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Can recent immigrants to the United States get health coverage if they’re over 65?

Q: We would like our 80-year-old grandmother to come to the USA and live with us so we can take care of her. How do we get health insurance for her?

A: You’re in luck, thanks to the Affordable Care Act (ACA). And the American Rescue Plan has made coverage even more affordable for 2021 and 2022. You also don’t need to worry about the Trump administration’s immigrant health insurance requirements or changes to the “public charge” rule, as both have been revoked by the Biden administration.

Prior to 2014, there were few options available for someone in your grandmother’s position. Individual health insurance generally wasn’t available to people over age 64, and Medicare and Medicaid have five-year waiting periods for legal immigrants. (A few states have relaxed guidelines when it comes to Medicaid. See below.)

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Seniors were able to purchase travel insurance, but it generally doesn’t cover pre-existing conditions, and new coverage must be purchased periodically when the existing one expires, since they’re sold to cover a limited time frame.

But thanks to the ACA, seniors who aren’t eligible for Medicare – including immigrants – can purchase guaranteed-issue private health insurance in the exchange (marketplace), and can receive income-based premium tax credits to offset the cost if they don’t qualify for certain other government- or employer-sponsored coverage. There is normally an income cap equal to 400% of the poverty level, above which a household would not be eligible for premium subsidies. But the American Rescue Plan has eliminated that income threshold for 2021 and 2022, allowing higher-income households to qualify for subsidies if the benchmark plan would otherwise cost more than 8.5% of the household’s income.

The option to purchase coverage in the exchange with a premium subsidy continues even after the person has been in the U.S. for five years and becomes eligible to purchase Medicare coverage (see questions A.6 and A.8 on this guidance from CMS). People who are eligible for premium-free Medicare Part A (because they have worked in the U.S. for at least 10 years) are NOT eligible to receive premium subsidies in the exchange. But that restriction doesn’t apply to people who would have to pay a monthly premium for Medicare Part A.

How long do immigrants have to wait before they're eligible for Medicare?

If you’re a U.S. citizen or have been a lawfully present U.S. resident for more than five years, you can enroll in Medicare if you’re at least 65 years old or qualify for coverage due to a long-term disability. People who have paid into the Medicare system via payroll taxes – their own or a spouse’s – don’t have to pay a premium for Part A. This encompasses the vast majority of Americans, although there’s also an option for people to purchase Medicare Part A (with premiums of up to $471/month in 2021) if the enrollee doesn’t have enough work history to qualify for premium-free Medicare Part A.

But people who have not been in the U.S. for five years are not eligible to enroll in Medicare. Obviously, your grandmother hasn’t been paying Medicare payroll taxes in the U.S., which means she won’t be eligible for premium-free Medicare Part A. But federal regulations stipulate that she needs to have been lawfully admitted for permanent residence and have resided continually in the country for five years before she’s eligible to enroll – even with premiums.

Once she’s been lawfully present in the U.S. for five years, she’ll be eligible to enroll in Medicare if she wants to, but with premiums for Part A (and Part B, which all enrollees pay, regardless of their work history). Assuming she doesn’t establish a work history in the US and ends up having to pay Medicare Part A premiums forever, she may be eligible for premium assistance from the state Medicaid program (see page 5). But she would also have the option to maintain her individual market coverage through the exchange. She would still be allowed to receive premium subsidies, as clarified in the chart on Question A.8 in the CMS guidance.

But the details in Question A.9 are important here too: If she opts to keep her individual market coverage even after she has the opportunity to buy into Medicare (ie, once she’s been in the US for five years), she would then be subject to the late enrollment penalties if she ever decides to enroll in Medicare at a later date. And she would also be limited to enrolling only during the general enrollment period (the first quarter of each year), with coverage effective in July.

So for example, if she were to gain a substantial income later in life and no longer qualify for premium subsidies in the exchange, the plan she has in the individual market might end up being more expensive than Medicare. But she would have to wait until the annual general enrollment period to switch, and she would have to pay the late enrollment penalty for Medicare Part A and Part B, based on the amount of time since she was first eligible to enroll (ie, when she had been in the US for five years) to the time that she actually enrolled.

Can immigrants buy individual health insurance?

This is the area that has changed the most for recent immigrants who are 65 or older. Prior to 2014, obtaining individual health insurance for your grandmother in the private market would have been difficult or impossible, since very few major insurers were interested in selling coverage to people over 65.

But the Affordable Care Act has changed that. Health history is no longer used to determine eligibility or premiums in the individual market, and private carriers now offer coverage to people who are 65 or older, as long as they are not enrolled in Medicare. (It’s against the law to sell individual coverage to someone who is enrolled in Medicare, but recent immigrants are not eligible for Medicare at all.)

