If you don’t have a Social Security number or an Individual Taxpayer Identification Number, your options for health insurance without an SSN or ITIN depend mostly on your immigration status and where you live. An ITIN can never substitute for an SSN on a federal Marketplace application, because ITINs exist only for tax purposes and can’t verify immigration status.1CMS Agent Broker FAQ. Can a Consumer Submit an ITIN in Place of an SSN on Their Marketplace Application But not having an SSN at all is a different situation: lawfully present applicants without one can still apply, and people with no eligible immigration status have separate paths to care that don’t require either number.
Applying for a Marketplace Plan Without an SSN
If you file taxes with an ITIN, skip the SSN question each time it appears on the Marketplace application.2Health Reform Beyond the Basics. Key Facts on the Application Process for Families That Include Immigrants An application cannot be delayed or denied because you don’t have an SSN. Instead, you provide your citizenship or immigration status, and the Marketplace verifies it electronically through the Department of Homeland Security’s SAVE system.3CMS. Health Coverage Options for Immigrants
If the automated check fails, a secondary verification runs over three to five days. If that also fails, you’ll receive a Data Matching Inconsistency notice and have 95 days to submit supporting documents. During that window you can still enroll and receive subsidies while the issue is pending.4CMS. Marketplace Verification of Citizenship and Immigration Status
On Covered California, applicants without an SSN can indicate the reason (such as holding an ITIN or not qualifying for an SSN) and proceed. A tax filer whose income is used to determine household eligibility for financial help must provide their ITIN if they don’t have an SSN.5Covered California. Immigration Toolkit California encourages applicants to submit the paper form even if some fields are incomplete rather than wait.6DHCS/Covered California. Application for Health Coverage
Who Can Actually Buy a Marketplace Plan
Marketplace coverage is open to U.S. citizens and people who are “lawfully present.” That category covers lawful permanent residents, refugees, asylees, people granted Temporary Protected Status, holders of valid non-immigrant visas, and many other humanitarian and legal statuses.7HealthCare.gov. Immigration Status and the Marketplace Undocumented immigrants cannot buy Marketplace plans, even at full price.
The subsidy rules have narrowed. Under the 2025 federal budget law (H.R. 1), premium tax credits for lawfully present immigrants with incomes below 100 percent of the federal poverty level ended January 1, 2026. Beginning January 1, 2027, subsidies will be restricted to U.S. citizens, lawful permanent residents, certain Cuban and Haitian entrants, and citizens of Compact of Free Association nations. Refugees, asylees, trafficking survivors, and people on work visas will still be able to buy unsubsidized Marketplace plans but will lose premium tax credits.8Health Reform Beyond the Basics. Changes Coming to ACA Marketplace Policies
A June 2025 CMS rule also removed DACA recipients from the definition of “lawfully present,” making them ineligible for Marketplace enrollment entirely, even at full cost.9Federal Register. Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability
Medicaid, CHIP, and Emergency Medicaid
Medicaid and CHIP ask for an SSN if you’re eligible for one, but you can’t be denied coverage while an SSN application is pending, and the agency must help you apply.2Health Reform Beyond the Basics. Key Facts on the Application Process for Families That Include Immigrants Federally funded Medicaid generally requires “qualified” non-citizen status: lawful permanent residents, refugees, asylees, Cuban and Haitian entrants, trafficking victims, and certain others.10Medicaid.gov. Overview of Eligibility for Non-Citizens in Medicaid and CHIP Most qualified immigrants face a five-year waiting period, though refugees, asylees, Cuban/Haitian entrants, and trafficking victims are exempt.
