Success getting healthcare coverage for immigrant parents over 65

[Mrpatient 1]

4 hours ago, Mrpatient said:

Read through the discussion. Thank you missads. The debate at the crux of it is whether someone who can be claimed as a dependent can opt out and instead file their own income tax and get tax credit benefits. From what I know that is perfectly fine from IRS ‘ perspective as well as from healthcare perspective. At least that’s what I found on the IRS website as well - under section who should file a tax return -extrapolated. 

 

Also, here’s a similar question when roles reversed- can a child less than 26 file their own tax return and benefit from tax credits : https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/my-parents-are-self-employed-and-buy-coverage-through-the-marketplace-they-earn-too-much-to-qualify-for-subsidies-im-24-and-only-earn-30000-a-year-about-255-of-fpl-my-parents-don/

Here’s another q&a that answers the same fundamental question: https://www.google.com/amp/s/www.inquirer.com/philly/health/healthcare-exchange/faq/If_an_adult_lives_with_parents_what_counts_as_household_income_for_ACA.html%3foutputType=amp

[neo_ny 22]

On 1/20/2016 at 1:20 PM, missads said:

At the risk of repeating other posts, I just wanted to share my experience of being able to find affordable health insurance for my parents. Here are some details:

Parents - over 65, here on Green Card (permanent residents)

Living in the US for less than 5 years (about 2 years)

Eligible for tax subsidy through Obamacare (this does NOT constitute a public charge)

Residents of State of Michigan, have social security numbers

Eligible for Silver level insurance plans

Filed their $0 federal/state taxes jointly, separate from mine (I do NOT claim them as dependents on my tax return - this is important)

I had searched the healthcare.gov website last year for insurance for them and came up empty handed. We purchased "travelers insurance" online (***removed***) but got shafted. My parent had a major health incident and they didn't cover anything (all claims were denied as pre-existing condition) Stay away from these types of insurance.

I tried healthcare.gov again this year and couldn't find anything again. Many seem to assume, wrongly, that everyone over 65 is eligible for Medicare by default. This isn't true for immigrants, they need to have lived in the US for at least 5 years before they can participate in Medicare.

Anyway, the short story is healthcare.gov has still not caught on to this. If you want to purchase health insurance, you will need to work with a healthcare navigator. There are several public service organizations that have these navigators who will help you for free. They will help you do the application over the phone, and then it works just fine. I am in Michigan and went through Jewish Family Service. Have your parents green cards and SSN handy, that is all they need.

There appears to be a widely held misconception that immigrant seniors over 65 are not covered by Obamacare. This is absolutely NOT true. You don't have to wait for 5 years for Medicare to kick in. Recent immigrants older than 65 can purchase health insurance via healthcare.gov, just like any other US citizen or legal permanent resident. Some state exchanges might not know it, the person you talk to on the phone might not know it, the healthcare.gov website certainly doesn't appear to understand this special situation, but trust me parents on green cards who have been in the US less than 5 years ARE eligible for subsidized health coverage.

I was able to get health insurance for my parents who have no income, for around $100 a month per parent (after a $1000 tax subsidy, because their income is less than limit of ~$21K) Now that is REALLY affordable, and it is proper mainstream insurance (Blue Cross Michigan) None of that travelers' insurance BS.

Just trying to get the word out, because the open enrollment deadline is January 31st. If your parents arrive after Jan 31st, you can still sign up at that time, because their arrival date qualifies as a special "life event". But if they are already in the US, please sign up by Jan 31st. Otherwise they will have to wait until November for the next enrollment period to begin.

Hey there!

 

Your post was very helpful in signing my mom up for health insurance via ACA after getting her green card.  I was wondering if we need to do anything to plan for the future? i.e currently since she has been  a permanent resident for less than 5 years she is ineligible for Medicare/Medicaid and hence can sign up under ACA even being 65+.  Does this calculation change once she has been a permanent resident for more than 5 years?  At that point will she be considered eligible and we will need to "buy" Medicare instead of her being on a subsidized ACA plan?  Your initial post was from 2016 and you must be coming up on that 5 year requirement if you have not already, how are you planning on handling it?  

 

Appreciate your input!

 

Thanks!