The ACA also stipulates that older enrollees cannot be charged more than three times the premiums that younger enrollees pay. Since most individual market enrollees are 64 or younger, this rule typically means that a 64-year-old will pay no more than three times as much as a 21-year-old for the same coverage. But if an 80-year-old enrolls in that plan, her premium will be the same as a 64-year-old.

So for the first five years that your grandmother lives in the United States (during the waiting period for Medicare), she’ll be able to purchase individual health insurance through the exchange in the state where she lives. Depending on her income, she may be eligible for subsidies to lower the cost of the premiums, and if her income is doesn’t exceed 250% of the poverty level, she’ll also be eligible for cost-sharing reductions if she buys a silver plan.

For American citizens and immigrants who have been in the U.S. for at least five years, premium subsidies are only available if the household’s income is at least 100% of the poverty level. The idea is that people below that threshold are eligible for Medicaid instead (although that hasn’t been the case in 12 states where Medicaid expansion has been rejected, leaving a coverage gap). But that lower income threshold doesn’t apply to recent immigrants, as they aren’t generally eligible for Medicaid coverage.

So even with income below the poverty level, a recent immigrant who is lawfully present in the U.S. can obtain a plan in the exchange/marketplace with premium subsidies. As of 2021, a recent immigrant with income below the poverty level would have to pay nothing at all (after subsidies) for the second-lowest-cost silver plan in the exchange (prior to the American Rescue Plan, they would have had to pay about 2% of their income for that plan, but the ARP has enhanced the premium subsidies for 2021 and 2022, to make coverage more affordable).

Once your grandmother has been lawfully residing in the U.S. for five years, she’ll be eligible to purchase Medicare. But she’ll also have the option to continue to buy coverage in the exchange instead, and she’ll be able to continue to receive a premium subsidy (and cost-sharing reduction, if applicable) through the exchange if she’s eligible based on her income.

Read more about health coverage for immigrants.

Are immigrants eligible for Medicaid?

A 1996 welfare reform law stipulates that immigrants must have five years of legal U.S. residency to become eligible for federal benefits such as Medicaid. The rules were relaxed somewhat in 2009, under the Children’s Health Insurance Program Reauthorization Act (CHIPRA), to allow states the option to provide federally-funded Medicaid and CHIP benefits to pregnant women and children, even if they have not resided in the U.S. for five years, and most of the states have opted to do so (some cover only children, while others cover both children and pregnant women). But some states have opted to also use state funds to provide coverage to additional recent immigrant populations.

According to HHS data (see figure 4), as of 2011, 15 states allowed the use of state funds to provide Medicaid benefits for qualified immigrants who would otherwise be ineligible because of their immigration status – including the fact that they had resided in the United States for less than five years (note that New Jersey is included in HHS’ list of states that provide state-funded Medicaid coverage to recent immigrants, but New Jersey has changed that rule and no longer does so). But as of 2016, an Urban Institute report indicated that only six states and DC were funding public health benefits for immigrants who had not yet been in the U.S. for five years.

If your grandmother has a limited income, don’t rule out Medicaid as an option until you check with your state Medicaid office. But be aware that it’s unlikely that she’ll be eligible for Medicaid benefits, as few states provide Medicaid coverage for elderly recent immigrants.

Employer-sponsored coverage

Even if you have health insurance coverage through your employer, you can’t add your grandmother as a dependent (California lawmakers are considering legislation that would allow people to add parents or stepparents as dependents on their health coverage; the legislation passed the California Assembly in June 2021, and is under consideration in the Senate).

However, some families that own and operate a small business actually hire their older family members as employees so they can offer them health benefits. This option might make sense if you have your own business, but rest assured that coverage for your grandmother is now available in the individual market, making it much easier than it used to be for elderly recent immigrants to obtain health insurance when they arrive in the U.S.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Dee Pollock
2 years ago

My wife recently received her green card and wants health care insurance. Perfect health, no pre existing conditions. I am Chairman of The Board of Rural Critical Hospital located in Wickenburg AZ so understand health care.
Louise Norris was highly recommended…could I chat/ with her

Admin
2 years ago
Reply to  Dee Pollock

We’ll reply by email at the address you provided.

