It's been a few years since @missads wrote a very helpful post about getting ACA insurance for immigrants over the age of 65. The original post (linked below) is still a good read for anyone going through this process.
I recently helped a relative apply for insurance through the ACA. There is a lot of confusion regarding whether immigrants can use the ACA, is this a public charge, do they get medicaid or medicare, etc? If you are over 65, many will assume that you simply get Medicare (as indicated by @missads's post). Similarly, if you have lower income, people assume you will get Medicaid. For new immigrants to the US, neither would apply (with few exceptions). I will try to provide some information regarding this based on our own experience.
We initially contacted a licensed insurance agent to go through this process. The agent was familiar with the ACA, but was as unfortunately not familiar with immigrants applying for insurance through the ACA (mostly confusion regarding the public charge rule, which I guess is confusing by design). The agent also said that a social security number and green card were required, but these documents are not required (as indicated in other posts in this forum as well). Initially, we got short term insurance for the first few months, which was okay for medications, but had high deductibles, was subject to preexisting condition rules, had poor hospitalization coverage, and had higher premiums. Thankfully, we did not need to use this insurance, but the lack of coverage and acceptance at most hospitals was something that was hanging over our heads.
We then started looking into applying for insurance through the ACA. We actually called the ACA help line and were told that we could apply, but that we would not get a subsidy since the applicant was an immigrant with no income (they thought that the subsidy could not be calculated since there was no income to base the subsidy off of)
At this point we figured we had nothing to lose, so we then applied for insurance through the ACA website, and were successful. We received a decent subsidy as well. This made both HMO and PPO plans very affordable (all were less than $300 a month, and many of the HMOs were less than $100 a month).
In the Healthcare marketplace, plan availability and pricing varies state to state, and even zip code to zip code. One plan may be $500 a month in one state/zip code, and the same plan may be $300 a month in another state/zip code, so your pricing may vary.
1. What immigration statuses qualify for insurance through the ACA?
See link here: https://www.healthcare.gov/immigrants/immigration-status/
Note that this also includes applicants to certain statuses as well.
2. I am going through the adjustment of status/AOS process, am I eligible?
Yes: https://www.healthcare.gov/immigrants/immigration-status/
Applicants for any of these statuses qualify to use the Marketplace:
- Temporary Protected Status with Employment Authorization
- Special Immigrant Juvenile Status
- Victim of Trafficking Visa
- Adjustment to LPR Status
- Asylum (see note below)
- Withholding of Deportation, or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT) (see note)
This would include those who entered in on a K1/K2/K3 visa, as these are categories that will go through the adjustment of status (AOS) process.
3. What documentation do I need to prove immigration status?
The ACA application provides a list of acceptable immigration documents.
4. I have not received my physical green card, how can I prove my immigration status?
The ACA application list of acceptable immigration documents includes "Immigrant Visa with I-551 language" and "Temporary I-551 stamp". It also includes"I-797 Notice of Action"
5. I am going through Adjustment of Status/AOS via K1 or via marriage in the US, how can I prove my immigration status?
The ACA application list of acceptable immigration documents includes "I-797 Notice of Action"
6. I am one of the handful of people who has a K3 visa, and will be going through Adjustment of Status/AOS process as well, how can I prove my immigration status?
The ACA application list of acceptable immigration documents includes "I-797 Notice of Action"
7. Why not just get Medicaid or Medicare?
Most new immigrants do not qualify for medicaid and/or medicare. Medicare is a system that one must pay into (by working a certain amount of time in the US, if I am not mistaken). Immigrants with less than five years of presence in the US are not eligible for Medicaid except for certain situations (See Medicaid website for more information)
8. So I can't get medicaid, can I at least qualify for an ACA subsidy?
This is probably the most confusing part of the application and the ACA in general, but the answer is Yes, you may qualify for a subsidy based on your income.
Reference: https://www.irs.gov/instructions/i8962
Alien lawfully present in the United States.
Certain aliens with household income below 100% of the federal poverty line are not eligible for Medicaid because of their immigration status.
You may qualify for the PTC if your household income is less than 100% of the federal poverty line if you meet all of the following requirements.
- You or an individual in your tax family enrolled in a qualified health plan through a Marketplace.
