Oleksandr Rohovnin It is extremely risky to not have health insurance in the United States, whether you are a resident or an immigrant. Over 92% of Americans own a health insurance plan, with the average personal healthcare expenditure exceeding $10,000.
For non-U.S. citizens, though, things are complicated. All guests of the country are eligible for health insurance, but the available coverage and enrollment conditions vary depending on the status of the non-resident.
This article explains what health insurance coverage is available for specific categories of non-U.S. citizens.
Is Health Insurance Mandatory for Immigrants?
Health insurance coverage is not mandatory in the United States, except that in some states not having health insurance will result in tax penalties. Healthcare services are expensive in the United States, so all immigrants and expats should at least consider purchasing a health insurance plan to mitigate financial risks while abroad.
Is Health Insurance for Immigrants Worth It?
Health insurance for immigrants is absolutely worth it, although it may be tempting to save on it, especially if you are not going to stay in the United States for long.
Even a single medical check-up can cost thousands of dollars, which is hundreds of times higher than the average health insurance monthly premium. An unforeseen medical emergency can drain tons of money from you and even leave you without necessary medical treatment.
How Can Immigrants Obtain Health Coverage in the United States?
Whether immigrants, expats, and foreigners are eligible for coverage largely depends on whether they are lawfully present in the United States.
- Documented (lawful) immigrants and green card holders are eligible for the same health insurance options as regular U.S. citizens are, including coverage from the Health Insurance Marketplace.
- Undocumented immigrants are not eligible for coverage through the Health Insurance Marketplace but can still buy health insurance from private insurers.
Who Are Documented (Lawfully Present) Immigrants?
Lawfully present immigrants are:
- Immigrants with the ‘qualified non-citizen’ status: lawful permanent residents, lawful temporary residents, green card holders, refugees, asylees, trafficking victims, student visa holders, worker visa holders, citizens of Palau, Marshall Islands, and Micronesia, and more.
- Holders of humanitarian statuses: Temporary Protected, Convention Against Torture, Special Juvenile, etc.
- Holders of valid non-immigrant visas.
All lawfully present foreigners are subject to the same health insurance rules and regulations as regular citizens of the United States, including the ability to buy health insurance from the Health Insurance Marketplace.
The full list of statuses that qualify for the Health Insurance Marketplace is here.
Health Insurance Marketplace: Coverage for Lawfully Present Immigrants
The Health Insurance Marketplace is a national health insurance market where you can find the coverage that fits your needs and budget. Most plans include doctor visits, prescriptions, hospitalization, preventive care, and other essential benefits.
The Health Insurance Marketplace is run by the federal government, but some states do have their own health insurance marketplace. All U.S. residents and those lawfully present in the United States can buy health insurance coverage from the national Marketplace.
How Can a Non-Citizen Apply for a Health Insurance Marketplace Plan?
As a non-citizen, you can apply for a Marketplace plan:
- During the Open Enrollment Period: online, by phone, or via a paper application.
- If you qualify for a Special Enrollment Period based on your household income or due to a qualifying life event (losing your health insurance coverage, getting married, having a baby, moving, etc.).
- If you qualify for the Children’s Health Insurance Program (CHIP) or Medicaid.
Here’s more info on how you can apply for the 2022 Health Insurance Marketplace.
What Coverage Can Immigrants Choose on the Marketplace?
All eligible immigrants can choose from:
- Health Maintenance Organizations (HMO). Working through a network of healthcare providers, an HMO will assign you a primary care doctor who will then refer you to relevant specialists.
- Most understandable and straightforward, except that a referral from your primary care doctor will likely be required to see a doctor.
- Least freedom to choose your healthcare provider.
- Preferred Provider Organizations (PPO). Unlike HMOs, PPOs allow you to choose your primary care doctor from a bigger network of doctors. Choosing an out-of-network physician is also possible, but it will increase your premium.
- Moderate amount of paperwork (no reference needed).
- More freedom to choose your healthcare provider.
- Exclusive Provider Organizations (EPO). With EPOs, you don’t have to have a primary care doctor, but you still have to choose your healthcare provider from a predetermined network. Out-of-network providers are not allowed.
- High-quality providers (no reference needed)
- Most affordable
- Point-of-Service Plans (POS). A mix of PPO and HMO, POS plans allow in-network and out-of-network providers with a reference from your primary care doctor.
- Catastrophic plans. Serving people aged 30 or more, catastrophic plans allow free preventive care and three primary care visits (in-network) before the deductible applies.
- High-Deductible Health Plan (HDHP). An HDHP is a version of an HMO, PPO, EPO, or POS plan that allows you to pay for medical expenses with money from your federal taxes. For 2022, the IRS defined an HDHP as any plan with a deductible of $1,400 for a person or $2,800 for a family.
