Immigration Statuses and the Marketplace

Eligible Immigration Statuses for Marketplace Coverage  |  Undocumented & DACAmented Individuals Special Marketplace Rules for Seniors  |  PTC for Certain Lawfully Present People w/ Low Income  |  Special Rules for Married Nonresidents  |  Resources

Lawfully present immigrants are eligible for coverage through the Health Insurance Marketplace.


Eligible Immigration Statuses for Marketplace Coverage

“Qualified” Immigrants:

  • Lawful Permanent Resident (LPR/green card holder)
  • Refugee
  • Asylee
  • Cuban/Haitian Entrant
  • Paroled into the U.S. for at least one year
  • Conditional Entrant
  • Granted Withholding of Deportation or Withholding of Removal
  • Battered Spouse, Child and Parent

Others:

  • Member of a federally-recognized Indian tribe or American Indian born in Canada

Other “Lawfully Present” Immigrants:

  • Granted relief under the Convention Against Torture (CAT)
  • Temporary Protected Status (TPS)
  • Deferred Enforced Departure (DED)
  • Deferred Action (except DACA)
  • Paroled into the US for less than one year
  • Individual with Nonimmigrant Status (includes worker visas; student visas; U visas; citizens of Micronesia, the Marshall Islands, and Palau; and many others)
  • Administrative order staying removal issued by the Department of Homeland Security
  • Lawful Temporary Resident
  • Family Unity

* Exception: Individuals granted deferred action under the 2012 Deferred Action for Childhood Arrivals (DACA) program are not eligible to enroll in coverage in the Marketplace.

National Immigration Law Center- “Lawfully Present” Individuals Eligible under the Affordable Care Act


Undocumented & DACAmented Individuals

Undocumented & DACAmented individuals are ineligible to purchase health plans in the individual Marketplaces, event at full price. They can purchase private coverage outside the Marketplace or through their employer.

Undocumented & DACAmented individuals can apply for health insurance for eligible family members, and be part of a household for eligible family members.

They may be eligible for health programs available to ALL, regardless of immigration status. Examples of these programs are emergency-only medicaid, programs using federal health care block grants, programs providing health services necessary to protect life or safety (emergency medical, food or shelter, mental health crisis, domestic violence, crime victim assistance, disaster relief), hospital financial assistance programs or charity care, community health centers/FQHCs, and migrant health centers.


Special Marketplace Rules for Seniors

Seniors who are not eligible for premium-free Medicare Part A may be eligible for enrollment in Marketplace plans and PTC/CSR.

To qualify for premium-free Medicare Part A, individuals must have met the applicable work history requirement or quarters of coverage (QC):

  • QC are earned by paying Social Security and Medicare payroll taxes; people working full-time generally earn four QC in a year.
  • People can get quarters of coverage based on their own work history or in some cases the work history of their spouse.


PTC for Certain Lawfully Present People w/ Low Income

Lawfully present people are eligible for PTC if they are not eligible for Medicaid due to their immigration status even if their income is below 100% FPL.

This includes lawfully present people who are:

  • Not “qualified” immigrants
  • Qualified immigrants who are subject to and have not met the 5-year bar

Many lawfully present people with incomes in the Medicaid range or below 100% FPL are eligible for PTC and CSR.


Special Rules for Married Nonresidents

To qualify for PTC, an applicant that is married must file jointly with their spouse. Generally, you cannot file as married filing jointly if either spouse was a nonresident at any time during the tax year.

However, a nonresident married to a U.S. citizen or resident can choose to be treated as a U.S. resident and file a joint return. A citizen or resident married to a nonresident (who does not choose to be treated as a resident) may also file as head of household if they support a child or another closely-related relative. See IRS Publication 501. 


Resources

Health Reform: Beyond the Basics Webinar OE6: Immigrant Eligibility for Health Coverage Programs

Making Coverage Accessible: Working Effectively with Vulnerable and Underserved Populations – Part I Webinar

Making Coverage Accessible: Working Effectively with Vulnerable and Underserved Populations – Part II Webinar

Making Coverage Accessible: Providing Effective Communication and Language Assistance Service

Reference Guide: Documents Used to Verify Immigration Status

Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs

National Immigration Law Center: FAQs The Affordable Care Act & Mixed-Status Families

Henry J Kaiser Family Foundation Health Coverage of Immigrants Fact Sheet