Around 44.1 million immigrants lived in the U.S. in 2020 according to the American Community Survey from the U.S. Census Bureau. That’s roughly 14% of the nation’s population. Immigrants are a diverse and resilient group, but face unique barriers to health care access in the U.S.
Noncitizen immigrants (including lawfully present and undocumented immigrants) are much more likely than U.S. citizens to be uninsured, according to a 2021 Kaiser Family Foundation (KFF) report. Several factors contribute to this high uninsurance rate, such as eligibility restrictions for enrollment in the Affordable Care Act (ACA) Health Insurance Marketplace, the Children's Health Insurance Program (CHIP) and Medicaid; enrollment barriers for private insurance coverage; and limited access to employer-sponsored coverage.
Changes in government immigration and insurance policies directly affect immigrant health as well. U.S. federal policies focused on limiting immigration, increasing funding for immigration enforcement and limiting public assistance for immigrant families induce chronic stress and distrust among immigrant families. Given official White House reports that causally link health insurance with better health in those with chronic conditions and reductions in mortality, the underinsurance of immigrant populations is a public health issue.
Learn more about the importance of health insurance for immigrants and the steps they can take to secure it.
How Do Immigrants Obtain Health Insurance?
Health insurance is a contract that stipulates that a third-party insurer will pay some or all of an individual’s health care costs. In exchange, the insured person periodically pays the insurer a premium, whether or not they use covered health care services.
Options for Securing Health Insurance as an Immigrant
Uninsured immigrants have a few options when it comes to obtaining health insurance.
Health Insurance Brokerages and Agencies
Immigrants, including undocumented immigrants, can purchase private health insurance. Private health insurance, also called commercial insurance, is health insurance offered by a private company. Immigrants can seek enrollment advice and search for health insurance brokerages and agencies through the National Immigration Legal Services Directory.
Purchasing a private insurance plan as an immigrant can be expensive. However, public insurance plans sponsored by the U.S. government are typically not available, so private insurance may be the best option for undocumented immigrants to get health insurance.
Employer-Sponsored Programs
Health insurance plans that employers provide for their employees and their employees’ dependents are called employer-sponsored insurance plans. Immigrants who enroll in their employer’s insurance plan may have many of the same benefits they would receive in an independently purchased insurance plan.
The Affordable Care Act mandates that businesses with more than 50 full-time employees (called applicable large employers) must offer health insurance plans.
Federal and State Insurance Marketplaces
The ACA’s Health Insurance Marketplace is a federal service that enables eligible immigrants to shop for insurance plans, including subsidized plans. Subsidies are tax credits that can lower the cost of health insurance for those who qualify.
Lawfully present immigrants are eligible for insurance through the Health Insurance Marketplace. The government defines a “lawfully present immigrant” as a person who has at least one of the following:
- Qualified noncitizen status
- Legal status conferred by certain laws (such as the LIFE Act, Family Unity Program or temporary resident status program)
- A valid nonimmigrant visa (NIV)
- Humanitarian status (including asylum applicants, those with Temporary Protected Status or Special Immigrant Juvenile Status and those who have protection under the Convention Against Torture and human trafficking legislation)
Healthcare.gov has a list of up-to-date explanations of current eligibility requirements. The website also states that “information about immigration status will be used only to determine eligibility for coverage and not for immigration enforcement,” which may give peace of mind to immigrants who are apprehensive about seeking health insurance in the U.S.
More detailed info on U.S. visas is available from the U.S. Department of State Bureau of Consular Affairs.
At the time of writing, undocumented immigrants are not eligible for Marketplace coverage.
HealthCare.gov and GoodRx report that the four eligibility requirements are: 1. Must be a U.S. citizen or national or be lawfully present in the U.S. 2. Must currently live in the U.S. 3. Must not be incarcerated. 4. Must not be covered by Medicare.
Medicaid and Medicare, for Those Who Are Eligible
Federally funded Medicaid and the Children’s Health Insurance Program are available to immigrants who have held “qualified” status for five years or longer. These programs are also available without the five-year wait period to:
- Veterans
- Active duty military and their families
- Refugees and “humanitarian” immigrants
New immigrants are ineligible for Medicare, regardless of their age. But legal immigrants who are 65 or older and have worked at least 10 years in jobs where they (or their spouses) paid Medicare payroll taxes can purchase Medicare Part A.
