Are you preparing to move to the United States or already living there? The American healthcare system is fundamentally different from the French system. Without insurance tailored to your visa type, a single emergency room visit can cost tens of thousands of dollars. This guide explains everything you need to know to choose the right coverage for 2027.

Why Health Insurance Is Critical for Visa Holders in the USA

Unlike France, there is no universal public health coverage in the United States. As an expat or immigrant, you are responsible for securing your own private health insurance. Your health coverage is also part of your U.S. immigration strategy: a weak plan can trigger public-charge concerns or complicate visa renewals.

What Changes on January 1, 2027

A federal law adopted in 2025 reserves ACA premium tax credits for green card holders (lawful permanent residents), Cuban and Haitian entrants, and COFA nationals starting January 1, 2027. Temporary work and study visas — E-2, L-1, H-1B, O-1, TN, F-1 — lose this financial assistance.

You can still buy a Marketplace plan, but at full price. For most French-speaking families on visas, this means comparing three options starting fall 2026: full-price ACA, private US plan off-Marketplace, or international expat plan. The right choice depends on your status, age, health, and expected length of stay.

Your Status Before and After January 1, 2027

The right to buy coverage doesn't change. What changes is the right to financial assistance.

Your Status Year 2026 Year 2027 → What Remains Available
Green card (LPR)
Permanent resident		 Subsidized Subsidized ACA with tax credit, income-dependent
Visa E-2
Investor / trader		 Subsidized No assistance Full-price ACA · private US plan · expat plan
Visas L-1, H-1B, O-1, TN
Temporary work		 Subsidized No assistance Employer plan if offered · otherwise full-price ACA, private, or expat
Visa F-1, J-1
Student / exchange		 Subsidized No assistance University plan · international student plan

Sources: KFF, Georgetown CHIR, HealthCare.gov. State rules may differ.

Full-Price ACA, Private US Plan, or Expat Plan?

Option 1: Full-Price ACA

Best for: Pre-existing conditions, ongoing pregnancy, ongoing treatment.

  • Network: Often HMO/EPO, regional network
  • Pre-existing conditions: Covered, no exceptions
  • Medical screening: None
  • Coverage in France: Emergencies only, very limited
  • Enrollment: Open enrollment period or qualifying event

Option 2: Private US Plan

Best for: Healthy family, long-term installation, need for a national network.

  • Network: National PPO, access without primary care physician
  • Pre-existing conditions: Varies by contract
  • Medical screening: Generally yes
  • Coverage in France: Limited
  • Enrollment: Year-round

Option 3: International Expat Plan

Best for: Limited-duration stay, frequent trips back to France, family remaining in Europe.

  • Network: International, reimbursement on invoice
  • Pre-existing conditions: Often excluded or with waiting period
  • Medical screening: Yes
  • Coverage in France: Yes, this is the main benefit
  • Enrollment: Year-round

Real Quote · Family of 4 · Florida · August 2026

≈ $1,700
/ month — Full-price ACA, no subsidy
≈ $1,300–1,500
/ month — Comparable private PPO plan

Two adults ~40 years old, two children, Florida, August 2026. These amounts illustrate a specific case: they are neither an offer nor a rate guarantee. A premium depends on each insured person's age, county, household composition, deductible level, and for private plans, medical history. Figures reviewed quarterly.

What I Recommend, Profile by Profile

These recommendations assume no employer-sponsored coverage. If your employer offers a plan, compare it first: it is almost always more advantageous.

Entrepreneur on E-2 (family, 35–50)

Private US PPO plan. You lose the subsidy and you're staying several years. The PPO's appeal isn't primarily price: it's broader coverage and far more flexibility — national network, direct specialist access, fewer geographic constraints.

Employee on L-1 or H-1B (no employer plan)

Full-price ACA, then reassess. If a green card is in process, you regain the subsidy upon obtaining status. Staying on ACA avoids having to re-qualify medically when switching.

Family with a pre-existing condition (all statuses)

Full-price ACA, in the vast majority of cases. It's the only regime that cannot refuse, surcharge, or exclude an existing condition.

Several months per year outside the US

International expat plan. The decisive criterion isn't total expatriation duration, but time actually spent outside US territory. A US plan leaves you without coverage during those periods; an international plan follows you.

