All immigrants, documented or undocumented, can legally purchase private insurance in the U.S. if they can afford it. Depending on your immigration status, you may be able to access federal and state benefits to make healthcare more affordable. This article will help you understand the different aspects of healthcare in the U.S. and determine if you qualify for federal or state health benefits. After reading this article, you will be able to make more informed choices about your health insurance options.
Written by Jonathan Petts.
Updated August 15, 2022
1. How Does Health Insurance Work in the U.S.?
Healthcare insurance in the United States is hard to navigate. The U.S. system differs from insurance systems in many other countries.
U.S. employers often provide insurance to their employees as a benefit. Sometimes, an employer may also offer coverage for noncitizens. Eligibility for employer healthcare coverage varies by company.
If you don’t get insurance through your employer, there are some low-cost healthcare options available. Low-income people may be eligible for Medicaid. The Medicaid program is a federal public health insurance program. It helps low-income individuals cover their medical costs. Your eligibility for Medicaid depends on your income. Eligibility often varies by state. If you’re 65 or older, you may also be eligible for Medicare, which is another federal healthcare program.
Private Health Insurance Costs
If your employer doesn’t offer health insurance or you aren’t employed or don’t want your employer’s plan, you can also buy health insurance directly from a private company. One difference here is how your premium is calculated. Your premium is the amount you pay each month for your plan.
Private insurers typically base your plan premium on your health risk factors. But if you purchase a plan on the healthcare “marketplace,” your premium will mostly depend on your income level. This is because the federal government partially subsidizes marketplace plans, also known as Obamacare.
No matter which kind of insurance you have, there will be a few different kinds of costs associated with your health plan that you should know about. We’ve already covered premiums, but you may also have to pay a deductible, copay, and/or coinsurance.
What is a deductible?
Besides premiums, privately insured people will also pay deductibles. A deductible is the amount you have to pay for most medical services or medications before your plan begins to cover costs. Your deductible will be a set amount. You can usually find it in your plan information packet.
For example, if you have a $1,500 yearly deductible, you must pay the first $1,500 of your medical costs before your plan kicks in to cover further costs. Often, the higher your deductible, the lower your monthly premium. When you’re deciding which is better for you, you’ll want to look at your medical needs and circumstance.
If you don’t visit the doctor regularly, have a chronic or ongoing medical condition, or take many prescriptions, your annual medical costs are probably pretty low. In this case, it may be beneficial for you to take on a plan offering a higher deductible but a lower overall premium. But if you are treating a chronic or ongoing health issue, have several prescprtions, and visit the doctor regularly, you may opt for the opposite — a plan with a lower deductible and higher monthly premium.
What is a copay?
Some plans also include copayments, or copays. A copay is a set fee you pay for a doctor visit or to fill a prescription. Usually, you pay a copay at an appointment or when you pick up a prescription. Typically, plans with high deductibles don’t require copays for office visits or prescriptions.
What is coinsurance?
You’ll also need to consider coinsurance. Your coinsurance determines how much your insurance covers after you meet your deductible. It’s usually expressed as a percentage. For example, let’s say your coinsurance is 25%. In this case, you’d need to pay 25% of your covered medical bills, and your plan will cover the remaining 75%.
What else do you need to know about private insurance?
Keep in mind that certain services may not be covered by all plans. Some charges may exceed a plan’s maximum reimbursable charge. Be sure to read your plan’s policies carefully and consider your potential healthcare needs when choosing a private plan.
You should note that many private plans don’t include vision or dental coverage. You may need to buy separate plans for these areas.
2. Can a Non-U.S. Citizen Get Medical Insurance?
Yes, a non-U.S. citizen can get medical insurance. There are insurance options available to people of all statuses. In the U.S., most people with lawful status purchase private health insurance through a state or federal marketplace. Plans on the marketplace may have tax or other benefits that lower overall costs.
Low-income immigrants, pregnant women, and children are sometimes eligible for state or federal health benefits as well.
Private insurance companies offer plans that are not listed on the marketplace. Undocumented immigrants may be able to buy private insurance plans not listed on federal or state exchanges.
When applying for insurance, a company may ask about your immigration. The company can only use your status to determine eligibility. They won’t reveal your status to any authorities.
3. What Federal Health Insurance Benefits Can Immigrants Receive?
Depending on your specific status, you may be eligible for certain types of U.S. health insurance. After five years of residence, green card holders become eligible for Medicaid and CHIP, the Children’s Health Insurance Program. To qualify, you must meet all the usual program criteria. You’ll also need to prove your low-income status. The U.S. government uses federal poverty levels (FPLs) to determine benefits eligibility.
Undocumented immigrants aren’t eligible for federal health insurance plans. They may be eligible for other programs, such as emergency medical assistance under Medicaid or services through federally qualified health centers or public health programs.
