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The coronavirus pandemic has laid bare many inequities in the United States, including the gap in medical care for those with insurance and those without. To make it even worse, immigrants, especially the undocumented, struggle to understand America’s complex health system. Furthermore, this population may be on a limited budget, thus precipitating the need for free or low-cost medical services. That’s where we come in.
As a helping hand in your new land, our services help you understand the culture and processes of the United States. Today, we are going to talk about health insurance in America: what it is and alternative options for free or low-cost medical care for immigrants. Unlike other countries, such as Canada, where every citizen is guaranteed paid health insurance, America’s individualistic, pull-you-up-by-your-bootstraps culture leads to the endless discussion of making healthcare affordable to everyone in the country versus only to those who can afford it.
WHAT IS HEALTH INSURANCE? WHY IS IT SUCH A BIG DEAL AND SO POLITICIZED IN THE UNITED STATES?
According to healthcare.gov, health insurance is a contract between you and your health insurer wherein the health insurer is required to pay some or all of your medical care costs in exchange for a premium, or the amount you pay for your health insurance every month. Health insurance provides access to medical care for both physical and mental health and substance abuse such as alcoholism or drug addiction. Everything medical – from a yearly dental checkup to surgery to counseling to hospital stays while giving birth – costs a lot in the U.S. Americans mostly get health insurance through their employers or the healthcare marketplace put on by the federal government, which will be discussed in detail later on in this post. Dental insurance, which pays for visits to the dentist and dental procedures/services, is separate from medical insurance.
WHAT DOES HEALTH INSURANCE COVER?
Your health insurance coverage will differ according to the policy you buy. In general, most health insurance policies cover preventive services, or screenings that can detect disease or help prevent illnesses or other health problems. Health insurance coverage does not mean every visit or medical service you engage in is free. You may be required to pay the remaining balance after your health insurance pays its part for the services. For a detailed breakdown of health insurance coverage, including copayments, premiums, and deductibles, check out this primer: https://familydoctor.org/health-insurance-understanding-covers/
WHAT IF I CAN’T AFFORD HEALTH INSURANCE?
Paying medical expenses out of pocket, or the amount you pay on your own because the service is not covered by your insurance or is only partially covered, can be debilitating for some families and put them in debt. However, you have other options both at the state and community-levels to seek free or low-cost medical care. You should take advantage of these options and get medical treatment when necessary, especially if you are sick or think something is wrong.
Explore the following options to find the care you need, can afford, and qualify for:
COMMUNITY HEALTH CENTERS
Supported by the government, community health centers provide efficient primary care at an affordable cost. A primary care practice is a patient’s first exposure to the healthcare system and serves as an individual’s source for complete health care services. Primary care doctors do not have a specialization, unlike an OBGYN (obstetrician/gynecologist) or a surgeon, but are trained to recognize symptoms, diagnose illnesses, and provide care for patients or refer them to a specialist, if needed.
Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, such as diabetes, asthma, heart and lung disease, depression, cancer and HIV/AIDS, in a variety of health care settings. Seeing your primary care physician at a community health center is much cheaper than a visit to your local hospital’s emergency department. These community health centers also can provide translation services to their patients.
Find a community health center near you using this tool: https://findahealthcenter.hrsa.gov/
HOSPITAL EMERGENCY ROOMS
Though this option is NOT low-cost or free, you can visit your closest hospital’s emergency department if you are in dire, urgent need for medical attention. Under federal law, hospitals that receive support from the federal government (as most do) are required to care for patients who need emergency care, regardless of their immigration or health insurance status. Shortly after your stay, you will receive a bill for the services. Without health insurance, these bills can be very high, depending on the care you received in the hospital. Hospitals are only required to provide care until the patient is stabilized, or, in other words, the patient’s condition has not gotten worse or deteriorated. Hospitals must also create a release plan for you for when you leave the hospital.
Because emergency departments do not require an appointment, you may wait a long time to be seen by a doctor if there are many other patients in the ER that day. When you arrive at the ER, a triage nurse will ask you for your symptoms to determine the severity of your situation. If other patients have more serious injuries or illnesses that require immediate attention, they will be seen before you.