States can waive the five-year bar for lawfully residing children and pregnant women. As of early 2025, 38 states had done so for children and 32 for pregnant women.11The Commonwealth Fund. What Recent Policy Changes Mean for Immigrant Health Coverage Twenty-four states and D.C. also use the CHIP “From Conception to End of Pregnancy” option to cover prenatal care regardless of the parent’s immigration status.12KFF. State Health Coverage for Immigrants and Implications for Health Coverage and Care Starting October 1, 2026, H.R. 1 will narrow federal Medicaid and CHIP to lawful permanent residents, certain Cuban/Haitian entrants, and COFA migrants.13SHVS. How H.R. 1 Impacts Coverage for Non-Citizens
Applying for or receiving Medicaid or CHIP is not a “public charge” factor and should not affect your ability to become a permanent resident or citizen, with a narrow exception for people receiving long-term government-funded institutional care.10Medicaid.gov. Overview of Eligibility for Non-Citizens in Medicaid and CHIP
Emergency Medicaid pays hospitals for emergency care provided to people who meet all standard Medicaid requirements except immigration status. It is not comprehensive insurance. An emergency medical condition means acute symptoms severe enough that lack of immediate treatment could seriously jeopardize health, impair bodily functions, or cause serious organ dysfunction, including emergency labor and delivery.14New York State DOH. Emergency Medical Condition FAQ In most states you don’t apply separately; the hospital initiates the process, and no immigration documentation is required from the patient.15NC Medicaid. Immigration Status and Eligibility for NC Medicaid
Coverage for Mixed-Status Households
In households where some members are citizens or lawfully present and others are not, the eligible family members can still enroll. An undocumented parent can apply on behalf of a U.S.-citizen child without providing the parent’s own immigration status or SSN.16HealthCare.gov. Coverage for Immigrant Families Marketplaces and Medicaid agencies cannot require citizenship or immigration information for household members who aren’t seeking coverage, and they cannot deny benefits because a non-applying family member declined to share their status.3CMS. Health Coverage Options for Immigrants
A non-applicant is only required to provide an SSN when the family is seeking financial assistance, the non-applicant is the household’s tax filer, and the non-applicant actually has an SSN.17KFF. FAQ on Mixed Immigration Status Families and Marketplace Coverage
State Programs Open Regardless of Status
Some states use their own money to cover residents regardless of immigration status. Many of these programs are under fiscal pressure, and several are scaling back or pausing new enrollment, so check current rules with your state before relying on them.
Fourteen states and D.C. provide fully state-funded coverage to income-eligible children regardless of status: California, Colorado, Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, Utah, Vermont, and Washington.12KFF. State Health Coverage for Immigrants and Implications for Health Coverage and Care New Jersey and Vermont also cover income-eligible pregnant people regardless of status.
Seven states and D.C. have expanded state-funded coverage to some adults regardless of status, but access varies and is shifting:
- California will pause enrollment for non-pregnant undocumented adults 19 and older in January 2026, end dental benefits for that group in July 2026, and introduce $30 monthly premiums for non-pregnant adults ages 19 to 59 in July 2027.
- Colorado’s OmniSalud program offers state-funded Marketplace coverage without asking for an SSN or immigration status, though its SilverEnhanced Savings financial assistance has been reduced for 2026 and is allocated by lottery among existing participants.18Connect for Health Colorado. OmniSalud19Colorado Division of Insurance. OmniSalud
- Illinois ended Health Benefits for Immigrant Adults (ages 42 to 64) on July 1, 2025. Coverage for seniors 65 and older remains active but is paused for new enrollment.20Illinois HFS. Health Benefits for Immigrant Adults
- D.C. plans to pause enrollment for adults 26 and older and end all coverage for adults 21 and older by October 2027.
- Minnesota plans to end coverage for undocumented adults 18 and older by January 2026, with enrollment paused since June 2025.
- Oregon covers all income-eligible adults.
- Washington offers Marketplace coverage through Cascade Care, though subsidies were unavailable for 2025 and a separate expansion capped at 13,000 people has paused enrollment.
Community Health Centers and Emergency Care
Federally Qualified Health Centers are designed to serve anyone regardless of insurance, immigration status, or ability to pay. They provide medical, dental, behavioral health, and preventive care on a sliding fee scale based on income.21Arkansas Department of Health. Federally Qualified Health Centers You can find one through the HRSA Health Center Finder at findahealthcenter.hrsa.gov.