Insurance Through the Federal Marketplace
In 2010, the U.S. government passed the Affordable Care Act (ACA). This is often referred to as Obamacare. The ACA established marketplace healthcare benefits and extended eligibility for these programs to lawfully present immigrants. ACA benefits can include tax credits and cost-sharing reductions.
The ACA also created plans offering basic services on federal and state exchanges. Private insurance providers offer medical insurance plans on the marketplace.
You are eligible for a marketplace health care plan if you are a lawful permanent resident or a lawfully present immigrant. Lawfully present immigrants include the following:
Those with qualified noncitizen immigrant status
Those with valid nonimmigrant visas
Humanitarian entrants — This includes Temporary Protected Status and Special Juvenile Status holders. This also includes asylees, trafficking victims, and torture victims.
Those with legal status from temporary resident status, the LIFE Act, or FAMILY Unity individuals
Note that Deferred Action for Childhood Arrivals (DACA) recipients don’t count as lawfully present.
Medicaid is insurance funded by federal and state governments. The program is available to U.S. citizens and lawfully present immigrants, including green card holders, asylum seeks, refugees, VAWA recipients, and trafficking victims. While Medicaid is a federal benefit, access to Medicaid varies widely among states. As an immigrant, you may also face a waiting period before you become eligible for Medicaid.
If you qualify for a green card through family, employment, or one of the special circumstances outlined above, you should look into adjusting your status. Adjusting status allows you to apply for your green card and claim benefits like Medicaid.
The Children’s Health Insurance Program (CHIP) provides low-cost health coverage to some children. Eligibility depends on household income. CHIP enrollment covers children in families with incomes above the level covered by Medicaid.
CHIP has similar eligibility requirements to Medicaid for immigrant families. CHIP welcomes qualified immigrants who are lawfully present in the United States. To qualify, you should meet the five-year residency expectation. However, some states make exceptions for lawfully present children and pregnant women.
4. What State Health Insurance Benefits Can Immigrants Receive?
Medicaid and CHIP are federal programs. However, your access to both will vary by state.
Some states have their own state exchanges or marketplaces where immigrants may buy insurance plans. These exchanges sometimes have similar tax benefits and cost-sharing benefits as federal exchanges.
Some states also offer additional health insurance benefits to immigrants. For example, New York provides free and low-cost insurance for adults who don’t qualify for Medicaid. As an immigrant with a valid visa or deferred action status, you may qualify for this plan. However, DACA recipients don’t qualify.
To learn more about your state’s healthcare offerings, you should do some research. Most states have websites and offices dedicated to helping people access state benefits. Healthcare.gov provides a free tool to find local help.
5. Do Undocumented Immigrants Get Health Insurance in the U.S.?
Undocumented immigrants cannot receive federal benefits. Federal benefits include insurance plans on the federal marketplace exchanges and Medicare. However, undocumented immigrants can buy private insurance from certain companies.
Children who are eligible based on income can receive state-funded health insurance in California, New York, Illinois, Massachusetts, Washington, D.C., Oregon, and Washington State. They may receive this insurance regardless of their immigration status.
Lawfully present children of undocumented immigrants may be eligible for certain federal and state benefits. Virginia, Texas, Maryland, and several other states also grant pregnant women Medicaid or state-run health insurance coverage regardless of their immigration status.
Note that insurance applications only ask about the immigration statuses of those receiving the benefit. This includes applications on the federal health insurance marketplace. For example, if you and your children are lawfully present and seeking insurance, but your undocumented spouse is not lawfully present. You only need to provide your and your children’s status when applying for health benefits.
If you’re only seeking insurance for lawfully present family members, you shouldn’t worry about other relatives’ statuses. If a relative doesn’t have a valid status under U.S. immigration law, it won’t affect your lawfully present relatives.
Immigrants looking for marketplace coverage should check out HealthCare.gov for more information.
6. Will Doctors or Hospitals Turn Away Non-U.S. Citizens Who Don’t Have Insurance?
No, doctors and hospitals won’t turn away uninsured non-U.S. citizens. Many nonimmigrant U.S. citizens receive care without insurance. In 2020, about 28 million people reported that they did not have health insurance over the past year. These individuals could still request services if needed.
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA). This law says that doctors and hospitals can’t refuse treatment in the emergency room. Even if you aren’t able to pay the estimated bill, you can receive medical attention. Without insurance, you may need to pay a flat fee before receiving services. Some doctors and dentists offer lower rates for uninsured individuals.
If you are worried about healthcare costs, know that you can talk to your doctor about the costs before receiving treatment.
Navigating the health insurance landscape in the United States can be difficult. Finding and qualifying for U.S. health benefits will be an easier process for U.S. permanent residents. If you successfully apply for a green card, you may gain access to more affordable, reliable medical coverage.
Applying for a green card can be complicated, but help is available. If you are eligible, our free web app will walk you through the green card application process and help you prepare and file your application with the U.S. government. If our app isn’t a good fit, we may be able to refer you to an experienced immigration attorney to help. Click "Get Started" to see how we can help make your American dream come true!