[SkipSherv 1]

Just a note and something to be aware of when purchasing healthcare from the exchange.  It's just like regular insurance, which means the more you use it, the higher the premiums go in subsequent years.  In our case, it started to be relatively good deal, but after a few E/R visits and hospital stays our premiums doubled and affordable healthcare quickly became unaffordable. 

[Boiler 43,634]

ACA premiums do not vary with claims

[SkipSherv 1]

1 minute ago, Boiler said:

ACA premiums do not vary with claims

Not during the year.  Your premiums don't change during the year.  Subsequent years, the premiums rise for all sorts of reasons which I'm sure includes your age and existing health condition based on previous year usage.   Here's my actual costs based on retirement income, age, etc...

 

My monthly premium for ACA Platinum plan (Family of three ages 50s, with child under 18) two with pre-existing conditions:
Health Exchange - Platinum Plan
Family of Three - Monthly Premium

2015	$               1,360.00
2016	$               1,675.00	$   (315.00)	-23%
2017	$               2,300.00	$   (625.00)	-37%
2018	$               3,600.00	$(1,300.00)	-57%
2019	$               4,200.00	$   (600.00)	-17%
2020	$               3,500.00	$     700.00	17%
2021	$               3,000.00	$     500.00	14%
2022	$               4,660.00	$(1,660.00)	-55%

[Boiler 43,634]

The whole point of the ACA is that it is not rated on pre existing conditions or prior claims

[SkipSherv 1]

2 hours ago, Boiler said:

The whole point of the ACA is that it is not rated on pre existing conditions or prior claims

OK, you're right.  I should have said, "they find ways to increase premiums that are legal."  😉   I'm barely getting a 2% COLA increases in my retirement every year, while my health insurance increased an average of 23% per year.

 

[Boiler 43,634]

I think Medicare went up about that this year, Politicians get paid so no problem.

[missads 59]

9 hours ago, neo_ny said:

Hey there!

 

Your post was very helpful in signing my mom up for health insurance via ACA after getting her green card.  I was wondering if we need to do anything to plan for the future? i.e currently since she has been  a permanent resident for less than 5 years she is ineligible for Medicare/Medicaid and hence can sign up under ACA even being 65+.  Does this calculation change once she has been a permanent resident for more than 5 years?  At that point will she be considered eligible and we will need to "buy" Medicare instead of her being on a subsidized ACA plan?  Your initial post was from 2016 and you must be coming up on that 5 year requirement if you have not already, how are you planning on handling it?  

 

Appreciate your input!

 

Thanks!

Hi, I'm glad this thread has been helpful in getting health insurance for your mom. There were a lot of negative posts earlier questioning the veracity of what I was saying, but as the saying goes - the proof is in the pudding! 

 

Regarding your question about what happens after the 5 year waiting period... First off, Medicare is a program for senior citizens only, unlike Medicaid. To be eligible for Medicare, a senior needs to have worked a minimum of 40 quarters in the US. That's 10 years of employment in the US - not likely to happen for immigrant parents! So Medicare is essentially out of the question.

 

Now about Medicaid - a program that covers people of any age who are economically disadvantaged (no income, below 125% of the poverty line etc.) Immigrant parents who are not employed (zero income) fall into this category. The catch is that there is a 5 year waiting period. After 5 years, immigrants are eligible to switch to Medicaid, or continue with ACA (rules might vary from state to state, especially if your state has its own health insurance exchange or uses the federal marketplace.) Medicaid rules vary from state to state, it is a STATE program that is partially funded by the federal government. Blue states are more liberal in their rules and usually let immigrants sign up for Medicaid after  years, most red states exclude immigrants from Medicaid no matter how long they've been in the US. Look up whether your state participated in Medicaid expansion.

 

For my parents specifically, we decided to continue with Obamacare (with the usual subsidized premiums) after 5 years, because of the higher quality of care. Medicaid is free, but has a limited network of doctors who accept it, and offers the lowest cost (= basic level) of care. For example, if your parents need a new medication that is more effective but expensive, Medicaid will only cover the cheaper, less effective medication. Think of Medicaid being like an HMO (limited network, lots of restrictions, but cheaper), versus ACA being more like a POS / PPO health plan (more flexibility, higher level of coverage, but relatively expensive.) For my family, the trade off in premium cost vs quality of healthcare was a no-brainer. The one advantage of Medicaid is it includes dental coverage. With the ACA you need to buy dental coverage separately (or find community resources that donate dental services or offer them at a substantial discount - this is what my parents did.)

