In the United States, health insurance helps you and your family access necessary care, and it protects you from unaffordable medical bills. But healthcare can be confusing for immigrants because there isn’t a single form of health insurance in the United States. Instead, the U.S. healthcare system is a combination of publicly and privately funded programs with different requirements and rules for eligibility, depending on factors like where you live, your immigration status, and your income.
The good news is that many resources exist to help you understand your insurance options so you and your family can be protected. This article will explain what you need to know about U.S. healthcare as an immigrant, including the difference between publicly and privately funded programs and the definitions of common terms like “primary care physician” and “PPO.”
Why You Want Healthcare as an Immigrant
Nobody plans to get sick or hurt, but unfortunately, it can happen to anyone — and when it does, it pays to be insured.
Think of health insurance as a contract between you and the insurance company. When you buy a plan, the company agrees to pay part of your medical costs. Health insurance helps cover the costs of care like emergency room visits, medicine, and regular check-ups with your doctor so you and your family can stay in good health.
The Affordable Care Act requires most U.S. citizens and lawfully present immigrants to a minimum level of coverage, but there isn’t a penalty if you don’t have health insurance.
However, uninsured adults in the United States are more likely to have poor health than insured adults. And according to the Kaiser Family Foundation, people of color are less likely to have health insurance than white people. That’s a problem because people without insurance have worse access to care than people who are insured, and when the uninsured do seek care, they often face unaffordable medical bills.
An Overview of Healthcare Options for Immigrants
Many people in the United States have health insurance through their employer, but not all employers offer insurance plans. Some insurance plans will not cover everything you and your family need or can afford. That’s why people enroll in public programs like Medicare or Medicaid, or they shop for private insurance plans. We’ll explain both below.
Am I eligible for health insurance?
Lawfully present immigrants are eligible for health coverage through the Health Insurance Marketplace, a service operated by the federal government that helps people shop for and enroll in health insurance.
“Lawfully present” means that you have:
- Qualified non-citizen immigration status without a waiting period, such as a green card holder, asylee, or refugee
- Humanitarian status or circumstances
- A valid non-immigrant visa
- Legal status conferred by other laws, such as temporary resident status
- Or any of these immigration statuses
It’s important to know that you can find health insurance that you can afford. Through the federal Health Care Reform law, also known as the Affordable Care Act, ACA, or Obamacare, you may qualify for subsidies that make health insurance cheaper.
And if you don’t have eligible immigration status, you may still qualify for limited emergency services through Medicaid, depending on your state. Undocumented immigrants are not eligible for Medicaid or Marketplace coverage.
Publicly Funded Insurance Programs
If you are a lawfully present immigrant and meet your state’s income eligibility rules, you’re generally eligible for two government-funded programs: Medicaid and Children’s Health Insurance Program (CHIP).
Medicaid
As a state and federal program that provides health insurance for low-income individuals, Medicaid coverage can vary depending on where you live. It might be called something different, like Medi-Cal in California and Apple Health in Washington, and the services may vary from state to state.
Broadly speaking, Medicaid covers services like inpatient and outpatient hospital services, physician services, and laboratory and x-ray services. The income levels vary by state, but even if you don’t qualify based on income, you may be eligible for state programs based on factors like family status and disability.
CHIP
For families that earn too much money to qualify for Medicaid, CHIP provides low-cost coverage for children. Like Medicaid, CHIP is administered at the state level, so eligibility and coverage will vary depending on where you live. But every state offers CHIP benefits, which cover services like routine check-ups, immunizations, prescriptions, and emergency services.
You can apply for and enroll in Medicaid or CHIP any time of year. If you qualify, your coverage starts immediately. However, it’s important to note that some states require a five-year waiting period before you can enroll in these programs.
The best way to find out if you qualify is to fill out a Marketplace application. If you (or someone in your household) qualifies, you’ll be contacted by your state agency about enrollment.
It’s important to note that some states require a five-year waiting period for some lawfully present immigrants. That means you must maintain your qualified status for five years before you can enroll in Medicaid and CHIP.
However, you may still be eligible for emergency Medicaid, or other insurance programs available on the Marketplace.
Private insurance programs
Private health insurance is any form of coverage that is offered by a company, rather than the state or federal government. Employer-sponsored plans are generally private insurance plans.
Just because an insurance plan isn’t government-funded doesn’t mean it’s less affordable; depending on your income, you may be eligible for subsidies that make some private plans cheaper. You may also be eligible for state-approved private health insurance plans, such as Qualified Health Plans available in the state of Washington.
You can find private health insurance on the Marketplace. As opposed to off-Marketplace plans, private health insurance on the Marketplace are required to cover health benefits deemed essential, such as emergency services, hospitalization, mental health and substance use disorder services, and prescription drugs.
Keep in mind that you can only enroll in private health insurance on the Marketplace during the Open Enrollment period. Certain life events, like moving or getting married, are considered qualifying life events that allow you to enroll in health insurance outside of the Open Enrollment period.