All the immigrants arriving in the U.S. first need to make effort to obtain health insurance because unlike other countries, the U.S. does not have universal health coverage, and even government-sponsored health plans like Medicare and Medicaid are not available for new immigrants.
Some of the health insurance options for new immigrants as well as those who have been in the U.S. for a long time are discussed below:
Do Immigrants have access to ACA Premium Subsidies?
Premium tax credits or premium subsidies offered only through exchanges are available only for lawfully present residents including a long list of immigration statuses. The immigrants who have recently arrived in the U.S. with income below the poverty level are entitled to receive subsidies. However, this is not the case for non-immigrants or immigrants who have been lawfully present in the U.S. for more than five years. Premium subsidies are not available to applicants with income below the poverty level because as per the ACA such people should receive Medicaid coverage instead of private plans in the exchange. But since immigrants who have recently arrived are not eligible for Medicaid until they have been in the U.S. for at least five years, so premium subsidies are available to them. Even the states have the option to use their funding to expand Medicaid coverage to recent immigrants, which some states do particularly in the case of pregnant women.
The lawmakers while writing the Affordable Care Act realized that the lower-income threshold for premium subsidies would leave low-income immigrants without any real coverage options. Thus they provided premium subsidies to new immigrants with income below the poverty level. Therefore in every state, recent immigrants having lawfully-present status are eligible for premium subsidies even if their income is below the poverty level.
Immigrants need to provide documents to give proof of their lawful presence
The health insurance exchanges during the enrollment process need to verify that the immigrant is lawfully present in the U.S. The applicants are required to provide their immigration status on the application and include their alien number. If applicants are unable to enter the document number or if they get an error, then they also have an option to upload a copy of their immigration documents, or can mail the documents to the health insurance exchange. If the applicants are not able to provide immigration documents, then their coverage gets retroactively canceled. If applicants are unable to provide adequate proof of their immigration status then their coverage gets terminated every year. Thus, immigrants who enroll and find difficulty with the system verifying immigration status should pro-actively act otherwise their coverage could be terminated. Immigrants should consult to the exchange for help or at an enrollment center to ensure that their documentation is accepted.
Coverage Options for Immigrants who are 65 or Older?
For recent immigrants aged 65 or older, there were few options available before 2014. Generally, private health plans were not available for anyone over the age of 64, and they were also unable to obtain coverage through Medicare and Medicaid, so older immigrants had to rely only on the long-term travel insurance plan unless they were offered an employer-sponsored plan in the U.S.
Even after the five years period, immigrants were not able to afford Medicare plans. Though immigrants of age 65 or older were allowed to purchase medicare plan but the high monthly premiums of both Medicare Part A and Part B prevented them to enroll. Thus lawfully-present immigrants only have the option to enroll in private plans in the individual market after arriving in the U.S. Due to the ACA, immigrants are no longer prevented from enrolling in a private plan if they are over the age of 64.
Immigrants who don’t qualify for premium subsidies are required to pay the full price of the plan. However premium for individual and small group plans are capped at a maximum of three times the premium charged from a 21-year-old individual, as per the ACA. Thus, the premium amount for an 85-year-old will be the same as a 62-year-old person. The premium for senior immigrants can be less than three times the premium for 21 years old if the state requires a lower ratio but it cannot be higher than the three times premium of younger people.
Besides these, even travel insurance plans and inbound immigrant health plans available, though these plans are limited in scope compared to plans available in the health insurance exchange. These plans come with benefit caps and do not provide coverage for pre-existing conditions and are also not considered minimum essential coverage. However, as of 2020, there is no longer a penalty for being uninsured in the U.S.
Are Immigrants allowed to Enroll in Health Coverage Outside of Open Enrollment?
Immigrants on becoming a U.S. citizen or gaining lawfully-present status in the U.S. are allowed to enroll in a health plan outside the open enrollment period because this a qualifying event that gives them a time of 60 days to enroll in a health plan through the health insurance exchange. Some of the immigrants even get coverage through employer-sponsored plans that also have a special enrollment period for employees that are hired outside that open enrollment period or experience a qualifying event. Thus, even though the open enrollment period comes once a year, immigrants do have the option to enroll in health coverage irrespective of the time they immigrate.
Is It Possible for Undocumented Immigrants to have Coverage?
As per the Affordable Care Act, legally present immigrants have the option to enroll in health plans offered through the exchange and can even qualify for premium subsidies based on their income. However, ACA does not any provisions for undocumented immigrants to obtain coverage. The Affordable Care Act explicitly prevents undocumented immigrants from obtaining health coverage through the exchange despite paying the full price of the plan. Besides, undocumented immigrants are also not eligible for Medicaid. Thus, undocumented immigrants may obtain coverage either employer-sponsored plans or student health plans if they are eligible. They can also purchase individual market coverage from the private marketplace, outside the exchange. At present they are not able to enroll in health coverage through the exchange in any state.