By Ruben Sevumyants, founder of Pomogu
Health insurance is one of the first things newcomers ask me about, and one of the most confusing. The words are unfamiliar, the rules change from year to year, and a mistake can be expensive. The good news is that each of our three states runs an official marketplace, and each one offers free, trained help. This guide explains how the system is organized, what changed recently, and how to apply step by step.
This is general information, not legal or immigration advice. If you have a question about your immigration status, or about how using a health program could affect an immigration case, please speak with a licensed immigration attorney.
Most people in the US get coverage in one of three ways:
Through a job. Many employers offer a health plan. If you start a job that offers one, ask HR when and how you can enroll.
Through a public program. Medicaid and CHIP (the Children's Health Insurance Program) provide free or low-cost coverage to people who meet income, residency and immigration-status rules. In New Jersey this is called NJ FamilyCare. In Pennsylvania it is often called Medical Assistance.
Through the state marketplace. If you don't have job-based coverage, you can buy a private plan through your state's official marketplace, and depending on your income and status you may get financial help with the cost.
Each of our states runs its own marketplace:
New York: NY State of Health (nystateofhealth.ny.gov). It covers Medicaid, the Essential Plan, Child Health Plus and private plans in one place.
New Jersey: Get Covered New Jersey (GetCovered.NJ.gov). One application checks both for marketplace financial help and for NJ FamilyCare.
Pennsylvania: Pennie (pennie.com). Medicaid applications go through COMPASS (compass.dhs.pa.gov).
Private marketplace plans have an Open Enrollment period once a year. For 2027 coverage, the dates announced by the states are:
NY State of Health: November 1, 2026 to January 31, 2027. Enroll by December 15 for coverage starting January 1.
Get Covered NJ: November 1, 2026 to January 31, 2027. Enroll by December 31 for coverage starting January 1.
Pennie: November 1 to January 15. Enroll by December 15 for coverage starting January 1; enrollments from December 16 to January 15 start February 1.
Outside Open Enrollment, you can only enroll if you have a Special Enrollment Period, which comes from certain life changes. HealthCare.gov lists moving to the US from a foreign country as one of those changes, along with getting married, having a baby and losing other coverage. You generally have 60 days from the event to enroll, so if you have just arrived, don't wait.
Public programs work differently. Medicaid, the Essential Plan and Child Health Plus in New York, NJ FamilyCare in New Jersey and Medical Assistance in Pennsylvania accept applications all year round.
This is the part many people don't know yet. A federal law, H.R.1, signed in July 2025, changes who can get financial help.
According to HealthCare.gov, many lawfully present immigrants can still buy a marketplace plan. But starting January 1, 2027, only these groups can get savings (premium tax credits and lower out-of-pocket costs) on marketplace plans:
Lawful Permanent Residents (green card holders)
Cuban or Haitian entrants
Compact of Free Association (COFA) migrants
People with other statuses, such as many refugees, asylees, people with TPS or people on work visas, may still be able to enroll but pay the full price. New Jersey's Department of Banking and Insurance has confirmed the same change for Get Covered NJ.
Other changes are also happening. In New York, H.R.1 ended Essential Plan eligibility for about 450,000 people with incomes above 200% and up to 250% of the federal poverty level in July 2026. In New Jersey, eligibility for NJ FamilyCare now depends more on immigration status (with exceptions for children and pregnant women), and some adults face work or "community engagement" requirements starting January 1, 2027.
Because these rules are new and depend on your exact status, let the official application decide your eligibility rather than relying on advice from friends. If your status is complicated, talk to an immigration attorney before you apply.
Gather your documents. Have ready your passport and immigration documents (for example a green card, I-94, Employment Authorization Document or I-797 notice), your A-number or I-94 number if you have one, Social Security numbers for anyone who has them, and information about your household income.
Estimate your household income for the year. Financial help is based on income and household size, so think about what you expect to earn, not only what you earned last year.
Preview your options. Get Covered NJ lets you compare plans and estimated financial help with only your ZIP code, birth date and income. Pennie and NY State of Health also let you browse plans before you apply.
Book free help if you want it. All three marketplaces have certified assisters, and NY says its assisters offer help in multiple languages. Pennie lets you search for an assister by language. Assisters are free and can't tell you which plan to choose. Brokers can recommend a specific plan and may be paid a commission.
Fill in the application. Answer honestly and completely. The application will tell you whether you qualify for Medicaid or a similar program, or for financial help on a private plan.
Compare plans carefully. Look at the monthly premium, the deductible, out-of-pocket costs, which doctors and hospitals are in the network, and whether your prescriptions are covered.
Pay the first premium. Pennie, for example, says your enrollment is complete only after you pay your first month's premium. Until then, the plan isn't finished.
Keep your information current. Report changes in income, address or household size, and read every letter or message from the marketplace.
Premium: what you pay every month to keep the plan.
Deductible: how much you pay for covered care before the plan starts paying its share.
Network: the doctors and hospitals that work with your plan. Going outside the network usually costs more.
Passport and immigration documents, plus copies
SSNs for household members who have them
Estimated household income for the year
Your arrival date, if you are using a Special Enrollment Period
A list of your doctors and prescriptions
An appointment with a free certified assister, if you want help
First premium paid and confirmation saved
A few habits help a lot: use only the official websites listed above, keep copies of what you submit, and write down the date and name of anyone you speak with. New Jersey still requires residents to have health coverage, and residents without an exemption pay a penalty at tax time, which is one more reason not to put this off.
I run Pomogu, which helps Russian-speaking newcomers in NY, NJ and PA with paperwork and first steps. More at pomogusa.com.