Qasim Ali
2 years ago

Wonderful article, clearly explains the public charge definition in the light of new rule. However, it would be nice if a rough dollar amount range could be put against let’s say for a person who wants to buy private insurance without subsidies for an elderly parent > 65 years old. This would give an idea of what cost we are looking at for “heavily weighted positive factor” in the immigration process

2 years ago
Reply to  Qasim Ali

Qasim,
Are you wondering about the full-price cost of a health insurance policy? If so, that will vary considerably from one place to another. The good news is that the cost of a plan for a 95-year-old won’t be more than the cost of a plan for a 64-year-old, since the ACA’s age banding rules require an insurer to charge someone who is 64+ no more than three times the amount they charge someone who is 21.
But the prices vary from one insurer to another and from one area to another. For example, the cheapest full-price plan available for an elderly person in Cheyenne, Wyoming is currently $1,275 per month. But in Salt Lake City, Utah, an elderly person can get a full-price plan for $546/month.

Darvin R
5 months ago
Reply to  Louise Norris

What carrier would be the one to go to in Florida for a 70 year old man? TYIA

Sergey
2 years ago

I read this article and wondered how successfully the author placed all essential information about health insurance for immigrants in one post.
I highly recommend this article to everyone who are interested in this subject. Do not go to other sites, just read all above carefully.
Great thanks to author, now my not systemized knowledge of the subject converted into organized system.

Venkat
1 year ago

Hi My mother is living with me at New York and she will get green card in 4 months. She will be 73 years old in Dec 2020. I am looking for good health insurance covering pre-existing condition too.

1 year ago
Reply to  Venkat

She’ll be able to enroll in an individual market plan through New York State of Health: https://nystateofhealth.ny.gov/ That’s the state-run health insurance exchange in New York. Coverage is available for lawfully present immigrants regardless of age, and premium subsidies would be available to her if she’s eligible based on income. And if her income is too low for premium subsidies, she’d be able to enroll in The Essential Plan (a NY-specific plan for people with low-modest incomes; it does not have a five-year waiting period for coverage the way Medicaid and Medicare have).
Here’s more information that might be useful for you in terms of how individual market coverage works for immigrants: https://www.healthinsurance.org/obamacare/how-immigrants-are-getting-health-coverage/

Paul
11 months ago
Reply to  Louise Norris

Hi Louis or anyone in this thread,

My Mum ( 70 years) lives in PA state and she expecting Green card in next couple of months. Do we have subsidized insurance similar to NY state?

Editor
11 months ago
Reply to  Paul

Hi Paul,

Yes. Pennsylvania does not have a program like NY’s Essential Plan (those are unique to NY and MN), but health insurance subsidies are premium tax credits provided by the IRS, so they’re available nationwide.

Pennsylvania runs its own health insurance exchange, called Pennie: https://pennie.com/ You can use that website to find her a plan and complete the enrollment, although a broker or navigator will be able to help you if you’ve got questions about the available options.

Since she’s a new immigrant and thus not eligible for Medicaid or Medicare, she’ll be eligible for premium subsidies even if her income is below the poverty level.

Varadan Sevilimedu
11 months ago
Reply to  Louise Norris

Hi Louise or anyone in this thread,

I am Varadan. My parents are in India and are not green card holders yet but I plan to apply soon. They are 79 and 84 years old. I recently enquired from the getcovered.nj.gov folks over a phone call, regarding my parents’ insurance. Even though they were not able to provide me with a number for the amount of financial assistance that I might get without actually providing them with my parents’ green card number (which is not yet applied for), I learned that NJ has partnership with three companies – Amerihealth, Horizon Blue Cross Blue Shield and Oscar. I looked up quotes for them from the corresponding websites and they seemed very expensive (about 3000 to 4000 US Dollars a month). That being said, I definitely need an estimate of the financial assistance that I will get, before I can file for their green cards. So, I have two questions: 1. Is there anyway I can get an estimate of my monthly expenses for my parents’ health insurance so that I can have a rough idea before filing for their green card? and 2. Does my income figure into the amount of financial assistance I get or is it my parents’ income (parents’ income is zero since they won’t be working here)?

Any insights will be appreciated.

Best regards, Varadan

Guptajee
8 months ago

You can apply for GC first then calculate the cost. If you claim your parents as dependents then your income will be used to determine eligibility and/or financial assistance.

Dinkar
6 months ago

Hi Varadan – I am also from India and thinking of bringing my in-laws (currently not on green-card_. Health insurance is the big issue. The above article is truly amazing and re-assuring, but can you please send me details on how you went about it, since it specific to India and I also live in NJ? I would like to know what financial assistance I can get. Thank you.

Varadan
1 year ago
Reply to  Venkat

Hi Venkat,
Which insurance did you get for your mother. I have a similar situation also. Would you please be able to share?

