Can lawfully present immigrants below 100% of the FPL get APTC in 2027?

Short answer: No. Starting with Plan Year 2027, a consumer who is lawfully present in the United States but cannot get Medicaid because of their immigration status, and whose projected household income is below 100% of the Federal Poverty Level (FPL), is not eligible for the Advance Premium Tax Credit (APTC). They can still enroll in a Qualified Health Plan (QHP) — they just have to pay the full premium.

Why this changed

From 2014 through 2026, the ACA had a special rule for this exact situation. Normally you have to earn at least 100% of the FPL to qualify for premium tax credits, because people below that line were expected to be covered by Medicaid. Lawfully present immigrants who were blocked from Medicaid by their immigration status — most often by the five-year waiting period, or "five-year bar" — would have fallen into a coverage gap, so the law let them receive premium tax credits below 100% FPL instead.

Federal legislation enacted in 2025 repealed that special rule, and CMS carried the change into the Marketplace eligibility rules in the HHS Notice of Benefit and Payment Parameters for 2027. Beginning with Plan Year 2027, HealthCare.gov no longer has to — and will not — find these consumers eligible for APTC.

Who this affects

• Lawful permanent residents (green card holders) who are still inside the five-year Medicaid waiting period
• Other lawfully present immigrants who are barred from Medicaid by their immigration status
• In all cases: only when projected household income for the coverage year is below 100% of the FPL

It does not matter which state the consumer lives in. This is a federal eligibility rule, not a state one, and it applies the same way in every Marketplace state.

What does not change

• They can still buy a Marketplace plan. Lawfully present immigrants remain eligible to enroll in a QHP. The loss is the subsidy, not the coverage.
• Income at or above 100% FPL is treated differently. A lawfully present immigrant with projected income at or above 100% of the FPL can still qualify for APTC in 2027 — but for Plan Year 2027 the categories of immigration status that qualify are narrower than before, limited to lawful permanent residents, certain Cuban and Haitian entrants, and certain Compact of Free Association (COFA) migrants.
• Cost-sharing reductions follow APTC. No APTC eligibility means no CSR-level silver plan either.

A worked example

A consumer is lawfully present, cannot enroll in Medicaid because of her immigration status, and projects household income at 85% of the FPL for 2027. She wants a Marketplace plan with APTC.

She is not eligible for APTC for Plan Year 2027. She is below 100% FPL, and the special rule that used to cover her situation no longer exists. She may enroll in any QHP she qualifies for at the full, unsubsidized premium. A hardship exemption does not restore APTC eligibility — exemptions relate to the individual mandate, not to premium tax credits.

What to look at instead

If a client lands in this situation, these are usually worth checking before they walk away from coverage:

• Re-check the income projection. If the household realistically expects to earn 100% of the FPL or more for the coverage year, and the consumer holds a qualifying immigration status, APTC may still be available. Project honestly — the number has to be defensible at tax time.
• Employer coverage for the consumer or a spouse.
• Medicaid or CHIP once the five-year bar ends, and for children and pregnant women in states that have taken the option to cover lawfully residing immigrants without the waiting period.
• The lowest-cost bronze or catastrophic plan at full price, which is often less than people assume.
• A Federally Qualified Health Center (FQHC). FQHCs treat patients regardless of insurance status on a sliding scale based on income.

Two things to be careful about

State-based Marketplaces may have moved sooner. A few state exchanges applied the below-100%-FPL change starting in 2026 rather than 2027. If your client is in a state that runs its own Marketplace, confirm the rule for their specific plan year.

The tax side is separate from the enrollment side. Eligibility shown on a Marketplace application and what the IRS ultimately allows on a return are two different determinations. A client with questions about how this affects a prior or current tax year should speak with a tax professional.

Still not sure?

Immigration status and Marketplace eligibility is one of the easiest places to get an application wrong, and a wrong answer here can mean a repayment at tax time. Call us at (312) 726-6565 or email help@ihealthagents.com and we will walk through the household with you before anything is submitted.

This article explains federal Marketplace eligibility rules for Plan Year 2027 and is general information, not legal, immigration, or tax advice.