 

Hope this helps!

 

P.S. For anyone reading this who were able to get their parents / loved ones covered through the ACA, please share your success story on this thread. There is a lot of mis/disinformation out there about ACA eligibility for senior immigrants, and it pains me to see people suffer in silence when they have the option of getting quality healthcare through a government approved program that is the LAW of the land...

[Boiler 43,634]

You are incorrect about Medicare, if you do not have the 40 quarters you can buy into it.

 

Most threads I have seen here suggest the Exchange as the obvious place to start.

 

There are some other misinformation, for example some states California for example does not have a 5 year wait period for new immigrants to apply for Medicaid.

 

But all this is current, what will happen in the future is anybody's guess.

[missads 59]

True, my mistake. One could buy into Medicare. So explain me this - as a practical matter, why would anyone BUY into Medicare when they could get Medicaid for free, or get Obamacare for a substantial subsidy? How does it make financial sense for someone who has never worked in the US to buy into Medicare? Crunch the numbers and let us know.

 

Also, for the record I have previously posted in this very thread that California doesn't have the 5 year waiting period (AFAIK the only state in the country to do so. NY allows state Medicaid before 5 years, I haven't looked into it in detail.) CA is the exception to the norm though, everyone else has to wait 5 years to become eligible for Medicaid.

[yuna628 9,539]

7 hours ago, SkipSherv said:

OK, you're right.  I should have said, "they find ways to increase premiums that are legal."  😉   I'm barely getting a 2% COLA increases in my retirement every year, while my health insurance increased an average of 23% per year.

 

The rise in premiums typically will have nothing to do with how much you individually have had to use the plan or age, under ACA, and a lot to do with state regulations/regulators, the collective cost the insurance company is shelling out in that coverage area per year, strain of heavy collective use (a pandemic would do it), lack of competition, and general price control fluctuation costs. Some people, depending on the state may find their premiums rarely change or may even lower.

 

Medicare B premiums will rise soon largely because of new and extremely expensive drugs being available for treatment options and cost burden of COVID19... someone's got to collectively foot the bill.

 

1 hour ago, missads said:

True, my mistake. One could buy into Medicare. So explain me this - as a practical matter, why would anyone BUY into Medicare when they could get Medicaid for free, or get Obamacare for a substantial subsidy? How does it make financial sense for someone who has never worked in the US to buy into Medicare? Crunch the numbers and let us know.

 

Also, for the record I have previously posted in this very thread that California doesn't have the 5 year waiting period (AFAIK the only state in the country to do so. NY allows state Medicaid before 5 years, I haven't looked into it in detail.) CA is the exception to the norm though, everyone else has to wait 5 years to become eligible for Medicaid.

Well, for one... the person actually has to qualify for Medicaid financially to begin with, regardless of if they have been here long enough to be eligible to use it. Secondly, while I'm sure many successfully use it and have no issues with the quality of doctors available to them - I have to say in some areas you'd be better off seeking treatment with a good insurance. There are further regulations which are a bit complicated to explain that strongly limit treatment and choice of care with Medicaid. 

 

I can't exactly say what the benefit would be to buy into Medicare, but at least from the experience of my mom having cancer and my dad being critically ill -- there was virtually no worries about their care. Everything was paid for, they needed the best and they got the best. I can't say they'd have that peace of mind if they had something else.

[missads 59]

You do make some good points. I was primarily focused on a specific populace - immigrant parents who have no income.

Couple questions though. Did your parents become citizens before they could buy into Medicare? Also, could you share approximately how much it cost them to buy into Medicare? That information would be useful to other readers and help them make a more informed choice.

Kudos on taking care of your parents while they were seriously ill. I've been there, it's not easy...

[Boiler 43,634]

How many elderly people immigrate to the US with zero income? Must be very rare.

[missads 59]

On 11/18/2021 at 10:45 PM, Boiler said:

How many elderly people immigrate to the US with zero income? Must be very rare.

You sure about that? Elderly parents usually immigrate to the US to be with their kids & family, not to find a job and make some cash.