Student on F-1

Your university's plan first. Most institutions require their own coverage or a strict equivalent. Don't buy anything before reading their requirements.

Green card obtained

Subsidized ACA. Nothing changes for you in 2027. Just verify your income estimate each year: the 400% federal poverty level cap is back in effect since 2026.

Key Dates to Remember

  • January 1, 2026: End of subsidies for incomes below 100% of the federal poverty level. Cap restored to 400%.
  • November 1, 2026: Open enrollment for coverage year 2027 begins. This is the window where the change becomes concrete on your premium.
  • January 1, 2027: Tax credits reserved for green card holders, Cuban and Haitian entrants, and COFA nationals.

Frequently Asked Questions

I'm on an E-2 visa. Will I lose my ACA subsidies in 2027?

Yes. Starting January 1, 2027, premium tax credits are reserved for permanent residents (green card), Cuban and Haitian entrants, and COFA nationals. Temporary work and study visas — E-2, L-1, H-1B, O-1, TN, F-1 — no longer qualify. Buying a Marketplace plan at full price remains possible, but without financial assistance.

Can I still buy an ACA plan without a subsidy?

Yes. The change affects financial assistance, not the right to buy. A lawfully present person can still enroll in a Marketplace plan at full price. Depending on your profile, a private off-Marketplace plan or an expat plan may be cheaper for comparable coverage — but not always, and never if you have a pre-existing condition.

What's the difference between an ACA plan, a private US plan, and an expat plan?

An ACA plan covers the ten essential benefits and cannot deny a pre-existing condition. A private US plan off-Marketplace uses national PPO networks and generally applies medical screening. An international expat plan covers care in the US and during trips back to France, but is not ACA-compliant and often excludes pre-existing conditions.

When should I enroll for coverage year 2027?

Open enrollment for coverage year 2027 generally begins November 1, 2026, with state-variable closing dates. Private and expat plans can be purchased year-round.

I just arrived in the US. What should I do in the meantime?

Arrival in the US is a qualifying life event that opens a special enrollment period on the Marketplace. If your timelines are short or your status isn't yet regularized, a short-term or expat plan can cover the interim period.

Does buying health insurance affect my immigration case?

A plan bought without financial help has no effect. However, according to Maryland's state marketplace, from September 18, 2026 using Medicaid or a private plan with financial help may be considered in a future green card application (public charge rules). If a green card is in your plans, talk to an immigration attorney before choosing.

Let's Run the Numbers on Your Situation

I'm a licensed insurance broker working with multiple insurers. I can compare the three options on your actual numbers — status, age, state of residence, income, medical history — and tell you which costs the least for the coverage you need. In French.

Request a Free Quote Contact Me on WhatsApp

About the Author

Charlyne Rasolonavalona is a licensed health insurance broker in the United States with over 10 years of experience in the American system. She assists French-speaking families — E-2 entrepreneurs, L-1 employees, students, new residents — in choosing and enrolling in their health coverage, in French.

License No. G066759 0215 · Contact: +1 305 965 7628 · WhatsApp

States where licensed (12): Florida (FL), New York (NY), Texas (TX), Georgia (GA), North Carolina (NC), South Carolina (SC), Virginia (VA), New Jersey (NJ), Ohio (OH), Tennessee (TN), Indiana (IN), Nevada (NV)

Partner insurers (17): UnitedHealthcare, Aetna, Cigna, Anthem (Blue Cross Blue Shield), Oscar, AvMed, Healthfirst, Ambetter, Capital Health, Allstate, 22Health, IMG (UnitedHealthcare Global), GeoBlue (Blue Cross Blue Shield Global), WorldTrips, Zion, DentaQuest, Solstice

Sources

  1. KFF — Key Facts on Health Coverage of Immigrants
  2. Georgetown CHIR — Recent Federal ACA Marketplace Changes
  3. HealthCare.gov — Immigration statuses that qualify for Marketplace coverage
  4. KFF — Which lawfully present immigrants qualify for Marketplace coverage?
  5. healthinsurance.org — Will you receive an ACA premium subsidy?

Disclaimer: This page provides general information about US health insurance regulation and does not constitute legal, tax, or immigration advice. Rules vary by state of residence and evolve. Verify your personal situation with a licensed broker or HealthCare.gov before making any decision.