- The enrolled individual is lawfully present in the United States and is not eligible for Medicaid because of immigration status.
- You otherwise qualify as an applicable taxpayer (except for the federal poverty line percentage).
Since we met these requirements (enrolled in an ACA plan, will file taxes on our own/not as a dependent, and are not eligible for Medicaid), we qualified for a subsidy, subject to the calculations.
9. How do I qualify for a subsidy?
The ACA application will ask you for information regarding your estimated income for the year. There are many threads and forums that discuss how to estimate your income, so I won't go through that here. It is understood that if you underestimate or overestimate your income, everything will get adjusted during when federal income taxes are filed.
When filling out the application, we indicated "No, I have not been denied medicaid" (because we never applied), but then answered "Yes" to "Were you found ineligible for Medicaid based on immigration status". It is a bit confusing since we did not apply for Medicaid, but this seemed the closest since we knew that we were not eligible for Medicaid based on immigration status. This is the key sequence of questions that will force the system to evaluate your application and calculate a subsidy based on being an immigrant who does not qualify for medicaid (as indicated on IRS form I-8962). If you select "No" for "Were you found ineligible for Medicaid based on immigration status", your application will be forwarded to Medicaid, which can be problematic for a number of reasons, namely - delays (Medicaid takes a lot of time), you will likely be denied anyways (immigration status), potential issues related to being a public charge (still being litigated, but better to not deal with that if at all possible), and the system will show that you applied for Medicaid.
10. I just came to the US, how do I prove my income (or lack thereof)?
If you arrived during the previous year (for example, you arrived in December 2019, and are applying for ACA insurance in 2020), you should file a tax return even if your income is $0.00. This was also mentioned by @missads. Make sure that the ACA applicant is not claimed as a dependent on someone else's taxes. If they are claimed as a dependent, then the TOTAL HOUSEHOLD INCOME will be used in the ACA subsidy calculations.
If you haven't filed taxes yet, the ACA has an "income worksheet" that can be used to prove income. Since we had no income at the time of application, we write "$0.00" for the value, and then write an explanation below (where the form asks for any additional information). We explained that the applicant was a new immigrant and did not have any income, and that they would file taxes at the appropriate time. We also attached a copy of the visa and I-551 stamp indicate the date of entry. Moving forward, you should file taxes each year (even if your income is $0.00), as this will be the standard way of proving income (or lack thereof).
11. I did not receive my SSN/SS card, how can I apply?
The ACA application does not require a social security number (the field is optional)
12. When should I apply?
ASAP! You have 60 days within a given "life event" to apply for insurance. "Gaining lawful immigrant status" or "Gaining LPR status" (I don't recall exactly what the wording was) is an applicable life event. If you apply before the 15th of the month, you will get insurance beginning the next month. If you apply after the 15th, your insurance will be active after an additional month.
For example:
If you apply on November 12, your insurance will be active December 1.
If you apply on November 16, your insurance will be active January 1.
13. I just arrived to the US, and open enrollment is over, how do I apply?
See #11 above. "Gaining lawful immigrant status" is a life event, so you can apply. It is best to apply as soon as possible, as the clock begins the day you enter the US.
14. What about the public charge rule?
The public charge rule was in court when we went through this process. However, many posts have indicated that taking ACA subsidies does not make one a public charge. This also appears to be indicated here: https://www.healthcare.gov/immigrants/lawfully-present-immigrants/
Enrollment in a Marketplace plan (with or without premium tax credits) is not a public benefit under the public charge final rule.
Previously, this was also inferred to at this link as well: https://www.uscis.gov/news/public-charge-fact-sheet
15. I want to get my SSN to make things simpler
There are many posts on VJ about SSNs not being sent in a timely manner, and SS office closures during the COVID-19 pandemic. Please refer to these posts for guidance on obtaining a SS number. The general theme, at the time of this writing, is that you can call the local SS office and plead your case.
16. People on VJ, among other places, say "why don't you just work?"
Many immigrants with LPR status are retired, so they have worked, but have incomes that are low enough to qualify for a subsidy. Others may be looking for work, but still need coverage in case something happens.
17. Can I really file taxes even if my income is $0.00
Yes, the IRS allows you to file taxes even if your income is $0.00