Thank you,

Varadan

Nikki Flores
1 year ago

Hi. I’m planning on petitioning my father who is currently in the Philippines, so he can stay with me here in California. He is 83 years old, with pre-existing condition. He doesn’t have any income, and doesn’t own any asset worth over $1,000. Once my petition gets approved, would he be able to apply for medi-cal once he gets here in California? If not, is there any low-cost health coverage available for him?

Elizabeth Gonzalez
1 year ago

Hello. My mother is 74, she received her permanent residence since 2011. She has been traveling back and foth because of my sister who has been denied the visa and who depends on my mom. The idea has olwas been for my mom to stay here in California but she hasn’t been able to stay more than three months. Now she is ill and I want to bring her here for treatment. She never workde here and she doesn’t have health insurance. What Insurance can I get for her to be able to take her to good hospitals. She doesn’t have any income but my husband and I could pay for her premium if necesary. Because of the pre-existance and the age, private insurances won’t take her and because she hasn’t work here, she doesn’t apply for medicare. Could you please help me find a solution for her? I would need to bring her in less than two months and I don’t want to take her just anywhere because she doesn’t have insurance, I need to do things right.

Louise Norris
1 year ago

I’m sorry your mother is ill, and I hope you’re able to help her get the treatment she needs. If she hasn’t resided continuously in the US for the last five years, she would not be able to enroll in Medicare. Her pre-existing conditions would not keep her from enrolling in a private ACA-compliant plan in the individual market (ie, through Covered California), but she would need a qualifying event in order to enroll outside of open enrollment. Here’s a guide to the various qualifying events: https://www.healthinsurance.org/special-enrollment-guide/why-you-need-this-book/ If she’s been living overseas and is returning to the US, she would qualify for a special enrollment period triggered by a permanent move: https://www.healthinsurance.org/special-enrollment-guide/how-your-big-move-can-trigger-an-sep/
She could also enroll in a plan through Covered California during open enrollment, which begins November 1. But coverage selected during open enrollment doesn’t take effect until January 1. So if she’s moving back to the US in the near future, the permanent move special enrollment period is probably a better option, as it will allow her coverage to take effect sooner.

Srkpriv
1 year ago

Your mother will be eligible for CA Medi-CAL (medicaid) in California

Jerry Mullins
1 year ago

Could you please tell me the cost of health insurance for 87 year old in Florida I would like to bring my sister back to the USA from England she had a green card but it has ran out thank you.

Admin
1 year ago
Reply to  Jerry Mullins

Jerry, this article has more information about individual health insurance for immigrants. You can use the quote form at the top of the page to get an idea of the plans available and plan costs. https://www.healthinsurance.org/obamacare/how-immigrants-are-getting-health-coverage/

You can also call the phone number at the top of the page to talk about your coverage needs with a professional licensed in Florida.

Pete
1 year ago

Hello,

My wife currently doesn’t work but we are sponsoring both of her parents to immigrate to the US. We file a joint tax return and I make over $100k. Her father will be over 65 when they get here. Would her parents be able to get subsidized health insurance from the market or do I make too much and would have to pay the full premium? We currently reside in Nevada. Thank you!

Editor
1 year ago
Reply to  Pete

We recommend that you speak with a financial advisor for specifics about your situation. But in general, when determining their eligibility for premium subsidies in the marketplace, your income would only be considered if you’re planning to claim them as tax dependents on your own tax return. Assuming that’s not the case, they would apply for premium subsidies based on their own income, and would then file their own tax return to reconcile the subsidy amounts that are paid on their behalf.

Miriam
1 year ago
Reply to  Louise Norris

Hello!
I would like to follow up on this as I am in a similar situation, planning (along with my husband) to sponsor my mom for a green card. I am reading in other sources that for legal immigrants who have signed a legally binding affidavit of support on or after December 19, 1997, the income and resources of the sponsor are counted as available to the immigrant when determining the immigrant’s eligibility for ACA health plan. It appears this is regardless whether the immigrant is listed as a dependent on the sponsor’s tax return. Most immigrants cannot apply for green card without their US citizen direct relative sponsorship, so does that mean that would make them ineligible for health coverage through ACA because of level of income of their sponsors? Or only limits the eligibility for subsidies?
The other question is, how does one obtain a health plan in the USA via ACA if they do not have a SSN issued to them yet, as they are just applying for permanent residency (not a green card holder yet).
Thank you!

foo bar
1 year ago
Reply to  Miriam

Miriam –
I am reading in other sources that for legal immigrants who have signed a legally binding affidavit of support on or after December 19, 1997, the income and resources of the sponsor are counted as available to the immigrant when determining the immigrant’s eligibility for ACA health plan

where are you seeing this? Do you have any sources? I’m in the same boat that’s why I’m asking.

