What kind of preferential health insurance can people who are in the USA in different statuses count on (part two)

In the USA, there are a huge number of types of visas and immigration statuses, and, probably, no less options for health insurance. It's easy for visitors to get confused and lose money on out-of-pocket medical bills, on unfavorable insurance, or because they don't know they're eligible for benefits.

ForumDaily in partnership with a well-known New York insurance company Fidelis care prepared a series of articles on preferential health insurance policies that people with different immigration status in the United States can take out. The first article in this series is about insurance for those who are in the United States on work, student and some other visas - read here to register:.

Please note that this data is for New York State, where FidelisCare. Conditions and insurance options for immigrants may vary from state to state.

Health insurance and immigration status

Whatever status and age you are in America, remember that by law, all New Yorkers have the right to:

1. Equal treatment in medical institutions, regardless of country of origin and language of communication.
2. Providing emergency medical care, regardless of solvency.
3. Free language assistance if needed. As a rule, hospitals and social services provide a free interpreter in the main languages ​​of communication.
4. Privacy when accessing medical services in New York City and State. When applying for health insurance, information about your immigration status may only be used to determine eligibility and not for further referral to immigration authorities and prosecution.

What insurance you qualify for depends on several factors:

1. family composition and income level;
2. your immigration status;
3. how many years have you lived in the US.

The Federal Poverty Level (FPL) is used to calculate family income. is a measure of income published each year by the US Department of Health and Human Services (HHS). How much your income is above or below the Federal Poverty Level determines whether you are eligible for certain benefits and low-cost health insurance. Figures for 2022 can be seen in the table below or here to register:.

Immigration statuses in America can be divided into two large groups: LAWFULLY PRESENT - foreigners who legally live in the US and have the right to buy insurance through the NY State of Health; and illegal immigrants - persons with limited status or who do not have documents legalizing their stay in the United States. Representatives of this group have limited opportunities to purchase insurance.

The so-called qualified immigrants (QUALIFIED IMMIGRANT) have legal status:

• holders of green cards, student and work visas
• immigrants serving in the US military and their families;
• Refugees
• immigrants whose deportation was canceled by the court
• victims of human trafficking (visa category T)
• immigrants who received a password in the US for more than 1 year
• Wives and/or children of US citizens or green card holders who have experienced domestic violence.

Additionally, persons in the status of PRUCOL (PERMANENTLY RESIDING UNDER COLOR OF LAW) have the right to preferential insurance, these are immigrants who do not have the right to permanently live in America, but their status is legal and gives them the right to temporarily stay in the United States on the basis of special programs or to process certain documents. Such persons include:

• U, K3/K4, V and S visa holders;
• persons who have applied for a change of status and are awaiting a decision
• persons who received a password for less than 1 year
• Temporary Protected Status (TPS) immigrants
• beneficiaries of the DACA program (a program that protects against deportation of illegal immigrants brought to the United States by children).

Medicaid and MediCare are the most well-known preferential insurance, but they are not available to everyone.

There is probably no immigrant who has not heard about Medicaid and MediCare, but, unfortunately, getting such insurance is quite difficult due to strict requirements.

You may qualify for Medicaid if:

• you have legal status in the United States;
• income does not exceed $18 per year (for one person; income limits for families can be viewed here);
• you have been in the country for at least 5 years.
• Also, children and pregnant women can apply for this insurance, regardless of status (including illegals) and length of stay in the country.

If you want to apply for MadiCare, then another 10 years of work experience in America (your or your spouse) and an age of 65 years will be added to the requirements. We wrote about these insurances in detail in our recent article.

Please note that using Medicaid and MediCare not subject to the public charge rule and will not adversely affect your prospects for US citizenship. Read more about the Public Charge rule and medical benefits at our material.

Preferential insurance with less stringent requirements

But many immigrants do not meet the stringent requirements of Medicaid and MediCare. So what about those who have lived in the US for less than 5 years, are not a pregnant woman, a child or a pensioner (65+ years)? For such people in New York, there are also several options for preferential health insurance.

