Health Insurance for U.S. Immigrants
by Tony Novak, CPA, MBA, MT, NAHU certified consumer driven health care consultant, updated
July 27, 2012
This article highlights some of the important considerations of immigrants
to the U.S. when it comes to making health insurance choices
and lists a few of the more popular low cost health
insurance options available throughout most of the United
Immigrants are more likely to be uninsured
Immigrants to the U.S. are twice as likely to be uninsured
as other Americans. While 1 in 6 of all Americans lack
health insurance, the ratio of uninsured immigrants is 1 in
3 according to the 2009 report by the Center for Immigration
Studies. Stated another way, immigrants and their dependent
children make up 17% of the total U.S. population but
represent 32% of the total of those without health
insurance. Illegal immigrants are even more likely to be
uninsured. We estimate that as many as 2 out of 3
illegal immigrants have no health insurance.
Collectively, these indications suggest
that immigrants are more likely to: 1) work in jobs that do
not provide employer-provided health benefits, 2) have a low
income, and 3) face language barriers, lack education and
resources necessary to access insurance exchange.
It is important to realize that these three factors act in
combination, rather than individually, to contribute to the
high rate of uninsured immigrants. For example,
college-educate middle income immigrants who could afford
health insurance are almost as likely to be uninsured as
other immigrants. In this respect, the situation is the same
as with other uninsured Americans, where research indicate
the lack of health insurance cannot be attributed solely to
income or affordability of insurance (Note 1).
significant difference between uninsured immigrants and
other uninsured Americans is the length of time without
insurance. The majority of Americans without insurance
remain uninsured for less than a year. In contrast, the
Center for Immigration Studies found that 29% of immigrants
who entered the US in the late 1980s are still uninsured
almost two decades later. Chronically uninsured are less
likely to access routine medical care and early screenings
and this is suspected to contribute to greater (an more
expensive) medical problems over the long term.
Despite these challenges, some type of insurance exchange is available the majority of immigrants,
regardless of other factors.
Citizenship and social security number requirements
Despite popular notion to the contrary, citizenship is
not a significant issue in qualifying for health
insurance. Enrollment in U.S. health insurance plans
does not require U.S. citizenship.
In fact, most insurance applications do not ask about
citizenship. Most domestic insurance plans do require
applicants to have a social security number or
tax identification number (TIN). A TIN is available to
any person who does not qualify for a social security
number, regardless of legal status, so this requirement
should not be a deterrent to anyone who needs health
Legal and political considerations
State law - Health insurance in the
United States is primarily controlled by state law. That
means that their are 50+ variations on every topic
associated with health insurance. For an incoming immigrant,
the most important immediate consideration is that the
location at the time of purchase affects the insurance
choices available. Once a health insurance is issued it is
equally valid in all states so the only concern is the
availability of the best insurance at the location of
purchase. Whenever possible, an immigrant should consider
the options of purchasing insurance before entering the U.S.
Migratory immigrants like farm workers, for example, will
find that health coverage to be more liberal and affordable
in one state than another. Some states like New York limit
the availability of the most attractive immigrant policies.
In this case it is possible to obtain a better insurance
value by purchasing insurance before relocating to New York
Currently about 4 million immigrant adults and about 5
million immigrant children are covered under state
Medicaid plans. These health benefits are increasingly
at risk by state governments facing budget deficits (see
"Impact of federal health reform law" below).
The Commonwealth of Massachusetts, for example,
announced plans to drop Medicaid coverage for more than
400,000 legal but low income immigrants. Budgetary problems are likely to
persist for the foreseeable future in many states
so we expect this trend of cutting Medicaid eligibility
for immigrants to continue.
Health insurance and immigration reform
- The political debate continues on
the best way to integrate those undocumented residents
already living and working in our communities. Many believe that denying
health coverage to any specific
group is not only ethically wrong and impractical to
enforce, it would ultimately be damaging
to the rest of us as well. A recent New York Times
editorial summed up this position stating "There is a line beyond which antipathy to the undocumented can be damaging to those voters' health, not to mention the federal budget".
