With the passage of the Affordable Care Act (also known as “Obamacare”), U.S.-born citizens are required to maintain private insurance coverage through their employer or enroll in healthcare coverage through state exchange systems. Failure to do so results in a federal tax penalty unless the individual is exempt because of low income.
The Affordable Care Act requirements for other individuals present in the United States vary depending on the individual’s immigration status.
Naturalized citizens
Individuals who became U.S. citizens through naturalization are afforded the same rights and protections as U.S.-born citizens. Likewise, naturalized citizens also have the same obligation as U.S.-born citizens to enroll in healthcare coverage.
Lawfully present immigrants
These individuals have the same coverage mandate and tax penalty for non-coverage, but are only eligible for limited federal coverage.
Lawfully present immigrants may enroll in a “qualified health plan (QHP)” from the state insurance exchanges with no waiting period. In addition, they may be eligible for premium tax credits and lower copayments.
The majority of lawfully present immigrants are only eligible for Medicaid after a five-year waiting period. States can choose, however, to grant Medicaid and Children’s Health Insurance Program (CHIP) benefits to children and pregnant women who are lawfully present.
Undocumented immigrants
Individuals who are undocumented are not covered by the Affordable Care Act. They are also not allowed to purchase coverage through the state exchange system. However, nothing prevents an undocumented immigrant from purchasing insurance coverage through a private insurer.
In addition, undocumented immigrants are not eligible for tax credits or lower copays. They are not eligible for Medicare, non-emergency Medicaid, or CHIP. On the other hand, undocumented immigrants are not required to obtain healthcare coverage.
Undocumented immigrants, however, are still covered for emergency care under federal law and are eligible for Emergency Medicaid if they have low income or no income. Undocumented immigrants are permitted to seek nonemergency health services at their own expense via community health centers, clinics, and safety-net hospitals.
It is critically important for undocumented immigrants to know that they should never misrepresent their immigration status to obtain these benefits. Such actions can have permanent, devastating effects on any future immigration benefits.
Special situations
Children who are U.S. citizens or who are lawfully present in the U.S. with undocumented immigrant parents may purchase coverage through the state insurance exchange, receive premium tax credits, lower copays, and are eligible for Medicaid and CHIP.
Deferred Action for Childhood Arrivals (DACA) recipients are ineligible for Medicaid, CHIP, or other benefits under the Affordable Care Act.
Verification requirements
Individuals must have their citizenship or lawful presence verified before they can enroll in private health insurance in the state exchanges, premium tax credits, Medicaid, or CHIP. Verification is performed through Social Security records, USCIS records (via their SAVE database), or through other documentation provided by the individual if the other options prove unsuccessful.
Individuals may be asked for a Social Security number to electronically verify household income. If the individual does not have a number, other proof of income will be accepted.
Most importantly, any information about immigration status may be used only to determine whether an individual is eligible.
For more information, please view the healthcare.gov links below (in Spanish and English).
Healthcare.gov – What do immigrant families need to know about the Marketplace?
Spanish version - ¿Qué necesitan saber las familias inmigrantes?
