Eligible for Obamacare at reduced cost or not ??

[AussieNemesis 16]

I am in the middle of AOS'ing from tourist to resident through marriage.

My husband is the US Citizen and has no need for insurance he is covered by the VA.

I have EAD, and Social Security number no Greencard yet.

Am I eligible for this Obamacare with reduced cost premiums as I work here (earning below the minimum wage) and pay taxes .... ?? The lady I saw about it in Kentucky today had no idea ! ! and told us to come back tomorrow and she'd try to find out ?

I have tried google and tried the state health care exchange sites and I can't figure it out.

Can anyone clarify for me please?

thanks

[darin&josh 18]

My understanding is that you should become eligible to purchase plans through the marketplaces once you are officially a permanent resident (i.e. get your green card). Once you are eligible to purchase plans through the marketplace, the main provisions of the Affordable Care Act apply, including the applicability of the federal subsidies as well as the individual mandate if you meet the criteria. However, the plans available through the exchanges will have rules set by each state (similarly for Medicaid); so your eligibility for those may depend on the rules set up by the state of Kentucky (but the person you are dealing with will be able to give you better and specific advice on that).

I'd recommend checking this site to see if your EAD would be sufficient to establish your eligibility: https://www.healthcare.gov/what-do-immigrant-families-need-to-know/

Edited March 19, 2014 by darin&josh

[AussieNemesis 16]

Thank you

That page states that the EAD card is acceptable so I'm printing it and taking it with us to the appointment today

Trust me when I say rural Kentucky doesn't always know the rules no matter who they are representing.... and that most of the people round here hate Obamacare in principle. That's why I asked here instead of relying on local info.

I appreciate the time you took to find that link for me !

hugz

[darin&josh 18]

While Iowa probably isn't quite at the same level as Kentucky, I think I have a reasonably good idea of what you mean given they are both rural, conservative states

Unfortunately it seems that lack of information and misinformation is the norm when it comes to the marketplaces and who is eligible for what, so I am not surprised that they were even more unsure when it came to working out whether you were eligible with your current status.

Hopefully taking along that information will make things move along faster, particularly as there is only a few days left to sign up.

Good luck today.

[AussieNemesis 16]

Hmm update

KYnect says I am not eligible so I had printed that webpage for them and they are apparently going to appeal the decision that said I was not eligible.

Weirder and weirder.

[darin&josh 18]

Hmm update

KYnect says I am not eligible so I had printed that webpage for them and they are apparently going to appeal the decision that said I was not eligible.

Weirder and weirder.

Did they specify what you were not eligible for, and why? It's possible they did not consider you a lawful immigrant and therefore not eligible to purchase any plans through Kynect; or they accepted you are a lawful immigrant but based on your income/circumstances considered you were either not eligible to purchase a plan or not eligible to receive the advance premium tax credit.

If you were considered not eligible because of your immigration status, then the following page has some good information and advice that would be worth reading (particularly the "lawfully present" fact sheet): http://www.nilc.org/ACAfacts.html

[AussieNemesis 16]

It's definitely due to immigration status. On income the insurance would be free.

I am in limbo I think, not yet a permanent resident as a decision has not been made on my AOS from tourist Visa Waiver to Immigrant through marriage to citizen.

And I think there is still a long road to travel to get the approval. See my time line below ...

[darin&josh 18]

Sorry to hear that it has been so difficult. I would still persist with it though. The rules governing eligibility are complex, but I would have thought that if you are legally able to work, then you are considered to be lawfully present, even if you are in the middle of the AOS process.

You mentioned that your insurance would be free based on your income. However, it's probably worth noting that it would only be free if you qualified for Medicaid, which you would not even if you had your green card (there is a five year waiting period, although individual states have exemptions). My understanding is the best you can hope for is to be deemed eligible for a marketplace healthcare plan and to qualify for premium support (the tax credit) to reduce the amount you actually pay each month.

As you know, once you have your green card the process will be a lot easier. If the final response you get back is that you are not eligible because of your current immigration status, I would then ask: "does obtaining a green card qualify as a major life change event that will allow me to re-apply outside of the open enrollment period?" If the answer is yes, it would at least mean you can apply straight away rather than having to wait for the next open enrollment period.

Edited March 21, 2014 by darin&josh

[Lynkali 163]

I am no expert, so I can only offer my opinion, but here goes: since you have such a low income and you're not applying in conjunction with your husband, you MAY be falling into a gap of coverage.

(1) If your income is above a certain amount, you will get subsidies (reduced cost but not "free") on any health plans you choose to enroll in. Those subsidies would apply to anyone with EAD or green card. Your income appears to be too low, however, so:

(2) If your income is below poverty level, then IF YOU WERE A CITIZEN you would qualify for Medicaid/Medicare (FREE health coverage). But as a Green Card holder, you cannot receive Medicaid/Medicare. Once you are a legal permanent resident for 5 years or longer, THEN you can qualify for Medicaid/Medicare.

So since your income is too low for subsidies, they would normally offer you free health coverage -- but they can't because your immigration status doesn't allow that. I don't see any solution for you under the ACA/Obamacare -- you'll probably just have to buy coverage on the open market.

However, if you apply under Obamacare WITH your husband together, then your income will most likely qualify you both for subsidized (lower cost) health coverage plans. That is what I (USC) and my green-card-holding husband have done, and in fact we applied and were enrolled when he had only his EAD. So EAD isn't the problem per se -- it's the low income that forces you into the Medicaid plans for which your immigration status isn't eligible.

I think. As I said I'm no expert, but it is an educated guess. I'd be VERY happy to be corrected if someone understands the system better!

[darin&josh 18]

I am no expert, so I can only offer my opinion, but here goes: since you have such a low income and you're not applying in conjunction with your husband, you MAY be falling into a gap of coverage.

