US Health Insurance for Visa Holders in 2026: Can E-2, L-1A and O-1 Families Get Cover?

Can E-2 visa holders get health insurance in the US?

Yes. An E-2 Treaty Investor is a non-immigrant, and HealthCare.gov's list of eligible immigration statuses includes "Individual with Non-immigrant Status", with work visas, student visas and "other visas" as examples. The page does not name each visa category, so the E-2, E-1, L-1A and O-1 are not listed one by one; they fall within that non-immigrant category as we read it, and the Marketplace checks your status when you apply.

Three basic conditions apply to everyone, according to the HealthCare.gov eligibility guide: you must live in the United States, be a US citizen or national or a lawfully present non-citizen, and not be incarcerated. A plan bought on the Marketplace is regulated US health insurance, not a travel policy, which is why it is the reference point for anyone moving to the US for the long term.

Health insurance is not part of the E-2 petition itself. It belongs to the move plan, alongside the visa route on our E-2 Treaty Investor visa page and the questions in our guide to the E-2 visa for Germans, Austrians and Swiss.

Who counts as "lawfully present" for the Marketplace?

"Lawfully present" is the term HealthCare.gov uses for non-citizens who may buy Marketplace coverage. Its page on lawfully present immigrants groups them into qualified non-citizens, humanitarian statuses, holders of valid non-immigrant visas and people with legal status under other laws. Its separate list of statuses also includes green-card holders and people who have applied for adjustment to green-card status. The table summarises what this means for the US routes our clients most often use.

The spouse and dependant rules in the table come from USCIS: E-2, L-1A and O-1. The E-2 and L-1A spouse may still request a work permit, but does not need one to work.

Do E-2 holders get Marketplace savings in 2026 and 2027?

From 1 January 2027, no. HealthCare.gov states that, due to a law change, from that date only Lawful Permanent Residents, Cuban or Haitian entrants and Compact of Free Association (COFA) migrants qualify for savings, and that other immigration statuses may be eligible for Marketplace coverage, but not savings. For E-2, E-1, L-1A and O-1 families, that means the full premium from the 2027 plan year onwards.

For the statuses that still qualify, the same HealthCare.gov page explains that an annual income between 100% and 400% of the federal poverty level may qualify you for the premium tax credit, with extra savings on out-of-pocket costs. For any coverage in the rest of 2026, whether your household qualifies for savings is confirmed on your Marketplace application; we do not assume it either way.

Can E-2, L-1A or O-1 families get Medicaid or CHIP?

Generally not. According to HealthCare.gov, Medicaid and CHIP require you to meet your state's income and residency rules and to hold one of a short list of statuses: Lawful Permanent Resident, Cuban or Haitian entrant, COFA migrant, or, in certain states, "lawfully residing" for pregnant women and children. Green-card holders are generally eligible only 5 years after they get that status. HealthCare.gov also notes that Medicaid may cover treatment of an emergency medical condition for people who meet all other state criteria but lack an eligible immigration status. For most of the families we advise, Medicaid is not part of the plan, and private cover is.

How much does health insurance in the USA cost?

We publish no premium figures, because HealthCare.gov itself gives none: the price depends on where you live and who you insure, and it changes every plan year. What the HealthCare.gov page on premiums does state is the rule set. Insurers may use only five factors:

• Age: premiums can be up to 3 times higher for older people than for younger ones.
• Location: where you live has a big effect on your premiums, so the state and county you choose for your business matter.
• Tobacco use: insurers can charge tobacco users up to 50% more.
• Individual or family cover: a plan that also covers a spouse or children costs more.
• Plan category: Bronze, Silver, Gold or Platinum.

Your health, medical history and sex cannot affect the premium. The plan categories describe how costs are shared once you use care: on average a Bronze plan pays 60% and you pay 40%, Silver 70% and 30%, Gold 80% and 20%, and Platinum 90% and 10%. A lower premium usually means a larger share for you when you need treatment. Every Marketplace plan must cover the same 10 essential health benefits, including preventive services, and, per HealthCare.gov on pre-existing conditions, must cover treatment for conditions you had before your coverage started.

For a family budget, this means the full premium for an older couple with children in a high-cost area is a real line item, often alongside the cost of the business itself. Our guide to moving to the USA lists the other costs to plan for.

Not sure which US route fits your family? The visa route affects more than residence: it shapes who may work, who can join an employer plan and when savings could apply. Book a free consultation with Mirabello Consultancy and we will map your route and the questions to settle with your insurer before you move.

When can I sign up after moving to the USA?

Open Enrollment runs from 1 November to 15 January each year. Outside that window you generally need a Special Enrollment Period, and the HealthCare.gov page on enrolment outside Open Enrollment lists a move to the US from a foreign country as a qualifying move. Losing other qualifying coverage can also qualify, generally within 60 days, while dropping cover voluntarily generally does not. HealthCare.gov also states that you may qualify if you gained an eligible immigration status within the past 60 days, where that is your first eligible status.