Undocumented immigrants may qualify for emergency Medicaid (not to be confused with Medicaid).
Why Immigrants Need Health Insurance
Why have health insurance as an immigrant? The enormous costs of health care in the U.S., coupled with the coverage insurance offers, are strong reasons in favor of getting health insurance as an immigrant.
Health Care Is Expensive
Health spending increased by 9.7% in 2020 in the U.S. according to the American Medical Association (AMA). When it comes time to pay the $4.1 trillion bill, the AMA found that 27.9% of health care spending came from private health insurance companies, 20.1% came from Medicare, 16.3% came from Medicaid and 3.8% came from other health insurance programs in 2020. Additionally, 9.4% was paid out-of-pocket, amounting to $388.6 billion.
Insurance Covers Essential Health Benefits
Insurance covers essential health benefits (EHBs) including:
- Emergency services
- Hospitalizations (for operations such as surgery)
- Pediatric services, including vision and dental care for children (which are not covered as EHBs for adults)
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Ambulatory patient services (outpatient care without hospital admittance)
- Pregnancy, maternity and newborn care
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services for chronic disease management
Four More Reasons Why Immigrants Should Secure Health Insurance
- Preventive care helps individuals avoid major health issues. Annual physicals, blood tests and health screenings save time and money in the long run.
- Health care emergencies can bankrupt uninsured individuals.
- People who lack health insurance are at higher risk for chronic disease.
- Individuals who lack health insurance often have poorer health care outcomes.
Private Health Insurance for Immigrants
There may be several ways to obtain private health insurance for immigrants. These are accessible through a combination of employers, agents/brokers and health insurance marketplaces.
HMO Programs
A health maintenance organization (HMO) program is a health insurance plan that limits coverage to care from doctors who work for a specific HMO. These programs typically do not cover out-of-network care.
PPO Programs
A preferred provider organization (PPO) plan is a health insurance plan that covers costs for medical providers in the plan’s network — such as doctors, hospitals and clinics. Providers outside of that network may also be covered, but for an additional cost.
Health Savings Account
Health savings accounts (HSAs) are savings accounts that enable an individual to set aside money for qualified medical expenses. These accounts are untaxed, which can lower the overall costs of health care when these funds are used to pay for copayments, coinsurance, deductibles and other medical expenses.
Public Health Insurance for Immigrants
Eligible immigrants may qualify for coverage through state Medicare and Medicaid agencies, as well as health insurance marketplaces for Medicaid applicants. Resources for immigrants who are interested in learning more about public health insurance include:
- USA.gov provides information on finding health insurance; understanding Medicare, Medicaid and CHIP; and paying for medical care.
- State Health & Value Strategies offers an overview of affordable health coverage for immigrants.
- State health departments offer state-specific resources for immigrants seeking health insurance. California, for example, offers Medi-Cal (the state’s Medicaid program) to all adults 50 years and older who meet economic eligibility rules, regardless of their immigration status.
Public Health Insurance for Children
The federal government provides some special public insurance options for immigrant children. The Children’s Health Insurance Program empowers states to provide coverage to pregnant women and children (depending on the state) who are lawfully residing in the U.S.
Historically, federal law required a five-year wait period to be eligible. Today, immigrants should visit their official state government health care website to determine:
- Eligibility requirements
- Income requirements
- Residency requirements
- Waiting periods
Health Insurance for Undocumented Immigrants
While undocumented persons are not eligible to access federal programs such as Medicare, Medicaid and ACA marketplaces, health care options may still be available. Options to obtain health insurance for undocumented immigrants include:
- Community health clinics. Low-cost care is often available through local community health care clinics. Undocumented immigrants may look for local community health clinics using national free clinic directories, such as the state-specific community clinic list from United We Dream, which lists clinics that offer services for uninsured people, including undocumented immigrants.
- Emergency care. Hospitals and emergency care centers are required by federal law to treat and stabilize all patients seeking emergency care, regardless of their immigration status. According to KFF, “Medicaid helps offset costs borne by hospitals in providing emergency care to undocumented immigrants by providing payments to hospitals for emergency care provided to individuals who are otherwise eligible for Medicaid but for their immigration status.”
