Under the ACA (beginning in 2014), all persons “lawfully present” in the United States must maintain minimum essential health insurance coverage for the whole year or must pay a penalty at the end of the year. This means that every lawfully present non-citizen in the United States must enroll in qualifying health insurance in the United States or pay the yearly penalty, unless the non-citizen maintains qualifying health insurance through an employer, individual, or government health insurance program. Lawfully present non-citizens include those persons in the United States with lawful permanent resident status (Green Cards); employment visas (E, H, L, R, or TN); and other miscellaneous lawful statuses (TPS, asylum, refugee status, non-immigrant visas, and deferred action/CAT/Withholding of Removal).
Lawfully present non-citizens can satisfy the health insurance enrollment requirement by enrolling in a federal or state healthcare insurance exchange, and by signing up for health insurance on one of these exchange websites (i.e., www.healthcare.gov). These websites allow uninsured individuals to find qualifying insurance through private insurers, if the individual’s employer does not provide health insurance coverage and the individual does not otherwise have qualifying health insurance coverage. Also, these websites allow lawfully present non-citizens to receive tax credits that will help them pay for their health insurance if their income is low.
One exception to the health insurance enrollment requirement for lawfully present non-citizens is that the law does not treat non-citizens as “lawfully present” under the ACA if the person cannot be reasonably expected to remain lawfully present in the United States for the entire term of the health insurance plans offered through the exchange websites. For example, H-2B visas allow foreign workers to enter the United States for ten month periods. If the insurance exchanges require enrollment in an insurance plan for longer than the worker can reasonably be expected to remain in the United States, the law does not consider them “lawfully present” under the ACA. These individuals do not need to enroll in qualified health insurance.
At this time, the health insurance exchanges are not fully operational. Texas does not have a state insurance exchange, and the federal exchange has been difficult to use. This means that we do not know if insurance companies will offer health insurance coverage for limited time periods for persons lawfully present in the United States on temporary visas or with other temporary statuses. In this uncertainty, I recommend that everyone with lawful immigration status in the United States enroll in an insurance exchange, and request insurance quotes. If you cannot find coverage reasonably limited to the time period you will remain in the United States, document your efforts, but do not enroll in a health insurance plan. You can use these records to prove that you tried to enroll, but cannot reasonably be expected to enroll in a plan that lasts longer than you expect to stay in the United States.
Note for Undocumented Immigrants: Undocumented immigrants are explicated exempt from the health insurance coverage requirements of the ACA. However, the law covers the U.S. citizen dependents (spouse and children) of undocumented individuals. Undocumented immigrants should seek health insurance coverage for their dependents under the ACA, if their dependents are not otherwise covered by an employer, individual, or government health insurance program.