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Health Insurance for elderly and new immigrants

We offer a variety of short-term and long-term visitor insurance plans for green card holders, individual travelers, parents who travel back and forth to the USA and their home country, and those traveling short-term back to the States.

These plans are also ideal for parents and/or senior citizens who predominantly live in their home country and come to visit their children and grandchildren here in the United States as green card holders.

We have dedicated the below page to highlighting the principal questions of immigrants about insurance plans available on the market today.

EPIA has you covered for all you insurance needs!

Did the ACA improve access to health coverage for immigrants?

For more than a decade, roughly one million people per year have been granted lawful permanent residence in the United States. In addition, there are about 11 million undocumented immigrants in the U.S., although that number has fallen from a high of more than 12 million in 2005.

New immigrants can obtain health insurance from a variety of sources, including employer-sponsored plans, the individual market, and health plans that are marketed specifically for immigrants.

The Affordable Care Act has made numerous changes to our health insurance system over the last several years. But recent immigrants are often confused in terms of what health insurance options are available to them. And persistent myths about the ACA have made it hard to discern what’s true and what’s not in terms of how the ACA applies to immigrants.

So let’s take a look at the health insurance options for immigrants, and how they’ve changed – or haven’t changed – under the ACA.

Can immigrants select from any available health plans during open enrollment?

Yes, as long as they’re lawfully present in the U.S. (Note that there is one exception: DACA recipients are considered lawfully present during their deferred action period, but they are not eligible to enroll in health coverage through the exchange.)

Open enrollment for individual-market health insurance coverage runs from November 1 to January 15 in most states, although there are some states that have different deadlines. During this window, any non-incarcerated, lawfully present U.S. resident (other than DACA recipients) can enroll in a health plan through the exchange in their state. It’s also an option to enroll outside the exchange during that window, although financial assistance is not available outside the exchange.

Are immigrants eligible for health insurance premium subsidies?

You do not have to be a U.S. citizen to benefit from the ACA. If you’re in the U.S. legally – regardless of how long you’ve been here – you’re eligible for subsidies in the exchange if your income is in the subsidy-eligible range and you don’t have access to an affordable employer-sponsored plan that provides minimum value. Premium subsidies are normally only available to exchange enrollees if their income is at least 100% of the federal poverty level (FPL), but subsidies also extend below the poverty level for recent immigrants, as described below.

Lawfully present immigrant status applies to a wide range of people, including those with “non-immigrant” status such as work visas and student visas. So even if you’re only in the U.S. temporarily — for a year of studying abroad, for example — you can purchase coverage in the health insurance exchange for the state you’re living in while in the US. And depending on your income, you might be eligible for a premium subsidy to offset some of the cost of the coverage.

Special enrollment period for new citizens

When you become a new U.S. citizen or gain lawfully present status, you’re entitled to a special enrollment period in your state’s exchange. You’ll have 60 days from the date you became a citizen or a lawfully present resident to enroll in a plan through the exchange, with subsidies if you’re eligible for them.

There are a variety of other special enrollment periods that apply to people experiencing various qualifying life events. These special enrollment periods are available to immigrants and non-immigrants alike.

Are recent immigrants eligible for ACA subsidies?

Yes. The ACA called for expansion of Medicaid to all adults with income up to 138% of the poverty level, and no exchange subsidies for enrollees with income below the poverty level, since they’re supposed to have Medicaid instead. But Medicaid isn’t available in most states to recent immigrants until they’ve been lawfully present in the U.S. for five years. To get around this problem, Congress included a provision in the ACA to allow recent immigrants to get subsidies in the exchange regardless of how low their income is.

Low-income, lawfully present immigrants – who would be eligible for Medicaid based on income, but are barred from Medicaid because of their immigration status – are eligible to enroll in plans through the exchange with full subsidies during the five years when Medicaid is not available. Their premiums for the second-lowest-cost Silver plan are entirely covered by the premium subsidy through at least the end of 2025 (this is due to the American Rescue Plan and its enhancement of the ACA’s premium subsidies; these provisions have been extended through 2025 by the Inflation Reduction Act)

In early 2015, Andrew Sprung explained that this provision of the ACA wasn’t well understood during the first open enrollment period, even by call center staff. So there may well have been low-income immigrants who didn’t end up enrolling due to miscommunication.

But this issue is now likely to be much better understood by exchange staff, brokers, and enrollment assisters. If you’re in this situation and are told that you can’t get subsidies, don’t give up — ask to speak with a supervisor who can help you (for reference, this issue is detailed in ACA Section 1401(c)(1)(B), and it appears on page 113 of the text of the ACA).

Lawmakers included subsidies for low-income immigrants who weren’t eligible for Medicaid specifically to avoid a coverage gap. Ironically, there are currently about 2 million people in 11 states who are in a coverage gap that exists because those states have refused to expand Medicaid.

Congress went out of its way to ensure that there would be no coverage gap for recent immigrants. But they couldn’t anticipate that the Supreme Court would make Medicaid optional for the states and that numerous states would block expansion, leading to a coverage gap for millions of U.S. citizens.

Can recent immigrants 65 and older buy exchange health plans?

Yes. Most Americans become eligible for Medicare when they turn 65, and no longer need individual-market coverage. But recent immigrants are not eligible to buy into the Medicare program until they’ve been lawfully present in the U.S. for five years.

Prior to 2014, this presented a conundrum for elderly immigrants, since individual market health insurance generally wasn’t available to anyone over the age of 64. But now that the ACA has been implemented, policies in the individual market are available on a guaranteed-issue basis, regardless of age. And if the plan is purchased in the exchange, subsidies are available based on income, just as they are for younger enrollees. (It’s unlawful to sell an individual market plan to anyone who has Medicare, but recent immigrants cannot enroll in Medicare)

The ACA also limits premiums for older enrollees to three times the premiums charged for younger enrollees. So there are essentially caps on the premiums that apply to elderly recent immigrants who are using the individual market in place of Medicare, even if their income is too high to qualify for subsidies.

Are undocumented immigrants eligible for ACA coverage?

No. Although the ACA provides benefits to U.S. citizens and lawfully present immigrants alike, it does not directly provide any benefits for undocumented immigrants.

The ACA specifically prevents non-lawfully present immigrants from enrolling in coverage through the exchanges (section 1312(f)(3)). And they are also not eligible for Medicaid under federal guidelines. So the two major cornerstones of coverage expansion under the ACA are not available to undocumented immigrants.

Some states — described in more detail below — have implemented programs to cover undocumented immigrants with low incomes, particularly children and/or people who are pregnant.

It’s important to understand that if you’re lawfully present, you can enroll in a plan through the exchange even if some members of your family are not lawfully present. Family members who aren’t applying for coverage are not asked for details about their immigration status. And clarifies that the immigration details you provide to the exchange during your enrollment and verification process are not shared with any immigration authorities.

EPIA has you covered for all you insurance needs!


EPIA inc. is a private Insurance Agency with no ties with legal entities. The information contained in this article is based on information provided by the Medicare Official Website.

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