Private Health Insurance for Undocumented Immigrants
Undocumented immigrants can purchase private health insurance in the U.S., as neither citizenship nor “lawfully present” status is required for private insurance eligibility.
However, undocumented immigrants must purchase this insurance outside of the federal Health Insurance Marketplace. The effect? Purchasing coverage directly from private insurance providers — without government subsidies or tax credits — can be extremely expensive.
The options to obtain private health insurance for undocumented immigrants include:
- Employer-sponsored programs. Legal employment requires proof of U.S. citizenship, lawfully present status or a work visa, which most undocumented immigrants do not have. So most undocumented immigrants will be ineligible for the jobs that provide health insurance. However, some undocumented immigrants can obtain coverage as a dependent through a spouse’s or parent’s employer-sponsored program. Not all insurance carriers or plans allow undocumented immigrants to seek employer-sponsored coverage as a dependent, though, so eligibility may be determined on a case-by-case basis.
- Student health plans. Some colleges and universities offer health insurance plans to students, regardless of their immigration status. Accepted and enrolled students should check their school’s student health care plans to determine their eligibility.
- Purchasing unsubsidized private health insurance Companies may offer undocumented immigrants private health insurance coverage depending on their country of origin and other factors.
State-Sponsored Health Insurance Options for Undocumented Immigrants
California, Illinois, Massachusetts, New York, Oregon, Washington and the District of Columbia (among other states) have expanded Medicaid coverage to include low-income children up to the age of 18 as well as pregnant people regardless of their immigration status.
State initiatives in California, Massachusetts and New York provide public health insurance for undocumented immigrants:
- California: County Medical Services Program. The CMSP offers health care coverage to low-income, uninsured, indigent adults who may not be eligible for any other publicly funded health care program. In 2022, California passed a law to become the first state to offer state-funded health insurance to all undocumented immigrants who are eligible state residents starting in January 2024 through their expanded Medi-Cal program.
- Massachusetts: Health Safety Net. The HSN supports undocumented immigrants by paying community health centers and acute care hospitals to provide services for uninsured and underinsured Massachusetts residents.
- New York: NYC Care. This initiative is a health care access program designed to guarantee no-cost and low-cost services to New Yorkers who are unqualified for health insurance or cannot afford health insurance.
Community health care centers provide low- or no-cost access to primary care for all U.S. residents, regardless of immigration status, according to Baldwin Family Health Care. 1. Services include medical, dental, prenatal and pharmacy care. 2. Fees are based on your ability to pay. 3. Proof of immigration status is not required.
Health Insurance for Green Card Applicants
Obtaining a green card takes an average of 7 to 33 months in the U.S., and it can take much longer. Thus, it can be a good idea to get some form of coverage or health insurance for green card applicants (officially known as permanent resident card applicants).
Also, keeping up to date with current health insurance requirements can make the difference between getting a green card application approved and not. While proof of health care coverage is not currently required, it can weigh favorably on a pending permanent resident application.
How to Get Health Insurance for Elderly Immigrants
There are various options for elderly immigrants to get health insurance if they have legal status in the U.S. They include:
- Private insurance. The ACA makes it possible for private carriers to offer coverage to immigrants 65 or older who are not enrolled in Medicare. The ACA also states that “enrollees cannot be charged more than three times the premiums that younger enrollees pay.”
- Medicare and Medicaid have five-year waiting periods for legal immigrants in most U.S. states.
Undocumented elderly immigrants are more likely to face barriers to accessing care and more likely to experience preventable chronic conditions such as hypertension.
State-Sponsored Health Insurance Options for Undocumented Older Immigrants
In January 2021, Illinois announced it would begin to offer public health insurance options for noncitizens aged 65 and older who do not have legal status. Other states may begin to offer this option in the future, which will allow more undocumented older people to seek the care they need.
Helping Immigrants Navigate the U.S. Health Care System
Immigrants seeking health insurance should understand their options before pursuing care in the U.S. While this source is intended as a comprehensive guide, you can learn more about the state-sponsored programs available to you by contacting the appropriate agency in your state to obtain additional information.
Infographic Sources:
GoodRx, “Who Is Eligible for Obamacare (Affordable Care Act) Coverage?”
HealthCare.gov, A Quick Guide to the Health Insurance Marketplace