A US green card buys you the right to purchase American health insurance. Free healthcare is not included. New EB-5 residents normally get a special enrollment period of about 60 days after becoming lawful permanent residents, and that window is when a Marketplace plan should be bought, because missing it can leave a family uninsured until open enrollment reopens in November. Budget seriously for this. An unsubsidized family policy is one of the largest recurring costs a new resident carries, and a single hospital admission without coverage can run past six figures.
Your first 60 days decide the year
Gaining lawful permanent resident status counts as a qualifying life event. It opens a special enrollment period, normally 60 days, during which you can buy a plan on the health insurance Marketplace without waiting for open enrollment, which in most states runs from 1 November to 15 January. States that operate their own exchanges set their own deadlines, so check the one where you will actually live.
Two practical blockers catch people. You will generally need a Social Security number to complete an application cleanly, and applying in your first week is worth doing, following the process described on the Social Security number and card page. If you adjusted status inside the country you may already hold an employment authorization document from Form I-765. That lets you take a job and whatever plan the employer offers, but the card itself is not coverage.
Take the arrival gap seriously. Travel medical insurance covering the weeks between landing and the start of a real policy costs very little and prevents an ugly surprise.
How an American health plan charges you
Four numbers govern what you pay, and they interact.
- Premium. The fixed monthly cost of holding the policy, owed whether or not you ever see a doctor.
- Deductible. What you pay yourself before the insurer starts covering most services.
- Coinsurance. Your percentage share of the bill after the deductible, commonly 20 or 30 percent.
- Out-of-pocket maximum. The annual ceiling on your own spending for in-network covered care, beyond which the plan pays everything.
Marketplace policies come in metal tiers. A bronze plan is built to cover roughly 60 percent of average costs, silver roughly 70 percent, gold roughly 80 percent, platinum roughly 90 percent, with premiums climbing as the deductible falls. Since 2014 no plan sold on an exchange may refuse you or surcharge you for a pre-existing condition, a genuine advantage over the short term policies still marketed hard to new arrivals.
Premium tax credits exist, calculated from household income measured against the federal poverty level. Most EB-5 families earn far too much to receive any, so run your math at full price. Remember that your green card makes you taxable on worldwide income, as the IRS explains in its guidance on determining an individual's tax residency status, and global income is what gets counted when subsidies are assessed.
Networks matter as much as price. An HMO costs less and routes everything through a primary care physician. A PPO costs more and lets you book specialists directly. Step outside the network and a covered service can become almost uncovered, so confirm that your specific hospital and your specific doctors are contracted before you enroll. Not the hospital group. The individual physicians.
Medicare and Medicaid both make you wait
Here is the most expensive surprise for investors who arrive near retirement.
Medicare eligibility begins at 65, yet premium free Part A requires 40 quarters, meaning ten years, of Medicare covered work in the United States. An investor who arrives at 60 will not have them. A lawful permanent resident without that work history can buy into Part A and Part B only after five years of continuous residence, paying a monthly premium for coverage that citizens with a work record receive free. Delay Part B enrollment once eligible and the late enrollment penalty adds 10 percent for each full year of delay, permanently.
Medicaid has a barrier of its own. Most lawfully present immigrants face a five year waiting period before qualifying for full Medicaid, a rule dating from the 1996 welfare law, though states may cover children and pregnant women sooner. Plan on private coverage for that entire span. Anyone weighing a move in their sixties should read EB-5 for Retirement in the US: Florida, Healthcare, Taxes, Cost next to this page.
What an emergency actually costs
Hospital emergency departments participating in Medicare must screen and stabilize anyone who arrives, whatever their ability to pay or immigration status. That duty comes from a federal law passed in 1986. Free it is not. You will be billed, and medical bills sit among the largest consumer debts in the country.
Since 1 January 2022, federal law has shielded patients from most surprise out-of-network charges for emergency treatment and for care delivered by out-of-network clinicians inside in-network facilities. Ground ambulance rides were left out of that protection and remain a frequent source of unexpected invoices.
Doctors have their own reason to look at EB-5
Two very different groups land on this page.
Foreign physicians working in America on temporary visas study EB-5 as an exit from employer sponsorship. That is a legitimate use. A doctor who invests $800,000 in a qualifying targeted employment area project, or $1,050,000 outside one, needs no labor certification and no sponsoring hospital, and USCIS sets out the underlying requirements on its EB-5 Immigrant Investor Program page. Capital risk replaces employment risk. For a physician earning well, that trade is often worth making, and the practical consequences are discussed in Employment and Business Opportunities After EB-5.
The second group is investors being shown healthcare projects, typically medical office buildings, surgery centers or senior living. Those deals can be perfectly sound. A doctors group brand on the marketing tells you nothing about the job creation model or the security behind the loan, so treat the label as a sales channel and read the offering documents exactly as you would for a hotel or an apartment tower. Whether to use a Regional Center at all is worked through in Regional Center vs Direct EB-5: Which Path Is Safer for Your $800K?.
Budget before you land
Numbers first, feelings later.
Employer sponsored family coverage in the United States now carries a total annual premium well above $20,000, most of which the employer absorbs. Buy equivalent coverage yourself on the open market and you pay all of it. Dental and vision are usually separate policies with separate premiums. Prescription costs depend on a formulary that can be rewritten each year, so a drug covered cheaply this year may sit in a higher tier next year.
One structure is worth learning. Pair a high deductible health plan with a Health Savings Account and you collect three tax breaks at once. Contributions are deductible. Growth is untaxed, and so are withdrawals spent on qualified medical expenses, with the annual contribution limits set by the IRS and revised each year. HSA balances roll over indefinitely and stay yours. You cannot contribute once you enroll in Medicare.
Two more items belong on the list. Long trips home are not covered by most domestic plans, and extended absences also endanger the residence itself, a point USCIS spells out in its guidance on maintaining permanent residence. Where you settle moves premiums a long way, because rates are set by geographic rating area, which is one more input for Choosing Where to Live in the US as a New Immigrant.
Mistakes that cost real money
Buying a short term plan as a permanent solution is the common one. Those policies run for only a few months under current federal rules and they can exclude pre-existing conditions outright. Coverage mandates barely touch them. Use one as a bridge, never as the plan.
Confusing the immigration medical exam with healthcare is another. The Form I-693 examination by a civil surgeon, or the panel physician exam abroad for consular cases, checks vaccinations and communicable disease. It treats nothing.
Assuming coverage travels with you is the third. Your home country's national health system almost certainly stops at its border, and a policy written at home rarely pays a US hospital directly.
Skipping the paperwork everything else depends on is the last. Get the Social Security number, then the driver's license, then the bank account, in that order, as set out in Settling In: Getting Social Security and a Driver's License.