Some states have initiated legislation that would
require a hospital report to Immigration Services any person
who seeks treatment without insurance who is unable to prove
citizenship. This reporting could be avoided though use of
Inbound Immigrant or other available insurance; citizenship
is not required. Insurance companies are not involved in the
legalization process and make no report to Immigration
Coverage for children - State Children's Health Insurance Plans (SCHIP) are
available to the children of all low and middle income
families regardless of legal status. While the number of
uninsured children has decreased as a result of these
programs, the children of low income illegal immigrants
are least likely to access the subsidized coverage available
through these programs. It is suspected that the fear of
being "discovered" prevents parents from enrolling their
children in SCHIP. Additional education an promotion of
the programs, including the national "Cover Kids Now"
campaign, appears to have had minimal impact in
recruiting the children of illegal immigrants.
Impact of federal health reform law
The federal government currently reimburses hospitals about
$20 billion per year for treating uninsured patients. Up to
40% of that cost is for treating illegal immigrants. The
health care reform law passed in 2010 will soon cut that
payment in half, based on the premise that fewer people will
lack insurance after 2014.
The problem is that undocumented immigrants are specifically
excluded from the health insurance exchange provisions of
the health care law that help people get insurance coverage.
Health insurance is available to illegal immigrants through
commercial health insurance exchanges like Freedom Benefits
but many just cannot afford it.
Hospitals are not allowed to refuse basic treatment based on
lack of insurance nor are they allowed to ask about a
patient’s immigration status.
This loophole in health care reform appears to be a
consequence of the politics. Politicians say that the issue
is “too hot too handle”. Hospitals are worried. Hospitals
located in poor urban or rural areas may be forced out of
business. Industry experts expect some to be purchased by
for profit companies that take more aggressive procedures to
exclude care for patients without insurance. For example,
elimination of emergency room services and requiring
patients to be referred by a participating doctor
significantly reduces the number of patients without
insurance. Community medical clinics may take up some of the
slack but cannot provide the level of medical care as a
hospital emergency room.
We expect that the outcome will be further division in the
quality of medical care available to those with health
insurance and those without coverage, regardless of
immigration status. A natural-born U.S. citizen living in a
low income area will find more difficulty obtaining medical
care without basic health insurance.
Commercial health insurance available to U.S. immigrants
The six most popular health insurance choices among immigrants using
Freedom Benefits online enrollment service are listed below with a brief description of each option.
Not all of these policies are available in all states. For full details
on each option, follow the link to the online rate quoting pages that include full descriptions of coverage,
definitions, exclusions and eligibility details.
- a health insurance
specifically designed for this purpose; provides up to 5 years of
liberal coverage at an affordable price. This plan has a low
annual deductible and includes maternity coverage. Maximum
benefits are lower than most other types of domestic health
plans. This combination of features makes this insurance the
most popular choice among working class immigrants who buy
their own health insurance.
HCC Life short term medical insurance
is a domestic major medical insurance coverage.
Enrollment support and policy contracts are available in
both English and Spanish language. Coverage can be issued
for up to six months on a month-to-month payment basis.
Patriot Exchange Program
is ideal for exchange students attending a U.S. college or
university. Coverage meets United States J1 travel visa
requirements and can be extended for up to 4 years after
entering the U.S.
Global Medical Insurance
is a superior renewable major medical insurance that
provides up to $8 million coverage worldwide that is
suitable for individuals who expect to travel often or spend
significant time in more than one country. Although this is
the most expensive option listed on this Web page, it is
less expensive than most U.S. domestic health insurance
Health Insurance is a versatile mini-med plan paying
defined amount per day hospitalization and doctor's
visit, priced on a scale that determines the dollar amount
of benefits available ranging from minimal/supplemental to a
higher price point similar to major medical coverage.
Value ER is a simple supplemental
policy that provides emergency coverage for accidents and
injuries of $1,000 per person (or $2,000 per family) for a
premium of $30 per month. This policy is unique in that the
price for individual coverage is the same as the price for a
whole family. We have
noticed this policy being used by migrant farm workers who
otherwise might not have any health coverage at all.
This article is meant to highlight just a few of the
available insurance choices for immigrants. Browse the listings on this Web
site for more options.
Enrollment assistance with all of these affordable insurance
plans is offered through OnlineNavigator service. Send an
Assistance for immigration documentation
The author Tony Novak is available to attorneys who
work in the area of immigration law to help provide
documentation of health insurance. More information at
Note 1- National Institute for Health Care Management (NIHCM)
report titled "Understanding
the Uninsured: Tailoring Policy Solutions for Different
", April 2009.
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