LOCAL HEALTH DEPARTMENTS
There are almost 3,000 local health departments in the United States whose sole purpose is to ensure the health and well-being of a community. Most local health departments serve diverse communities who struggle with resources. More than two-thirds of local health departments provide the following core services:
- Adult and childhood immunizations
- Prevention and control of communicable diseases, or those caused by viruses or bacteria like the flu or colds
- Community outreach and education
- Epidemiology and surveillance
- Environmental health regulation such as food safety services and restaurant inspections
- Tuberculosis testing
- Family planning (birth control, pregnancy counseling, and clinical tests including breast exams and tests for sexually-transmitted diseases)
Local health departments are associated with the health department of the state in which it resides. You can find a local health department in your city, town, county, or township. You may also find combination health departments that cover both the city and the county or multiple counties. However, please be advised that not all units of local government have health departments.
Find a health department near you using this guide from the National Association of City and County Health Officials (NACCHO) where you can search by your state or zip code: https://www.naccho.org/membership/lhd-directory
FEDERAL HEALTH INSURANCE PROGRAMS
There are various health insurance programs provided by the federal government; however, a person’s eligibility for each varies according to their immigration or citizenship status. Unauthorized immigrants are not eligible for federal health insurance programs but may be eligible for more discrete programs like emergency medical assistance under Medicaid, services in federally qualified health centers and certain public health programs. ‘Dreamers’, or undocumented immigrants who are permitted to stay in the U.S. under DACA, the Deferred Action for Childhood Arrivals law, are not eligible for federal health insurance programs.
The Affordable Care Act
In 2010, Congress passed the Affordable Care Act, also known as Obamacare (for then-President Barack Obama) which established the online health insurance marketplace at healthcare.gov. Here, you can search for health insurance programs that fit your needs and your budget. The Act extends health insurance to more than 30 million uninsured people, primarily by expanding Medicaid (see next section) and providing federal subsidies to help lower- and middle-income Americans buy private coverage. Those who do not acquire coverage have to pay a fine, which is a certain amount of money based on a percentage of your household income. With the online marketplace, you can avoid such fines by enrolling in plans that provide Minimum Essential Coverage (MEC).
Only lawfully present immigrants qualify for health insurance under the Affordable Care Act. This includes humanitarian entrants, victims of trafficking and certain immigrants with permission to live and work in the U.S. In addition, children are covered by the parent or legal guardian’s health insurance plan until they are 26 years old or until December 31 of the year they turn 26.
Non-Emergency Medicaid & Emergency Medicaid
Medicaid is a federal and state program that helps with medical costs for some people with limited income and resources. Citizens and qualified immigrants, including lawful permanent residents (green card holders), asylum-seekers, refugees, and victims of domestic violence and trafficking, are eligible to receive non-emergency Medicaid. Qualified immigrants must meet certain financial criteria. They also have to wait 5 years after their admittance date to the U.S. before they can obtain Medicaid, though some with certain statuses, such as an asylee or refugee, may be exempt from this requirement. It is up to each state to decide if it wants to extend or limit public benefits to immigrants, including whether or not to cover all lawfully present children and pregnant women without imposing the waiting period.
In addition, there is an option for Emergency Medicaid for those who do not qualify for regular Medicaid or have no health insurance. Citizenship or immigration status do not matter for obtaining such benefits. As the name suggests, a person’s medical expenses are paid for only in an emergency situation, where the person must be admitted to the hospital due to the sudden onset of acute symptoms and puts his or her life or health in immediate danger. Immigrants cannot apply for this benefit beforehand, but the hospital staff will be able to assist you with applying during your hospital stay. One requirement when applying for Emergency Medicaid is to submit a doctor’s note proving your situation was an emergency. Your family can also apply for Emergency Medicaid on your behalf by visiting their local social services department to apply or by applying online. If time is not of the essence, you can apply for these benefits by mail, but this usually takes substantially longer. To qualify for this benefit, you must meet the requirements for regular Medicaid: a certain income level, age, and ownership of property.