Naila
1 year ago

Hello Louise,
Thank you for the informative article. My parents are 75 and 62. They just got their green card and I know they are not eligible for the state or federally funded programs.
I would appreciate if I can speak to you, and get guidance on what insurance I can get them. We’re in NY. My sibling who sponsored them is in TX.
Hope to hear from you soon.

Editor
1 year ago
Reply to  Naila

Hello Naila,
They should be able to enroll in a plan through NY State of Health, so I’d advise you to start there: https://nystateofhealth.ny.gov/ You can contact them directly, or reach out to a Navigator in New York: https://info.nystateofhealth.ny.gov/navigatorsitelocations

Suzanne Hendery
1 year ago

Dear Louise, thank you for offering your excellent advice! I am seeking direction on bringing my 88 year old dad, who is a dual citizen- US and Canadian, with a pre-existing condition, who has lived in Canada for 45 years, to my home of Reno, Nevada to be a permanent resident. Early in his career, he lived in the US for 5+ years and paid payroll taxes. Your advice please. I would not list my dad as a dependent on my taxes, and he would not be eligible for Medicaid. Thank you!

Editor
1 year ago

Thanks, Suzanne! Since your dad would not be eligible to enroll in Medicare or Medicaid, he can enroll in a plan through Nevada Health Link instead (he would need 5 years of continuous presence in the US immediately prior to enrolling in Medicare; his 5+ years of prior work history would only be counted in terms of whether he’d need to then pay premiums for Medicare Part A, and it would have to be at least 7.5 years of work history in order to make a dent in the Medicare premiums).
Because he’s not eligible for premium-free Medicare (or any Medicare at all for the first five years after he moves to the US) and would also be ineligible for Medicaid for five years, he’d qualify for premium subsidies through Nevada Health Link if his income is between 0% and 400% of the poverty level. This would be based on the income that he files on his own tax return; your income would not be counted since he wouldn’t be listed on your tax return.
I’d advise reaching out to Nevada Health Link or to one of their certified enrollment assisters or brokers. Here’s the contact info: https://www.nevadahealthlink.com/get-help/

Ray Snook
1 year ago

My wife and I were greencard holders for 15 years, but left the U.S in 2017 to look after elderly parents in the UK. Our daughter is a US citizen and can sponsor us for greencards if we want to return to live in the US as retirees.
Would our 15 years of residency count for us to apply for Medicaid immediately or would we have to wait another 5 years upon returning?

Martha
1 year ago

Thanks for writing this article. If I were to bring my parents here, would their retirement savings count as income when determining whether they qualify for health care subsidies, or just the interest they make on those savings? They wouldn’t be working, so they wouldn’t have any additional income, they’d just be living off of their savings.

Editor
1 year ago
Reply to  Martha

Subsidy eligibility is based on an ACA-specific definition of MAGI: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/ For most people, it’s the same as AGI from their tax return, but there are a few things that have to be added in, if they have them.
So for example, if a person is taking withdrawals from a traditional (non-Roth) retirement account that was saved pre-tax in the US, the money withdrawn would all be taxable and would thus be counted as income. But if the withdrawals aren’t considered taxable income, they’re not going to affect AGI or ACA-specific MAGI.

Yonayumi
1 year ago

I am looking for medical health insurance options for my parents – both 74, not working, greencard holders and resident for 1.5yrs in WA. A health plan navigator told my parents would need to submit a joint $0 income (separate to our household) to avail cheap and affordable health plan. My husband and I were both working and the company shoulders our health insurance. If we consider household income, health plans for my parents would not be affordable and costs $1700 each per month. Is the navigator right, is this legal?

Editor
1 year ago
Reply to  Yonayumi

You’d only consider your income and your husband’s income if you claim your parents as dependents on your tax return. Otherwise, assuming they file their own tax return, it’s just based on their own income. If they have no income at all, they’ll qualify for a premium tax credit, as explained here: https://www.healthinsurance.org/obamacare/how-immigrants-are-getting-health-coverage/ (recent immigrants are not eligible for Medicare or Medicaid, which is why premium subsidies are available even to those with no income, as long as they’re lawfully present in the U.S.)

Kate Subu
1 year ago

Hello, My parents are 74 and 78 respectively. They are Canadian citizens living in India. I’m planning on sponsoring them for Green card so they can spend time in US. I know they will not be eligible for Medicaid. As far as the ACA is concerned, do they qualify for plans in NJ. How much does it cost? They will have minimum income so would qualify for subsidy i imagine. Please let me know the details. Thanks.