In July 2025, HHS reclassified the Health Center Program as a “federal public benefit” under the Personal Responsibility and Work Opportunity Reconciliation Act. If enforced, that classification would restrict health center services to U.S. citizens and “qualified” immigrants. A federal court granted a preliminary injunction on September 10, 2025, blocking enforcement in 21 states and D.C., finding that the Health Center Program statute requires centers to serve “all residents” in their service area. The federal government appealed to the First Circuit in November 2025. Even under the reclassification, HHS did not revise existing verification requirements, and nonprofit charitable organizations are not currently required under federal law to verify immigration eligibility.22American Bar Association. Immigrant Access to Health Centers and the Unknowns of PRWORA
Under the Emergency Medical Treatment and Active Labor Act of 1986, every hospital with an emergency department must screen and stabilize anyone who presents with an emergency condition, regardless of immigration status, insurance, or ability to pay.23NILC. Health Insurance and Care Rights Providers cannot deny treatment based on immigration status, language, appearance, or lack of a Social Security number. If a state requires hospitals to ask about immigration status, you are not obligated to answer, and a provider cannot refuse treatment if you decline.
Other services available regardless of status include immunizations and communicable disease treatment through public health departments, mental health crisis services, domestic violence assistance, and charity care at safety-net hospitals.
Alternatives That Aren’t Insurance
Healthcare sharing ministries are faith-based cost-sharing arrangements, not insurance. Some have flexible ID requirements. Liberty HealthShare lists the SSN field on its enrollment application as “optional.”24Liberty HealthShare. Liberty HealthShare Enrollment Application Medi-Share requires members to be “legal residents” and open a designated financial account, but its guidelines don’t list an SSN as a standalone enrollment requirement.25Medi-Share. Medi-Share Guidelines These programs are not regulated as insurance, don’t guarantee that bills will be shared, generally exclude preexisting conditions, and typically require members to attest to a Christian lifestyle. You remain personally liable for unpaid bills.
Fixed indemnity plans pay a preset dollar amount for specific services regardless of actual cost. They are not ACA-regulated, don’t count as minimum essential coverage, and are available year-round. Because they sit outside the ACA, their enrollment requirements differ from Marketplace plans.26UnitedHealthcare. Hospital and Doctor Insurance They typically exclude preexisting conditions for the first 12 months and pay far less than the actual cost of serious care, so treat them as supplemental.
Privacy, Data Sharing, and Public Charge
Federal law has historically protected information on Medicaid, CHIP, and Marketplace applications from being used for immigration enforcement. That protection is now contested. In mid-2025, CMS began sharing personal data of Medicaid enrollees with Immigration and Customs Enforcement. A coalition of 20 states sued, and in August 2025 a federal court blocked the practice, calling it a “bolt-from-the-blue reversal” that likely violated the Administrative Procedure Act.27Illinois Attorney General. Attorney General Raoul Secures Preliminary Injunction Blocking Medicaid Data From Being Used for Immigration Enforcement The injunction currently covers Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington. Residents of other states may face different circumstances.28EPIC. States Secure Injunction Against HHS Medicaid Data Sharing With DHS
The January 2025 rescission of ICE’s “sensitive locations” policy, which had shielded hospitals and clinics from enforcement, has added to concerns about seeking care. In a 2025 KFF/New York Times survey, 48 percent of likely undocumented immigrant adults reported avoiding medical care because of immigration-related concerns since the policy change. Hospitals remain bound by the Fourth Amendment and HIPAA; they are not obligated to release protected health information without a judicial warrant, and administrative immigration warrants are not sufficient to compel disclosure of patient records.29KFF. Health Care Providers Warn of Impacts of Increased ICE Presence at Health Care Facilities30Journalists’ Resource. What Does the Removal of the Protected Areas Policy Mean for Hospitals
A proposed DHS public charge rule issued in November 2025 and expected to be finalized in early 2026 would give immigration officers broader discretion to consider a wider range of public benefits when reviewing green card and visa applications. The proposal removes prior guidance that had largely limited “public charge” findings to cash assistance and long-term institutionalization, creating uncertainty about whether using services like community health centers could affect immigration cases.31Migration Policy Institute. Trump Public Charge Discretion If an immigration case is a concern, talking with an immigration attorney before enrolling in a benefit program is the safer route than guessing from current guidance.