Affidavit of Support Health Insurance: What Sponsors Owe

The affidavit of support (Form I-864) does not require you to buy health insurance for the relative you sponsor, and its current instructions do not ask about health coverage. What it does is make you legally responsible for keeping your relative at 125% of the federal poverty guidelines, and if they receive means tested benefits such as non emergency Medicaid or CHIP, the agency that paid can ask you to repay the cost. That makes a health coverage plan one of the most practical parts of sponsoring someone.

Key facts at a glance

• Income standard: USCIS Form I-864P sets the 125% threshold at $27,050 for a household of two, $34,150 for three and $41,250 for four in the 48 contiguous states, effective March 1, 2026.
• Benefits that count: I-864P lists food stamps, Medicaid, SSI, TANF and the State Children's Health Insurance Program as means tested public benefits.
• Benefits that do not count: I-864P excludes emergency Medicaid, immunizations and testing and treatment for communicable diseases, among others.
• When it ends: USCIS says the obligation ends when the immigrant becomes a citizen, is credited with 40 quarters of work, stops being a permanent resident and leaves the US, or when you or the immigrant dies. Divorce does not end it.
• Public charge: a DHS final rule published at 91 FR 45324 rescinds the 2022 public charge regulations, effective September 18, 2026, and keeps the I-864 as a factor officers consider.

Does the affidavit of support require health insurance?

No. The current I-864 instructions, edition dated 08/24/26, set out income, household size and asset rules, but contain no requirement to show a health plan. The September 2026 public charge rule does not add an insurance test in its text either.

That does not make health coverage optional in practice. The affidavit is, in USCIS's words, a contract between the sponsor and the US government. By signing it, you agree to use your resources to support your relative if it becomes necessary. A large hospital bill is one of the fastest ways that support can become necessary.

Is a sponsor responsible for the immigrant's medical bills?

The I-864 is not a promise to pay a particular hospital. It is a promise to keep your relative's income at a minimum level, and USCIS says the sponsored immigrant or a government agency may sue to enforce it. The medical risk shows up in two ways:

• Reimbursement: if your relative receives a means tested benefit such as regular Medicaid or CHIP, the agency may request repayment from you and can sue if it is not repaid, according to the I-864 instructions.
• Deeming: the instructions also say that agencies will consider your income and assets as available to your relative when deciding eligibility, which can make those programs harder to get at all.

Whether a sponsor can be pursued over a specific private debt is a legal question for an immigration attorney. This article is general information, not legal advice.

Which health benefits can trigger reimbursement?

The distinction that matters most is between emergency and regular Medicaid. I-864P lists Medicaid and CHIP as means tested public benefits, but explicitly excludes emergency Medicaid and immunizations and testing and treatment for communicable diseases. An emergency room admission paid by emergency Medicaid therefore sits outside the reimbursement rule, while months of regular Medicaid coverage do not.

Marketplace premium tax credits are not on the I-864P list of means tested public benefits. For many sponsored relatives, a Marketplace plan with tax credits is the main route to comprehensive insurance. KFF reports that lawful permanent residents keep access to those tax credits in 2027 even as other immigrant groups lose them. Our guide to the Marketplace for green card holders explains how to apply.

How does the five year bar interact with your sponsorship?

According to KFF, most green card holders must wait five years before enrolling in Medicaid or CHIP. Refugees and asylees are the main exceptions, but relatives you sponsor through a family petition usually are not. After five years, deeming can still count your income as theirs, so for many sponsored adults Medicaid stays out of reach while your obligation lasts.

Older relatives face a second wait. KFF explains that immigrants without enough US work history must live in the US for five years immediately before enrolling in Medicare. After that, Medicare.gov lists the 2026 cost of buying Part A at $311 or $565 a month, depending on work history, plus a standard Part B premium of $202.90. For a parent, that is a cost you may end up covering under the affidavit. Our article on the Medicaid bar for immigrant parents goes deeper on that case.

How do sponsors plan health coverage for relatives they bring over?

