As a lawfully present immigrant, you might wonder how to apply for health insurance in the United States. Your options will depend on your immigration status, as well as whether or not you have a job that offers private insurance. Our De Castroverde team explores the nuances of filing for health insurance as a lawfully present immigrant.
What’s a Lawfully Present Immigrant?
For health insurance purposes, a lawfully present immigrant can include the following:
- Lawful Permanent Residents (LPRs) or “green card holders.”
- Refugees, asylees, and persons fleeing persecution.
- Immigrants granted temporary protected status or other humanitarian immigrants, including those with Convention Against Torture and Special Juvenile status.
- Haitian/Cuban entrants.
- Immigrant survivors of trafficking, domestic violence, or other severe crimes.
- Immigrants with qualified non-citizen status without a waiting period.
- Valid non-immigrant visas.
- Legal status via laws such as the LIFE Act, family unity individuals, or temporary resident status.
Documented and undocumented immigrants can purchase private insurance in the United States, often through their employers. The application process may ask for your immigration status, but the insurance company will only use that to determine your eligibility. They won’t use that information to turn you into the authorities. Private insurance can also be purchased directly from the private insurance company if your employer doesn’t offer it or if you prefer not to go through their insurance. A private insurance company bases the premium or amount you pay for coverage each month on your health risk factors.
Health Insurance Marketplace
Lawfully present immigrants are eligible for coverage through the Health Insurance Marketplace, with premiums partially subsidized by the federal government. You may have heard these plans referred to as Obamacare. These insurance premiums are based primarily on your income, which can mean significant savings over private health insurance. Lower monthly premiums and out-of-pocket costs are based on your annual household income as follows:
- At 400% of the federal poverty level (FPL): You may qualify for premium tax credits to lower your monthly premium.
- Between 100% to 400% FPL: You may qualify for premium tax credits and other savings with Marketplace insurance.
- At or below 150% FPL: If your household income falls below 150% FPF, but you don’t qualify for Medicaid or the Children’s Health Insurance Program, you might be able to change or enroll your Marketplace coverage through a Special Enrollment Period.
- Below 100% FPL: If you don’t qualify for Medicaid at this level, you should qualify for premium tax credits and other savings through the Marketplace when you meet all other eligibility requirements.
Medicaid and Children’s Health Insurance Program (CHIP)
If you meet the state income requirements and residency rules as a qualified non-citizen, you could be eligible for Medicaid and CHIP. Many qualified non-citizens are required to wait up to five years after receiving qualified immigration status to get Medicaid and CHIP. Exceptions to this requirement include asylum seekers, refugees, LPRs, and more. To check if you qualify, visit HealthCare.gov for a complete list of immigration statuses.
Lawfully Residing Pregnant Women and Children
Twenty-nine states, plus the Commonwealth of the Northern Mariana Islands and the District of Columbia, have removed the five-year waiting period for lawfully residing pregnant women and children. Lawfully residing pregnant women and children are also eligible for CHIP in 21 of these states.
Public Charge Status
Receiving savings on health insurance in the Marketplace, applying for Medicaid or CHIP, or receiving Medicaid or CHIP benefits does not make you a public charge. It won’t affect your chances of becoming a U.S. citizen or LPR. The exception is for anyone receiving long-term care at the government’s expense in an institution, such as a nursing home. Barriers to obtaining a green card may exist for this small population.
Applying for Health Insurance on the Marketplace
Lawfully present immigrants can apply for health insurance on the Marketplace during the open enrollment for individuals. For most states, this enrollment period runs from Nov. 1 through Jan. 15, but you’ll want to check with your state to be sure of its exact dates. You can enroll in a health insurance plan through the exchange in your state during open enrollment. You can also enroll outside of this exchange during this time, but there isn’t any financial assistance available if you go outside the exchange.
Special Enrollment Period for New Citizens
A special enrollment period is available for your state’s exchange when you become a U.S. citizen or gain lawfully present status. This particular enrollment period lasts 60 days from when you became a U.S. citizen or gained lawfully present status. Special enrollment periods are also available to those experiencing qualifying life events, such as a marriage or divorce.
Costs Associated With Health Insurance
In addition to a monthly premium, health insurance can have various costs associated with care. Knowing the difference between these expenses is essential as you shop for health insurance on the Marketplace. Let’s look at deductibles, copays, and coinsurance.
What’s a Deductible?
A deductible is a set amount you pay before your health insurance plan takes effect. For example, if you have a $2,000 annual deductible, the first $2,000 of medical expenses will be your responsibility. A higher deductible may offer a lower monthly premium, but you need to consider the overall costs and not just the monthly savings on a premium.
What’s a Copay?
A copay is a set fee for a prescription, doctor visit, or specialist appointment. For example, you may have several medication tiers featuring a $10, $25, and $50 copay based on the prescription expense. Your copay is a portion you pay upfront, typically instead of a deductible.
Coinsurance refers to a portion you’ll be required to pay for services even after you meet your deductible. For example, if your deductible is $2,000 with a coinsurance of 25%, the first $2,000 medical expenses will be yours to pay in full. After that first $2,000, you’ll pay 25% off all services for the remainder of the year.
If you’re interested in gaining lawfully present status or have other questions regarding immigration law, contact our knowledgeable team at De Castroverde. Complete our secure online form or call us at 702-827-4891 to see how we can help you with your immigration needs.