify and notify all individuals who will lose eligibility due to the new immigration restrictions.

Impacts on the Marketplace (ACA)

H.R. 1 also restricts premium subsidies under the Affordable Care Act (ACA) in the health insurance marketplace. Only immigrants lawfully present in specific categories-including LPRs and COFA citizens-retain access to the tax credits that make marketplace plans financially accessible. This significantly reduces the alternatives available to immigrants who lose access to Medicaid.

For many immigrants in humanitarian categories, the combination of exclusion from Medicaid and loss of ACA subsidies creates an unprecedented coverage gap, leaving full-price private insurance as the only option-often unaffordable for low-income families.

Planning for Immigrants

In light of these changes, immigrants in the United States should consider proactive measures before October 2026:

• Check your immigration category: determine if your status falls within the categories that retain eligibility (LPR, Cuban or Haitian entrant, COFA citizen).
• Consider status adjustment: if eligible, starting or accelerating the green card process may preserve access to federal health programs.
• Research state options: some states may choose to fund their own health programs for categories excluded from federal coverage, though this depends on individual state legislation.
• Consider private insurance: individual plans outside the marketplace, though more expensive without subsidies, may be the only alternative for excluded categories.
• Act before the deadline: those currently using Medicaid or Medicare who may be affected should seek alternatives before October 1, 2026.

The changes introduced by the One Big Beautiful Bill Act represent a fundamental reconfiguration of immigrant access to the American health care system. For lawful permanent residents, the situation remains largely unchanged. For refugees, asylees, and other humanitarian categories, October 2026 marks the beginning of an era of significantly more restricted access-and the time to prepare is running out quickly.

Victoria Harper

Editor-in-Chief

Meet the author

Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.