Editor
1 year ago
Reply to  Kate Subu

Yes, they would be able to buy coverage through the health insurance exchange/marketplace in New Jersey. Here’s the exchange website, where you can see pricing (based on their income) and plan availability: https://www.nj.gov/getcoverednj/
And here’s more about the New Jersey exchange: https://www.healthinsurance.org/new-jersey-state-health-insurance-exchange/

John ] Edward
1 year ago

Hi Louise,

Awesome article! I have a quick question, my parents are GC holders living with me in US but receive pensions in India (7000 USD annual). They are eligible for ACA health plans but what is there gross income? Is it my Income since i claim them as dependents or their annual pension income from foreign accounts? If i used their income as gross income to buy the health plan (which will be heavily subsidized) then can i continue include them in my taxes as defendants or they should file separately?

Editor
1 year ago
Reply to  John ] Edward

The question of whether or not to claim your parents as your tax dependents would need to be addressed with a tax advisor, as it has a lot of ramifications either way.

But in terms of premium subsidies, it’s fairly straightforward: If you claim them as tax dependents, then the entire household income (yours and theirs) would be counted, as would all the members of the household (you, them, as well as any other people who show up on your tax return). So for example, if there are a total of five people on the tax return, you’d be looking at the federal poverty level numbers for a household of five, and comparing that with the total household income.m This article might be helpful in understanding how this works: https://www.healthinsurance.org/faqs/we-claim-our-son-but-not-our-daughter-on-our-taxes-how-are-premium-subsidies-calculated-for-families-like-ours/

On the other hand, if your parents file their own tax return, their subsidy eligibility would be based on their own total income versus the poverty level numbers for a household of two.

Cynthia
1 year ago

Are there a required numbers of hours an immigrant has to work over 5 years to be eligible for Medicare?

Karen kim
1 year ago

Hi, my mom is 70 years old and she will obtain green card this year. I recently found out that she won’t be eligible for any government health benefits for next 5years, so i am trying to buy a private health insurance since mom would need medical attention and daily medications. I have no idea what the cost will be like, or it’s even possible for her to get the insurance with pre-existing health conditions. Can you please advise me?

Varadan
1 year ago

I am from India. My parents are 83 and 78 and wish to come here to stay with us on green card (not filed petition yet, but will do soon). My mother has preexisting conditions. I would like to know what reasonable options for healthcare coverage are available for my parents in the first five years? Appreciate any information. Thanks!

Srkpriv
1 year ago

In California, permanent residents (Green Cards) who are senior citizens are covered by California Medi-CAL (Medicaid). I am sure other states may have similar facilities… Of course, through ACA you can buy medical insurance through ACA exchanges (which are subsidized for Senior Citizens in states where there is no medicaid or limited medicaid).

Last edited 1 year ago by Srkpriv
Varadan Sevilimedu
11 months ago
Reply to  Srkpriv

I live in NJ. The NJ familycare program – a counterpart, of California MedI-CAL (Medicaid) program, does not seem to cover insurance for elderly who have been in the US with a green card for less than 5 years.

Patricia Barboza
1 year ago

I would like to bring my father from Peru because I am a citizen of the USA and he is an 83-year-old man. Obviously, I will petition him, and based on the information I already read below I will need to buy for him a medical plan from the exchanges. I need to know what documentation would be needed to prove his only income is his pension so he can be eligible for the subsidies and credits. Another way to ask is if I am sponsoring him to come to live in the USA isn’t only me who has to show my income or is it both of us that we have to show our incomes?

Editor
1 year ago

This will depend on how he’ll be filing his taxes in the U.S. If he’ll officially be listed as a dependent on your tax return, then your income would be counted along with his pension income. But if he’ll be filing his own tax return, then only his own pension income will be counted by the exchange (and by the IRS, when his premium tax credit is reconciled on his tax return).

During the enrollment process, the exchange will ask for income details and may require proof of his income. If documentation is requested, they’ll let you know what they need (monthly pension statement, proof of bank deposit, etc.)

Here’s more information about health insurance for immigrants: https://www.healthinsurance.org/obamacare/how-immigrants-are-getting-health-coverage/ And you may find some helpful FAQs here: https://www.healthinsurance.org/faqs/

Best of luck with the move, and a big welcome to your father!

Maya
8 months ago

My mother is 81 years and is in the process of getting her GC from North Carolina. Can she get health insurance from NC?