(1) If your income is above a certain amount, you will get subsidies (reduced cost but not "free") on any health plans you choose to enroll in. Those subsidies would apply to anyone with EAD or green card. Your income appears to be too low, however, so:

(2) If your income is below poverty level, then IF YOU WERE A CITIZEN you would qualify for Medicaid/Medicare (FREE health coverage). But as a Green Card holder, you cannot receive Medicaid/Medicare. Once you are a legal permanent resident for 5 years or longer, THEN you can qualify for Medicaid/Medicare.

So since your income is too low for subsidies, they would normally offer you free health coverage -- but they can't because your immigration status doesn't allow that. I don't see any solution for you under the ACA/Obamacare -- you'll probably just have to buy coverage on the open market.

However, if you apply under Obamacare WITH your husband together, then your income will most likely qualify you both for subsidized (lower cost) health coverage plans. That is what I (USC) and my green-card-holding husband have done, and in fact we applied and were enrolled when he had only his EAD. So EAD isn't the problem per se -- it's the low income that forces you into the Medicaid plans for which your immigration status isn't eligible.

I think. As I said I'm no expert, but it is an educated guess. I'd be VERY happy to be corrected if someone understands the system better!

I don't pretend to be an expert either, and it's quite possible the coverage anomaly for low income immigrants is why the OP is having difficulty (particularly as you have firsthand experience with the marketplace system and signing up).

But for what it's worth, my understanding is where lawful immigrants are earning 100% or less of the poverty line and are not eligible for Medicaid (because they have not completed the five year waiting period), they should be eligible for marketplace plans and the premium subsidies (and the reduced out of pocket provisions): https://www.healthcare.gov/what-do-immigrant-families-need-to-know/

based only on my limited understanding of the issue, the coverage gap affects individuals (citizens and lawful immigrants with 5 or more years residency) in states that have not raised the income threshold for Medicaid eligibility to 138% of the poverty line (which was the original intent of the Affordable Care Act). The gap occurs when someone is earning below 100% of the poverty line but is still above the upper limit for Medicaid (which is around 48% in those states). The result is they are not only ineligible for Medicaid but they don't earn enough to qualify for a marketplace plan or the premium subsidies.

I'm sure the OP will be very interested to hear that your husband was able to access the marketplace plans with his EAD.

But I'd also welcome others to comment and hopefully provide greater clarity on the issue in order to assist the OP.

[Lynkali 163]

But for what it's worth, my understanding is where lawful immigrants are earning 100% or less of the poverty line and are not eligible for Medicaid (because they have not completed the five year waiting period), they should be eligible for marketplace plans and the premium subsidies (and the reduced out of pocket provisions): https://www.healthcare.gov/what-do-immigrant-families-need-to-know/

Ah, ok ... I had not read that link. I was going by the lawfully-present FAQs on the CoveredCalifornia website, which is the Exchange that my husband and I used, and they are not NEARLY as clear about the subsidies being extended to greencard holders. Your link above makes it clear that subsidies SHOULD be extended to LPRs when they would otherwise be eligible for Medicaid, so my interpretation is incorrect. I appreciate the clarification, and I'm really glad to know that there IS a subsidy extended to LPRs if their income is low.

Since that's the federal site, the rules should be the same for CoveredCalifornia and other State Exchanges, but I wonder if there's any discrepancies, or possibly just untrained workers processing the applications. I don't know, since my husband never tried to apply on his own -- we went in right away in December as a couple, and applied. Quite honestly I was expecting more issues in our application: at the time we applied, he didn't even have his EAD (only his I-94 which was expiring a month later) -- so we couldn't apply online, we had to send in the paper application. Then they accepted it (only with I-94) but two weeks later when we called in to inquire, they asked us for more legal presence documentation. We provided his EAD which he had gotten in the interim, and everything went smoothly. (Well, it went smoothly with the exchange -- the actual insurance company Kaiser has had horrendous billing/delay issues unrelated to our immigration status.) At this point he does have his green card, but we haven't even updated the Exchange site with that info -- they're still using the EAD that will expire in 2015.

[darin&josh 18]

Since that's the federal site, the rules should be the same for CoveredCalifornia and other State Exchanges, but I wonder if there's any discrepancies, or possibly just untrained workers processing the applications.

I suspect in some exchanges the frontline staff would have limited knowledge of the rules for those applicants that are outside the norm, particularly if someone is in the process of adjusting status like the OP. And I'd imagine somewhere like California would likely have exchange staff with greater awareness of immigrant status rules than Kentucky where they would be less likely to encounter applicants with lawful presence status. Although, I would also agree that there are likely some areas of discrepancies between state and federal rules.

I was happy to read that the application process was relatively straight forward for you and your husband.

Hopefully the OP will find out quickly about her appeal on her eligibility.

[Boiler 43,859]

You are eligible.

You are required to have it.

Free in this context presumably means that the tax credit matches the basic Bronze cover.

Be aware that what you are getting is not that good. But better than nothing.

Some LPR's can get Medicaid, not in this case.

[AussieNemesis 16]

Well I am so grateful for the input ..

Boiler is right that I didn't mean free as in entitlement, I meant it would work out to be free or close to it with the tax credit.

On monday I have to go see the helpful ( ! ) staff at the local food stamp and etc services office and show them all my paperwork and perhaps they will see that I do fit their categories after all. This is on the advice of the lady at Kynect who feels sure I SHOULD get the tax credit things.

I am sorry I seem so vague on this, I still don't have my head round the USA health care machine.

As I need several medications each month anything that can help with pharmacy and general practitioner costs alone would be of help.

My husband won't be applying as he'd lose his VA cover if he did.

[Boiler 43,859]

Strongly suggest you check the benefits on offer. You may be disappointed.