As a reminder, all preferential insurance is distributed through the NY STATE OF HEALTH MARKETPLACE under the Affordable Care Act (better known as ObamaCare)

All plans offered for NY STATE OF HEALTH MARKETPLACE, cover:

• ambulatory treatment;
• emergency care;
• hospitalization (if you are in the hospital for more than 24 hours, fewer hours are covered by outpatient services - point 1);
• care of pregnant women and newborns;
• mental health services and drug or alcohol addiction treatment;
• prescription drugs;
• rehabilitation services and devices (for example, physiotherapy is one of the services, and a corset is an example of a device);
• laboratory services (X-ray, computed tomography, ultrasound, etc.);
• preventive examinations or procedures;
• pediatrician services, including pediatric dentistry and ophthalmology.

Please note that insurance plans purchased through the Marketplace include:

1. deductibles (the so-called deductible - the amount that the patient must spend on medical services from his own pocket before insurance coverage begins to operate);
2. copayments (additional payment for the service/drug in addition to what is covered by the insurance). Charged after the payment of the amount didaktabl.
3. payment for some services at the patient's own expense. There are some things that are not covered by insurance.

1. ESSENTIAL PLAN - The most basic plan on the Marketplace

Immigrants should pay attention to the Essential Plan. This policy is for people with low or no income who are not eligible for Medicaid.

Leonid Kopeikin from FidelisCare clarified that people legally living in the United States (in any status) can apply for this insurance if they:

• have an age of 19 to 65 years;
• live in the state of New York;
• have no income or it is not higher than 200% of the federal poverty level (income per family, not per individual). You can get acquainted with the indicators of the federal poverty level depending on the composition of the family. here to register:.

There are four options for the Essential Plan, depending on the person's income level and status. At the same time, all four options do not provide for monthly fees, that is, they are completely free. Also Essential Plan does not have deductibles.

Who has access to the Essential Plan options in New York State:

• Essential Plan 1 – Individuals with income between 150% and 200% of the Federal Poverty Level (FPL). Essential Plan 1 has copayments.
• Essential Plan 2 - persons with income from 138% to 150% of the FPL.
• Essential Plan 3 - Individuals with income between 100% and 138% of the FPL who are not eligible for Medicaid due to immigration status.
• Essential Plan 4 - Individuals with no U.S. income or less than 100% of FPL who are ineligible for Medicaid due to immigration status.

The Essential Plan is open all year round.

The Essential Plan provides the same services as other health insurance plans: visits to doctors, including subspecialists (including preventive); examinations and tests recommended by your doctor; prescription drugs; hospital inpatient and outpatient treatment, as well as dental and eye care services.

Learn more about the Essential Plan here, as well as from specialists of the insurance company Fidelis care. They will, among other things, help you choose any other coverage plan that suits your needs and requirements. Consultation is available in Russian. Phone: (347) 642-2993, e-mail: [email protected]

Medicare for people under 65

Immigrants under the age of 65 may also apply for Medicare if they have a disability or end-stage renal failure. The 10-year U.S. service rule also applies.

IMPORTANT: if your immigration status, income, or family composition has changed since you purchased premium insurance, you must notify their insurance company within 30 days. In this case, your insurance plan will be revised (increasing or decreasing benefits, depending on how your situation has changed). Changes to be notified to the insurance company:

• different composition of the family (marriage, divorce, the appearance of children);
• income has changed (your salary has changed, you have been divorced or married, and this has affected family income);
• your immigration status has changed (for example, you have passed the 5-year milestone of living in the United States, which means you can now qualify for Medicaid);
• you have reached the age of 19 or 65.

If you do not report changes that involve reduced benefits (for example, income growth) on time, then most likely at the end of the year you will receive a bill for the difference for the entire insurance period.

Private insurance (no benefits)

3. Private health insurance through NY STATE of Health Marketplace

To be eligible for private health insurance through the NY STATE OF HEALTH MARKETPLACE, you must:

• legally reside in the United States;
• reside in New York State;
• do not have insurance from the employer;
• be between the ages of 19 and 65;
• have any level of income.

In this case, you can choose an insurance plan that exactly matches your needs and capabilities.

4. Private insurance purchased outside the NY STATE of Health Marketplace

Almost any immigrant in the United States can buy private health insurance at full cost through an insurance company. In this case, there are no restrictions on family composition, income and age. However, such insurance does not provide benefits.