Update: On November 2, 2019, a federal judge in Portland temporarily blocked the Trump administration from requiring immigrants to show they can get health insurance before getting a visa. Since then seven individuals and a nonprofit organization sued in an Oregon federal court to block the proclamation’s enforcement. The U.S. Department of Justice has appealed. We are awaiting a verdict.
A recent proclamation by the Trump administration will bar new immigrant entrances into the United States without proof that they can purchase unsubsidized health insurance within 30 days of entry. Starting November 3, 2019, it could force an immigrant attempting to gain entry to disclose their personal finances to prove they can indeed afford to purchase private health insurance that is separate from ACA plans on the federal exchange. Could short term health insurance be a health insurance option for immigrants needing to get coverage quickly?
The short and fast answer is no, most short term health insurance policies require an individual or a family to reside in the U.S. for at least one continuous year before they are eligible for insurance coverage. However, immigrants who have been in the country for a year or more can purchase short term medical insurance and get covered in 24-hours.
Health Insurance For Immigrants
Under the president’s proclamation, qualified health insurance would include employer-sponsored coverage or private coverage, such as unsubsidized coverage through the Obamacare marketplaces (both federal and state), short term health insurance or traveler insurance plans. So, any plan that is subsidized by the federal government or through a state exchange or Medicaid coverage, would not be considered approved coverage. This falls in line with healthcare immigration proposals made by the administration in 2018.
The suspension of granting immigrant visas would apply to individuals seeking an immigrant visa on or after November 3, 2019. The new rule would primarily affect family-based immigrants. It does not apply to refugees, asylees, individuals entering the U.S. as non-immigrants, and other specific groups.
Today certain types of lawful permanent residents with immigrant status can qualify to apply for and receive subsidies for an Affordable Care Act (ACA) plan on the federal marketplace or their state exchange (but it does exclude DACA recipients).
Immigrants who are qualified non-citizens are typically eligible for health insurance coverage through Medicaid and the Children’s Health Insurance Program (also known as CHIP) if they meet their state’s income rules and residency regulations. However, in order for an immigrant to “qualify” for Medicaid and CHIP coverage, non-citizens usually must wait 5-years before gaining qualified status. Refugees, asylees, or green card holders who used to be refugees or asylees don’t have to wait 5-years.
If an immigrant has lived in the United States for 12 months and has not returned to their original country, short term health insurance can be an option if they are in the 5-year waiting period or do not qualify for a financial subsidy through the federal or state marketplace exchanges.
How Short Term Health Insurance Can Fit Immigrant Needs
Short term health insurance, also referred to as temporary health insurance, is exactly what a non-permanent health plan might cover when there is a gap in coverage. An immigrant might come to the United States to work for an employer and have a 90-day waiting period before they can obtain health insurance coverage. Or, they don’t have access to employer benefits and it is outside of the open enrollment period for health coverage. In situations like this, temporary health insurance fills a need while the individual is waiting for permanent health coverage. It can also be a temporary solution while waiting for a green card or other forms of legal resident paperwork.
Advantages of Short Term Medical Insurance
Freedom to choose providers – Most temporary, short term health plans offer you the option to purchase a health policy with an open, all-access network. That means you are not regulated to see a doctor or medical facility in a specific network. This can be an advantage if you need to see a doctor who speaks a specific language or offers office staff to translate. However, some providers prefer working with networks alone. If there is a specific doctor or medical facility that is important to you and they only accept health plans that have a specific network, you can select a short term health plan with a PPO network. A PPO network requires you to only see doctors approved in the network for special in-network pricing. If you seek medical treatment outside of the network, you could be subject to full-price retail costs or out-of-network pricing depending on how your health plan is structured.
Flexibility on the number of days you can enroll – With short term health insurance coverage, you can enroll for a minimum of 30 days, up to 364-days, depending on your state coverage duration rules. And you can select the start date of coverage and pick the exact number of days you need to be insured. For example, if you are starting a new job next week, and you know there will be a 60-day waiting period before employer health insurance coverage begins, you can enroll in a short term medical plan for 67 days – 60 days of coverage to close the gap between day one of employment and day 60, plus an extra seven days of coverage to carry you through the week prior to starting your job. You never have to pay for coverage you don’t need, and you can cancel at any time if your health insurance situation changes.
Quick, online application – It doesn’t take long to shop, compare and enroll in a temporary health insurance plan. The average consumer applies for a short term health insurance plan in just over three minutes.* Once a plan is selected, the simplified application makes it easy to review the purchase and provide contact and payment information. Coverage can begin as soon as the next day, and plan documents are stored online so you can access at any time.
How Short Term Health Plan Policies Are Structured and Administered in the United States
The more you pay for health insurance, the more benefits you receive. The less you pay, the fewer benefits you receive, meaning, you are responsible for more medical care costs out of your own pocket. It’s important to take price into consideration. Do you feel more secure paying a higher monthly premium for more coverage? Or would you rather save on the monthly expense and pay out of pocket for a large medical if it arises? Here is how short term medical insurance is structured and administered:
Deductible – A majority of health plans have a medical deductible, including short term health insurance. This is the amount you have to pay out of pocket before the health insurance company is responsible for contributing to your bills. Deductibles can range from $1,000 to $10,000 for an individual and even more for a family.
Coinsurance – Many are not familiar with the term “coinsurance” but it is also a common expense on most health insurance plans. Focus on the start of the word, “co” which refers to more than one entity. Coinsurance means that after your deductible is met, you share a percentage of your medical costs with your health insurance company. This could be 20% or 30% of your medical bill cost, and your insurance carrier would pick up the rest. Some short term health insurance plans even have 50% coinsurance. Again, the more you have to pay out of pocket the less expensive coverage is, which is why you need to weigh your options.
Explanation of Benefits – When you have a short term health insurance plan, an Explanation of Benefits statement or EOB is what the third-party administrator that processes your claims sends to make sure you understand the charges you will be billed for. It outlines costs line by line so you have a breakdown of what your doctor’s office or facility charged for specific treatment.
Copays – If you anticipate seeing the doctor several times a year, it might be worth looking for a short term medical plan that offers doctor office copays for primary care or Urgent Care. With a copay, office visits would be cost a flat, predetermined rate and not be subject to the deductible and coinsurance. It is good to remember that any additional care or tests given at the time of the appointment are not part of the office visit and would be subject to the deductible and coinsurance.
Monthly Premium – If you need temporary health insurance for less than 180 days, you can typically prepay for the insurance plan. But if it is more economical for you to pay on a monthly basis, the “premium” is the cost billed each month.
Fine Print About Short Term Health Insurance
The short term medical insurance application does ask medical questions to ensure you don’t need ongoing care (and would probably benefit from a permanent, major medical insurance plan). Any pre-existing conditions are vetted out during the questionnaire process. If you have had a pre-existing condition in the past, it may not be covered under a temporary insurance plan. However, many new conditions diagnosed while covered under a short term medical plan would be subject to the deductible and coinsurance.
While short term health insurance is not a permanent solution for long-term coverage, immigrants seeking coverage while they are in a “coverage gap” can find short term medical coverage an option over being uninsured.
*Statistic based on Pivot Health average session duration analytics data.