- Low premium
- Higher out-of-pocket costs
Marketplace Health Insurance Discounts for Non-U.S. Citizens
Most health insurance discounts are based on your annual income and the federal poverty level (FPL).
| Annual Income to the FLP | Discounts |
| Above 400% of the FLP | Premium tax credits to help cover the premium |
| Between 100% and 400% of the FLP | Premium tax credits and other savings on the Marketplace plans |
| At or below 150% of the FLP, for those not eligible for Medicaid and CHIP | Get or change coverage through a Special Enrollment Period |
| Below 100% of the FLP, for those not eligible for Medicaid | Premium tax credits and other savings on Marketplace plans |
Medicaid and CHIP for Lawfully Present Children and Pregnant Women
Although the federal law requires that non-U.S. citizens meet a 5-year waiting period before they can enroll in Medicaid or CHIP, many states remove the waiting period to provide health insurance to lawfully present children or/and pregnant women*.
| CHIP (Children) | CHIP (Children and Pregnant Women) | Medicaid (Children) | Medicaid (Children and Pregnant Women) | Medicaid (Pregnant Women) |
| Arkansas, California, Connecticut, Delaware, Florida, Illinois, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Montana, Nebraska, New York, Nevada, North Carolina, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Washington, and Wisconsin | Colorado, New Jersey, Virginia, and West Virginia | Florida, Illinois, Iowa, Kentucky, Louisiana, Montana, Nevada, Oregon, Rhode Island, Texas, and Utah, | American Samoa, Arkansas, California, Colorado, Connecticut, Commonwealth of the Northern Mariana Islands (CNMI), Washington, D.C., Delaware, Hawaii, Maine, Maryland, Massachusetts, Minnesota, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, South Carolina, U.S. Virgin Islands, Vermont, Virginia, Washington, West Virginia, and Wisconsin | Wyoming |
*Learn more about travel insurance for pregnant women.
Affordable Care Act (ACA) Plans for Non-U.S. Citizens
Signed into law by President Barack Obama in March 2010, the Affordable Care Act (ACA), also known as Obamacare, is the healthcare reform designed to make health insurance more affordable and forbid insurers from denying coverage due to preexisting conditions.
The Affordable Care Act created the Health Insurance Marketplace and obliged ACA-compliant providers to include mandatory coverage, such as hospitalization, ambulatory patient services, laboratory services, prescription medication, pediatric services, emergency services, rehabilitative services, etc.
Lawfully present immigrants can take advantage of a special enrollment period to purchase an ACA-compliant plan on the Health Insurance Marketplace or from an ACA-compliant provider. Likewise, lawfully present immigrants with income below the poverty level can receive ACA subsidies.
Health Insurance for Green Card Holders, Expats, and Travelers
Green card holders, expats, and travelers are generally eligible for health insurance, but the available plans vary depending on their status and individual factors such as age, gender, state, etc.
For example, green card holders who don’t stay in the United States permanently and green card holders who are permanent U.S. residents will likely need different plans. That said, all categories of foreigners can buy a suitable healthcare plan on the Health Insurance Marketplace or from a private insurer.
How Much Is Health Insurance for Immigrants?
It’s impossible to accurately set the price range for health insurance for immigrants. The premium may vary from $25 per month to $150 or more per month depending on the immigrant’s status, age, gender, state, coverage type and limits, deductible, and more.
How Much Health Insurance Do You Need as a Non-U.S. Citizen?
It’s hard to accurately estimate how much coverage you may need, but you can estimate your risks based on what you will do during your stay in the United States. For example, engaging in extreme sports will significantly increase your insurance risks.
While policy limits vary from a few dozen thousand dollars to millions of dollars worth of coverage, the recommended amount of coverage would be up to $500,000 for up to 3 months.
Where to Buy Health Insurance for Immigrants?
Expats and other categories of non-U.S. citizens can buy health insurance from the Health Insurance Marketplace or private health insurance providers. Among the best insurers are Geo Blue, Cigna Global, and IMG.
FAQ
Can Immigrants Get Insurance in the United States?
Lawfully present (documented) immigrants, expats, and travelers are eligible for short-term and long-term health insurance in the United States. However, the degree of eligibility and the procedure for purchasing a policy depends on the state and the non-citizen’s status.
Can Undocumented (Unlawfully Present) Immigrants Get Insurance in the United States?
Undocumented non-U.S. citizens can purchase health insurance from private providers, but not from the Health Insurance Marketplace. In some states, there may be special insurance programs for immigrants. For example, immigrants can get health insurance coverage from San Francisco’s Healthy San Francisco and Los Angeles County’s My Health LA programs.
Can Immigrants Be Denied Coverage Due to Preexisting Conditions?
Insurance companies cannot deny health insurance or charge more due to preexisting conditions. However, preexisting conditions are usually not covered except for acute onsets of preexisting conditions.
Are Recent Immigrants Eligible for ACA Subsidies?
Lawfully present immigrants with income below the federal poverty level (FPL) can receive ACA subsidies.
Is Health Insurance for Immigrants More Expensive?
Being a non-U.S. citizen doesn’t affect the price of health insurance.
Oleksandr is an expert in deep research. He covers insurance topics across four major insurance verticals – auto, health, life, and home insurance – while taking into account the legal landscape of the state in question. Come rain or shine, you can expect regular quality blogs and timely updates from Oleksandr.
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