Over the
past few weeks, the public has been inundated with information about
Obamacare. We have heard of new health
care exchanges, tax credits, tax penalties, changes to Medicaid, but it is difficult
to understand exactly how Obamacare works—especially how it works for
immigrants.
What is Obamacare?
Obamacare,
or more formally, the Patient Protection and Affordable Care Act (ACA), is a
health care reform law enacted in 2010.
The changes under the law to the current U.S. health care system come in
stages—some parts of the law were implemented right away and some will be
implemented years after the law was enacted.
The most recent news coverage about Obamacare refers to the
implementation of the new health insurance marketplace or the “exchange.” The exchange offers health insurance plans of
various coverage levels (labeled bronze, silver, gold, and platinum) for those
individuals who do not receive health coverage through employment or Medicaid. The health insurance plans offered on the
exchange will vary from state to state.
Obamacare
will also offer a tax credit in 2014 to those individuals and
families with incomes between 100% and 400% of the federal poverty level (about $23,000 to $94,000 for a family
of four). This tax credit will help
cover monthly premiums and may be used towards the purchase of any plan sold on
the exchange.
Additionally,
Obamacare will offer two types of cost-sharing subsidies in 2014. The first is available to those individuals
and families with incomes between 100% and 400% of the federal poverty level, who purchase silver-level insurance
through the exchange. This first type of
subsidy is meant to reduce out-of-pocket exposure by reducing the maximum cap
set for consumer out-of-pocket spending under a health care plan and is paid
directly to the insurer. Obamacare also
provides a second cost-sharing subsidy to individuals and families who earn up
to 250% of the federal poverty level (about $58,875 for a family of four) and
purchase silver-level insurance through the exchange that will help reduce their
deductible and co-pays even if they do not come close to reaching the maximum expense
cap.
In 2014,
those who do not have health insurance coverage may have to pay a tax penalty. The tax penalty could be as low as $95 in
2014 but may be more depending on the uninsured’s income. The minimum tax penalty will increase each
year until 2016. This tax penalty is
also referred to as the individual mandate.
Certain exceptions apply, including exceptions for those who are
uninsured for less than 3 months, those who do not have to file a federal tax
return, or those who would have qualified for Medicaid but their state did not
expand the program.
Finally,
the ACA permits states to expand their Medicaid programs to cover all people
making up to 138% of the federal poverty level (about $33,000 for a family of
four).
But how
do these changes in the U.S. health care system affect immigrants?
Below I have outlined the eligibility requirements—both those that have
changed and those that remain unchanged by the ACA—for immigrants and
naturalized citizens.
Who is covered?
Naturalized Citizens and Lawful
Permanent Residents for 5 Years or More
·
Eligible
to purchase insurance through exchange
·
Subject
to tax penalty if do not have health insurance coverage, unless exception
applies
·
Low-income
individuals eligible for tax credit and cost-sharing subsidies*
·
Low-income
individuals eligible for Medicaid*
Lawful Permanent Resident for 5
Years or Less
·
Eligible
to purchase insurance through exchange
·
Subject
to tax penalty if do not have health insurance coverage, unless exception
applies
·
Low-income
individuals eligible for tax credit and cost-sharing subsidies*
·
Not
eligible for Medicaid until have held green card for more than 5 years
o Individual states may eliminate
the 5-year waiting period for eligible children and pregnant women but not for
other adults
Refugees/Asylees
·
Eligible
to purchase insurance through exchange
·
Subject
to tax penalty if do not have health insurance coverage, unless exception
applies
·
Eligible
for tax credit or cost-sharing subsidies*
·
Low-income
individuals eligible for Medicaid*
Non-immigrant Visa Holders
·
Eligible
to purchase insurance through exchange for coverage extending through period of
authorized stay
·
Subject
to tax penalty if do not have health insurance coverage, unless exception
applies or if not present in the U.S. for whole period of enrollment
·
Eligible
for tax credit or cost-sharing subsidies*
·
Not
eligible for Medicaid
Undocumented Immigrants and Deferred Action
for Childhood Arrivals (DACA) Recipients
·
Not
eligible to purchase insurance through the exchange
·
Not
subject to tax penalty
·
Not
eligible for Medicare, nonemergency Medicaid, CHIP (assistance for children and
pregnant women)
*Other
eligibility requirements apply.
Other
individuals who are eligible to purchase insurance through the exchange and whp
are subject to the tax penalty include:
asylum applicants who have work authorization, applicants for temporary
protected status (TPS) who have work authorization, applicants for adjustment
of status, applicant for withholding of deportation or withholding of removal
under CAT, those granted a U visa or status through VAWA, and those who have an
administrative order staying removal. Immigration status will be verified with
the USCIS before any benefit is granted.
By: Kelli Stout
Associate Attorney
The McCrummen Immigration Law Group, LLC