In practice, plan for the gap between landing and your first day of US cover. A short-term international policy may bridge it, and your timing should be confirmed with your insurer before you give up cover at home.

Does an L-1A or O-1 employer provide health insurance?

Often, yes, but it depends on the employer. On the L-1A, you transfer to a US company that is part of your group, and on the O-1 a US employer or agent files the petition on your behalf. Where that company offers a group health plan, employees in L-1A or O-1 status are usually covered on the same terms as other staff, and the plan's rules set whether your spouse and children can join. Check the plan's start date, the share of the premium you pay and family cover before you sign the employment terms.

On the E-2 you are the investor and you direct your own US business, so there is no employer to provide cover unless your company sets up a plan. Whether a small company can offer one, and whether you as owner can join it, depends on the plan and on state rules, and is confirmed with a licensed US insurance professional. If you are weighing these routes as a company owner, our comparison of the E-2 and L-1A for business owners sets out the other differences.

Are international or expat health plans an alternative?

They can be, as a bridge or alongside US cover, but they work differently. International health plans for people who live abroad are sold by private insurers, often on underwritten terms: the insurer may ask health questions, exclude or charge more for pre-existing conditions, and set its own limits on US treatment. They are not Marketplace plans, so the Marketplace rules described above, including the 10 essential health benefits and the protection for pre-existing conditions, do not automatically apply.

Before relying on one, compare it line by line with a Marketplace plan: US treatment limits, the annual cap if any, maternity and preventive care, how claims are paid in the US, and whether cover continues if you change country again. We do not recommend any insurer or broker, and Mirabello does not sell insurance.

Does my German, Swiss or Austrian health insurance cover me in the USA?

In most cases, not once you live there. Home-country health insurance law differs by country, so the three DACH systems are set out separately below, each as its own country's rule. Other nationalities follow their own country's rules.

Germany

Under German rules, the Federal Ministry of Health states that the benefits of statutory health insurance (GKV) are in principle provided only in Germany. Outside the EU and the EEA there are narrow exceptions for travellers, such as cover for treatment that is needed without delay for up to six weeks per calendar year, and only where you cannot buy private travel cover because of a pre-existing condition or your age, and your health insurance fund confirms cover before you travel. The German-US social security agreement does not help here: the German Liaison Agency Health Insurance (DVKA) lists only the pension branches as covered on the German side, not health or long-term care insurance. What happens to your membership, a private German policy or a dormant policy (Anwartschaft) when you move your residence is confirmed with your health insurance fund or insurer.

Switzerland

Under Swiss rules, the Federal Office of Public Health (BAG) states that compulsory health insurance generally ends on the date you leave Switzerland. Employees posted abroad generally remain subject to Swiss compulsory insurance. For people moving outside the EU, EFTA and the UK, the BAG notes that others can continue cover on a contractual basis, which is a private contract with an insurer, not compulsory insurance. Whether your insurer offers this, and on what terms for the USA, is confirmed with your insurer.

Austria

Under Austrian rules, the Austrian Health Insurance Fund (ÖGK) states that the agreement with the USA covers pension insurance only. For illness in a state with no agreement, the ÖGK states that you pay the treatment costs yourself, may submit the bills for a possible reimbursement based on ÖGK contract tariffs, and recommends private travel health insurance. For pensioners who move their residence to such a state, the ÖGK states that Austrian health insurance ends and that you must arrange your own cover abroad. Your own position when you move as an employee or business owner is confirmed with the ÖGK or your insurer.

The same logic applies to tax and pensions, which follow their own rules on leaving; see our guide to US taxes after moving from Germany, Switzerland or Austria.

Does a green card change my health insurance options?

Yes, in two ways. A green-card holder is a Lawful Permanent Resident, one of the three groups that, according to HealthCare.gov, still qualify for Marketplace savings from 1 January 2027, subject to income. Medicaid and CHIP also become possible, generally after the 5-year waiting period. The green-card routes we advise on include EB-5, EB-1A and EB-2 NIW; each has its own requirements, and USCIS acts on every petition on its merits.

Health insurance alone is rarely a reason to choose a route, but it is a fair part of the comparison. Our USA immigration overview sets out all routes side by side.

How Mirabello Consultancy helps

Mirabello Consultancy advises on the immigration route and coordinates every US case with an independent licensed US immigration attorney, who prepares and files the petitions. We do not sell insurance and this article is not insurance advice: we help you ask the right questions early, so that your family's cover is settled before the move rather than after it. You can also ask Mira, by Mirabello, for a first orientation on the US routes, or speak with our team.