Immigrants and Health Insurance

Immigrants and Health Insurance

During the open enrollment period—that usually runs from November 1st to December 15th in most states—there are a variety of options for buying healthcare plans, often with the help of subsidies. Every state has a different enrollment website. Some use the federal platform, while others manage their own.

If you are an immigrant and you have doubts about whether your immigration status will allow you to acquire insurance in the marketplace or not, read on to find answers to your questions.

Can immigrants buy insurance coverage through the health insurance marketplace?

The majority of documented immigrants can buy health insurance through the markets established by the Affordable Care Act (ACA). 

Undocumented immigrants cannot buy coverage through these markets.

Who is a “legal” immigrant in terms of health insurance?

Documented immigrants generally include:

  • Permanent residents (those who have a “green card”);
  • people fleeing persecution, including refugees and asylum seekers;
  • other humanitarian immigrants, including those with temporary protection status (TPS);
  • Cubans and Haitians; 
  • survivors of domestic violence, human trafficking, or other serious crimes; and
  • people with school or work visas

Does having insurance through Medicaid, CHIP, or the marketplace affect my chances of obtaining my permanent residence or citizenship?

Currently, obtaining healthcare through Medicaid, the Children's Health Insurance Program (CHIP) or the marketplace generally would not prevent someone from obtaining permanent residence (a green card) or citizenship. However, there are exceptions, as when someone receives long-term assistance from an institution backed by Medicaid, because he or she may be considered “a burden to the state.”

However, a rule proposed by the Trump administration in September, 2018 could make it difficult for documented immigrants to obtain permanent residence if they have received certain types of public assistance, including Medicaid, food stamps, or housing subsidies.

But these changes still have not been implemented. 

Are immigrants required to have heath insurance under the individual mandate imposted by the ACA? Do they have to pay a fine?

The majority of immigrants in the United States with papers are subject to the ACA individual mandate.

However, those who do not have coverage for the year of 2018 can claim an exemption from the tax fine directly in their tax return if they experienced circumstances that prevented them from receiving coverage. While taxpayers are not required to submit documentation to justify this exemption in their tax return, they should keep all documentation in their files.

From January 1, 2019, onward, there is no fine for not having health coverage.

Undocumented immigrants do not pay fines if they do not have health insurance.

Can all immigrants enroll in Medicaid or in the Children's Health Insurance Program (CHIP)?

The majority of documented immigrants that meet the requirements of the Medicaid and CHIP programs, such as income level, can enroll if they have lived in the United States for at least five years.

Some groups of documented immigrants do not have to wait five years before enrolling in Medicaid and CHIP. These include refugees, asylum seekers, and other humanitarian immigrants; veterans and military families; and pregnant women and children in certain states.

Some immigrants who have authorization to work in the United States cannot enroll in Medicaid even if they have been in the country for five years or more.

Undocumented immigrants cannot enroll in Medicaid or CHIP coverage.

Can members of a family with a mixed immigration status, where some are citizens or have papers while others are undocumented, enroll in Medicaid or CHIP or receive help to buy coverage through the marketplace?

Citizens and family members with papers can obtain health insurance coverage through Medicaid, CHIP, and the insurance marketplace, even if other members of their families are undocumented. Undocumented family members can apply for health insurance for family members who have residency or who are citizens. For example, an undocumented parent can request health insurance for his child who is a citizen.

When a family with a mixed immigration status applies for health insurance, the immigration status only needs to be reported for the family members who are seeking coverage. Those who will not have coverage, such as a parent enrolling his or her child, do not have to provide proof of citizenship or immigration status. 

Those who are not applying for coverage will be asked to provide a Social Security number, but they are not obligated to give it unless the family requests help for marketplace coverage costs and the person filling out the form is the one who declares taxes for the family and has a Social Security number. The information provided by applicants is not used for purposes of compliance with immigration laws.

Who does the marketplace ask for documentation?

Only those members of a family who are applying for health insurance are requested to provide proof of citizenship or immigration status. Anyone who applies should also provide his or her Social Security number if they have one. The information provided by applicants is not used for purposes of compliance with immigration laws.

The immigration or citizenship status of health insurance applicants is verified electronically using several systems, including the Social Security Administration, the Department of Homeland Security, and SAVE (Systematic Alien Verification for Entitlements).

If the immigration status of a person cannot be verified using the electronic system, the individual can submit other documentation to demonstrate his or her status.

Can immigrants receive help paying the premiums and/or shared costs of their health insurance?

Immigrants must be documented in order to obtain subsidies to help pay for the premiums and shared costs of health insurance bought on the marketplace. As is the case with citizens, they can obtain these subsidies, also known as tax credits, if their income is between 100% and 400% of the federal poverty line (between $12,000 and $48,000 annually for one person). They can also qualify for cost sharing reductions if they are between 100% and 250% of the federal poverty line. In order to receive this help, they should not have access to health insurance through work or be eligible for Medicaid.

Eligibility changes depending on the state.

Documented immigrants who earn less than 100% of the federal poverty line may also receive help paying premiums and shared costs if they cannot enroll in Medicaid due to their immigration status. Many immigrants with papers cannot enroll in Medicaid until they have been in the United States for five years or more.

Undocumented immigrants cannot receive help to pay premiums or shared costs, and cannot buy health insurance through the marketplace, even at full price.

Are young people with an immigration status under Deferred Action for Childhood Arrivals (DACA) eligible for Medicaid, CHIP, and the health insurance marketplace?

Some undocumented young people have a temporary permit to stay in the United States under the Deferred Action for Childhood Arrivals (DACA) program. These people are in the United States with papers and can receive a work permit and Social Security number. However, they are not eligible for Medicaid or CHIP, nor for the health insurance marketplace, in most states.

Where can immigrants who cannot enroll in Medicaid, CHIP, or the health insurance marketplace receive medical care?

Hospitals are obligated to provide emergency care and treatment to everyone independent of their immigration status and whether or not they have insurance, although they may send out the bill afterwards. Those who do not have insurance can also receive low-cost care at community health centers.

People can buy health coverage through their employer, their spouse's employer, or the individual insurance market outside of the state or federal marketplace. Some states and counties also offer health programs for immigrants.

Can looking for health insurance through Medicaid, CHIP, or the health insurance marketplace put undocumented families at risk?

Medicaid, CHIP, and the health insurance marketplace must protect people's information and keep it private. The information can only be used for eligibility and enrollment purposes. The information provided by applicants is not used for purposes of compliance with immigration laws.

Sources: Kaiser Family Foundation, CMS, cuidadodesalud.gov

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