Children’s Health Insurance Program (CHIP)
Parents whose income level disqualifies them from obtaining Medicaid but who need healthcare coverage for their children can apply to the Children’s Health Insurance Program (CHIP). This program provides health insurance coverage to low-income children under age 19 based on their household income. CHIP programs vary by state; some serve as an expansion of the state’s Medicaid program, a standalone insurance program, or a combination of the two. Legal immigrant children residing in the U.S. on or before August 22, 1996 are eligible. If children legally entered the U.S. after this date, there is a 5-year waiting period similar to that of Medicaid. Refugees are eligible for the first 7 years of residence. Like Medicaid, each state decides whether or not provide benefits for all lawfully present children and pregnant women, so check with your individual state to learn more.
For an overview of immigrant eligibility requirements federal programs, please visit https://www.ncsl.org/research/immigration/immigrant-eligibility-for-federal-programs.aspx
CLINICS AT MEDICAL AND DENTAL SCHOOLS AND CHARITABLE ORGANIZATIONS
These health care clinics are free and available at many large medical or dental schools. Here, a current medical or dental student provides you with healthcare services while being supervised by physicians who are part of the university’s faculty. According to the National Association of Free and Charitable Clinics, these types of clinics (including charitable pharmacies) provide a range of medical, dental, pharmacy, vision, and/or behavioral health services to the medically underserved and those with limited economic resources, regardless of the patient’s ability to pay. Some of these clinics may charge a small or sliding scale fee to patients. A sliding scale fee is a discounted fee based on a person’s income, meant to assist those who do not have the money to pay the full fee for the service. Only the uninsured, underinsured, and those who have limited to no access to primary, specialty, or prescription healthcare are eligible for these types of clinics.
To find a clinic near you, use this link to search by your city and state or zip code: https://www.nafcclinics.org/find-clinic
THROUGH YOUR COLLEGE OR UNIVERSITY’S STUDENT HEALTH INSURANCE PLAN
Check with your college or university about their health insurance plans for students. These plans are similar to those provided by employers in the U.S. and because the school pays the majority of the total cost for the plan, the premiums you have to pay will be lower. Student health insurance is usually more affordable and offers better quality options than those provided by private companies or the federal health insurance marketplace. These plans also qualify as Minimum Essential Coverage, which you need in order to avoid fines for not obtaining health insurance coverage.
Having health insurance for you and your family is a necessity in the United States. For those who cannot afford to buy health insurance, I hope these suggestions help you obtain the medical care you need at a price you can afford. If you have any questions or need assistance, please e-mail me at laura@goldenbeaconusa.com. Through our Resource Referrals program, we can help you find healthcare resources in your specific community and accompany you on appointments if needed. Please don’t hesitate to reach out and I will be happy to help you find what you need!
REFERENCES
- https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/
- https://www.aafp.org/about/policies/all/primary-care.html
- https://www.primarycare.theclinics.com/article/S0095-4543(16)30062-8/pdf
- http://affordablehealthca.com/timeline-obamacare/
- http://www.nachc.org/about/about-our-health-centers/what-is-a-health-center/
- https://www.healthcare.gov/immigrants/coverage/
- https://health.usnews.com/wellness/articles/2016-11-02/where-can-undocumented-immigrants-go-for-health-care
- https://www.fairview.org/patient-education/85339
- https://www.astho.org/Public-Policy/Public-Health-Law/Access-to-Care-for-Immigrant-Populations-Overview
- https://www.ncsl.org/research/immigration/immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx
- https://auglaizehealth.org/about-us/what-does-local-health-department-do-your-community
- https://www.ncbi.nlm.nih.gov/books/NBK221185/
- https://www.medicaid.gov/state-overviews/scorecard/breast-cancer-screening/index.html
- https://mymedicare.com/medicaid/emergency-medicaid/
- https://health.usnews.com/wellness/articles/2016-11-02/where-can-undocumented-immigrants-go-for-health-care
- https://www.ncsl.org/research/immigration/immigrant-eligibility-for-federal-programs.aspx
- https://www.ncsl.org/research/immigration/immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx
- https://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and-maps/state-and-local-health-departments
- https://auglaizehealth.org/about-us/what-does-local-health-department-do-your-community
- https://www.ncbi.nlm.nih.gov/books/NBK221185/
- https://auglaizehealth.org/nursing-division/family-planning-clinic