Think in phases rather than one policy. The plan below works for spouses, children and parents, with different emphasis for each:

• Arrival to first coverage: a short bridge plan from the day your relative lands until their long term coverage begins. The new immigrant plans on Ombrela exclude pre-existing conditions and have age limits, so check the terms for older relatives.
• Months one to sixty: an employer plan, if your relative works or can join yours, or a Marketplace plan. HealthCare.gov lists moving to the US from a foreign country as a trigger for a Special Enrollment Period.
• Children: many states cover lawfully residing children in Medicaid and CHIP without the five year wait; ask your state whether deeming applies before you enroll.
• Parents over 65: a Marketplace plan until Medicare is possible, then budget for Part A and Part B premiums.

Check bridge plan eligibility by home country. According to the plan catalog, IMG's Patriot plans exclude residents of countries including Nigeria, Ghana, Cuba, Venezuela and Iran, and Trawick's Safe Travels USA plans exclude residents of countries including the Dominican Republic, Haiti, Nigeria and most of the European Union.

What does the new public charge rule mean for sponsored relatives?

DHS's final rule, published July 20, 2026 at 91 FR 45324, rescinds the 2022 public charge regulations for applications for admission made, or adjustment of status applications submitted, on or after September 18, 2026. The rule restores broad officer discretion to weigh the totality of an applicant's circumstances and states that officers consider any Form I-864 submitted on the applicant's behalf. The rule says USCIS will issue guidance to help officers apply it. Because the effect on a given case depends on status and history, discuss benefit decisions with an immigration attorney before your relative applies for anything.

Download the sponsor health cost planning worksheet

Download our free Sponsor Health Cost Planning Worksheet below. It summarizes your I-864 obligation, flags which benefits carry reimbursement risk, records your relative's age and arrival date, compares coverage options and costs, and builds a budget and key dates calendar you can revisit each year until the obligation ends.

How to get covered

Line up coverage before the flight lands. You can compare new immigrant bridge plans on Ombrela by your relative's age, arrival date and home country, then move them to a Marketplace or employer plan. Premiums depend on age, coverage length, policy maximum and deductible, so compare live quotes, and use the medical cost estimator to size the risk you are underwriting as a sponsor.

Frequently Asked Questions

Do I have to buy health insurance for the person I sponsor on Form I-864?

No. The current Form I-864 instructions do not require the sponsor to buy or show health insurance. The form commits you to maintain your relative at 125% of the federal poverty guidelines and exposes you to repayment if they receive means tested benefits such as regular Medicaid or CHIP. Many sponsors buy or help pay for coverage anyway, because a large medical bill is the most common way support becomes necessary.

Will I have to repay emergency room costs covered by emergency Medicaid?

Emergency Medicaid is not a means tested public benefit for affidavit of support purposes. USCIS Form I-864P lists it among the excluded programs, together with immunizations and testing and treatment for communicable diseases. Regular Medicaid and CHIP are on the list of benefits that can lead an agency to request repayment. Ask an immigration attorney how your state applies these rules to your case.

Do Marketplace tax credits count against my affidavit of support?

Marketplace premium tax credits do not appear on the list of means tested public benefits in USCIS Form I-864P, which names food stamps, Medicaid, SSI, TANF and CHIP. According to KFF, lawful permanent residents keep eligibility for Marketplace tax credits in 2027, so a Marketplace plan is often the main comprehensive option for a sponsored green card holder who has no employer coverage.

When does my obligation as a sponsor end?

USCIS says the obligation ends when your relative becomes a US citizen, is credited with 40 quarters of work, or stops being a permanent resident, or when you or your relative dies. Divorce does not end it. If you are not a US citizen, the I-864 instructions require Form I-865 within 10 days of a move, with civil fines of $250 to $2,000 for failing to, or $2,000 to $5,000 if you knew your relative received benefits.

Sponsoring a relative is a long commitment, and health costs are where it most often gets tested. Plan each phase of coverage now, and get new immigrant quotes on Ombrela for your relative's first weeks in the US.