Hiren Patel
8 months ago
Reply to  Maya

Hello My dad coming first time to Connecticut as LPR status, he needs health insurance asap because of his cancer treatment. How can he get health insurance while waiting for his social card.?

Rahul
7 months ago

When father completes 5 years residency in the usa, he will be 75 years, and wont have worked in the usa (so we will have to pay for his medicare premiums). But will he also incurs penalties, because he didnt sign up at 65 (even if he was ineligible for medicare at that age).

gessy
7 months ago

My mom is a US resident, but has only been living in USA for 1 consecutive year (from Canada). She has worked in the United states for 5 to 6 years in the 1960’s. Is she eligible for Medicare?

Sara Gouw
7 months ago

Hi Louise,

Thanks for this great article. My mom will be getting her green card in 2022 and we live in Houston, TX. She is 74 years old. I’m looking for health insurance for her and she has pre-existing conditions. I have not claimed her as my dependent and she doesn’t have any income as she is retired with no pension. Can she apply for Medicaid in Texas? If I claim her as my dependent, I think our household income is higher then the eligibility limit for Texas Medicaid. Also, do you know whether Texas has any other kind of health insurance subsidies?

Thanks.

Last edited 7 months ago by Sara Gouw
Wayne
7 months ago

My dad just got his green card 3 months ago and he is 66 now, and he does not work. I am wondering how I can help him to buy medical insurance. Is he qualify for tax credit for buying the ACA insurances?

Admin
6 months ago
Reply to  Wayne
Umesh
6 months ago

My mom who is 81 years old recently got her GC and is living with me in Cleveland Ohio. She has not worked in US. What are my options to purchase health insurance for her? Can I get ACA insurance for her?

Editor
3 months ago
Reply to  Umesh

Yes, she can enroll in coverage through the marketplace, as described in the article above. The open enrollment period for 2022 coverage ended on January 15 in Ohio, but there’s a special enrollment opportunity this year for people whose income doesn’t exceed 150% of the poverty level. Depending on her income, she might qualify for that: https://www.healthinsurance.org/special-enrollment-guide/an-sep-if-your-income-doesnt-exceed-150-of-the-federal-poverty-level/ And there are various other special enrollment periods that allow people to sign up outside of the annual enrollment window: https://www.healthinsurance.org/special-enrollment-guide/why-you-need-this-book/

Without a special enrollment opportunity, the next enrollment window will begin November 1, for coverage effective January 2023.
After your mom has lived in the U.S. for five years, she’ll have an opportunity to enroll in Medicare if she’d like, although she’ll have to pay a premium for Part A (as well as Part B, which has a premium for everyone). If she’s eligible for a premium tax credit (subsidy) in the marketplace, she can choose to keep that instead, as it will likely be less expensive than paying for Medicare.

Ipshita
5 months ago

I am working towards getting my mother a green card to join me in USA. She is 76 years old with pre-existing conditions. What are my options for health insurance for her and how much will it cost approximately. I live in New Jersey. Thanks.

Editor
3 months ago
Reply to  Ipshita

The health insurance marketplace in New Jersey is GetCoveredNJ. You can use their plan cost/comparison tool here: https://www.nj.gov/getcoverednj/financialhelp/savings/ Since your mother won’t be eligible for Medicare, she’ll be able to enroll in a plan through the marketplace, with premium tax credits (subsidies) depending on her income. That plan comparison tool will show you the available options and how much they’ll cost, based on her projected annual income.

Phuong
4 months ago

My mother meets the 5 year green card requirement but she has not worked since she is elderly. I signed the affidavit of support so I assume the government will make me pay for her premiums until she’s got her citizenship. However her friends and family keep trying to tell me that my mother does not have to pay medicare premium because she has no income. Can you please tell me if she does have to pay or not?

Editor
3 months ago
Reply to  Phuong

Since she’s been here for five years, she has the option to enroll in Medicare. Since she has no work history, she would have a premium for both Part A and Part B (the combined total in 2022 is about $670 per month). But depending on her assets, she might qualify for a Medicare Savings Program that could cover the cost of Part B and possibly Part A: https://www.medicareresources.org/faqs/is-there-help-for-me-if-i-cant-afford-medicares-premiums/ Medicare Savings Programs are run by each state’s Medicaid office, so you’ll want to reach out to the Medicaid office in your state to see if she might be eligible (Medicare is a federal program; Medicaid is a joint state/federal program so there are differences from one state to another)

Phuong La
4 months ago

I’m looking to cover insurance for my mother who is 62 and just moved here to the United States with a green card 2 years ago (Salt Lake City, Utah). Currently I don’t know what the best plan to get for her, both in quality and financially. I was told by a friend online to go to this site and ask for Louise. Do you think you can help me?

Editor
3 months ago
Reply to  Phuong La

The best plans are going to be on HealthCare.gov, which is the health insurance marketplace in Utah. Here’s the plan comparison tool that you can use to see what plans are available for her: https://www.healthcare.gov/see-plans/#/ You’ll just need to input her age, zipcode, and income, and it will show income-based pricing for all of the available plans.

Open enrollment for individual/family health plans ended January 15, and the next open enrollment period begins November 1. But if your mother’s income doesn’t exceed 150% of the poverty level, there’s a special enrollment period opportunity that continues throughout this year: https://www.healthinsurance.org/special-enrollment-guide/an-sep-if-your-income-doesnt-exceed-150-of-the-federal-poverty-level/ (for coverage this year for a single person, 150% of the poverty level is $19,320 in annual income).

I’m glad my writing was helpful to your friend, and I hope that your mother is able to find a policy that will fit her needs. Here’s my summary of the Utah health insurance market, in case it might be helpful to you: https://www.healthinsurance.org/health-insurance-marketplaces/utah/

Aida
3 months ago

Your articles are incredibly thorough and helpful, Louise! Question about my parents who are green card holders. Can they stay on the Maryland Health Connection plan indefinitely and not switch to Medicare? My parents would pay the full premium for Part A due to my father does not have taxable work history in the US and Medicare would be much more expensive than staying on the ACA plan. They are currently 79 and my mom is 67. I just want to make sure they can choose to stay on ACA for the rest of their lives because they are not eligible for Part A free and that there is no negative consequence to that (i.e. can ACA kick them out at some point). I also want to spare them the late enrollment penalty fees that Medicare charges which I think are ridiculous. Any chance those penalties will go away?

Editor
3 months ago
Reply to  Aida

Yes, they can stay on a marketplace plan indefinitely. And if their income makes them eligible for a premium tax credit, they can continue to receive it indefinitely. See Question A.6 here: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/Medicare-and-the-Marketplace/Downloads/Medicare-Marketplace_Master_FAQ_8-28-14_v2.pdf

People who are eligible for premium-free Medicare Part A cannot continue to receive a premium tax credit after they’re eligible for Medicare. But that rule does not apply to people who would have to pay a premium for Medicare Part A.

The penalty would still be an issue if they ever decided to transition to Medicare in the future, after their initial enrollment window (when they’ve been here five years and have the option to start buying Part A and Part B). But as long as they stay on a marketplace plan, the penalties wouldn’t come up.

The primary advantage of Original Medicare plus Medigap is that it can be used nationwide, whereas most marketplace plans tend to have fairly local networks. So if they were to start traveling extensively in other states, paying for Medicare might make sense. But if they were to move to another state, they would qualify for a special enrollment period that would allow them to purchase a plan in that state’s marketplace, with the same sort of income-based subsidies that are available in Maryland.

Vineeta
3 months ago

Hi,l am trying to bring my mother on green card here in Virginia ,would like to know my options for medical insurance since she is 75 years old . Thanks

Editor
3 months ago
Reply to  Vineeta

Virginia uses HealthCare.gov as its health insurance marketplace, so you can use this tool to see the available plans, with income-based pricing: https://www.healthcare.gov/see-plans/#/

Virginia plans to set up their own exchange by the fall of 2023, so there will be some changes with the user interface at that point. Plan options and pricing do change from one year to the next, regardless of whether the state or federal government runs the exchange. Here’s more about Virginia’s health insurance marketplace: https://www.healthinsurance.org/health-insurance-marketplaces/virginia/

As noted in the article above, immigrants without a work history in the U.S. can qualify for income-based premium tax-credits (subsidies) in the marketplace, since they are not eligible for premium-free Medicare Part A.

Ket
2 months ago

Hello Louise Norris,

First of all thank you for detailed article and information. My mother is getting her Green card in 2 weeks and we are based in Delaware. I am a US Citizen but my mother has never worked in USA and now getting Green Card based on the Parent-child relation. She is 74 years old and I have had Visitor Insurance for her (which in all honesty is useless for pre-existing conditions and even for Doctor visits). I wanted to know if I can get my Mother qualified for Health Insurance as a Green Card holder and since she will not have any income (as she wont be working) is there any assistance she could get for her Insurance premiums. We are based in Delaware and I am just not able to find any information about Health insurance for Green Card (Permanent Resident status) people.
Appreciate if you can provide some information on this.

Thank you

K

Admin
Ket
2 months ago
Reply to  Steve Anderson

Thank you Steve, I will read this one

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