Health Insurance for Undocumented Immigrants

Undocumented immigrants are the least likely class of immigrants to have health insurance. According to the Kaiser Foundation, 46% of undocumented immigrants had no health insurance in 2019, compared to 26% of immigrants who were lawfully present and 9% who had become citizens. 

Undocumented immigrants, sometimes called illegal aliens, are those who do not possess a qualified immigration status, valid visa, tax I.D. number or other immigration documentation because they entered the U.S. illegally, overstayed their temporary legal visitation or otherwise violated the terms under which they were admitted to the country.  

Undocumented immigrants are not eligible to enroll in health insurance through the federal marketplace, nor are they eligible for premium tax cuts or subsidies. However, some undocumented immigrants may be able to get health insurance coverage through other means.

There are varying categories of immigrants, some of whom are eligible for marketplace insurance, state or federal benefits and private insurance. This article will explore health insurance as it relates specifically to undocumented immigrants.

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Can Undocumented Immigrants Enroll in Marketplace Health Insurance?

Health insurance purchased through the federal exchange – Affordable Care Act (ACA) or “Obamacare” plans – require U.S. citizenship or a lawfully present status in order to enroll.

Undocumented immigrants are not eligible to sign up for coverage, nor are they eligible to receive any tax cuts or subsidies. The application form requires an alien number or I-94 number to prove immigration status for those without a valid Social Security number. 

DACA (Deferred Action for Childhood Arrivals) status does not qualify one for marketplace health insurance. And undocumented immigrants may not be covered as a dependent on a documented immigrant’s plan either. 

However, an undocumented immigrant may apply for health insurance on behalf of a documented immigrant. For example, if a parent is undocumented but their child is documented, the parent may apply for health insurance for their child. Immigration status revealed on a marketplace application is not shared with immigration authorities. 

Can Undocumented Immigrants Purchase Private Health Insurance? 

There is no law barring an undocumented immigrant from purchasing private health insurance, and U.S. citizenship or a lawfully present status is not a requirement of eligibility. The only catch is that the insurance must be purchased outside of the federal marketplace. 

The cost of purchasing health insurance directly from a provider with no tax cuts or subsidies is high, and often unaffordable for undocumented immigrants. 

Can Undocumented Immigrants Enroll in Employer-Sponsored Health Insurance?

Undocumented immigrants are in some cases able to enroll in an employer-sponsored health 

insurance plan, and some undocumented immigrants may receive coverage through this avenue. However, proof of U.S. citizenship, lawfully present status or a work visa is required as a term of legal employment, so most undocumented immigrants are ineligible for the types of jobs that provide health insurance. 

Most undocumented immigrants who are covered by an employer-sponsored plan are dependents, such as a spouse or parent of an employee and not an employee themselves.

Undocumented immigrants may obtain employer-sponsored coverage as a dependent, but not all plans and carriers allow it.

Can Undocumented Immigrants Enroll in Medicaid and Medicare?

Generally speaking, undocumented immigrants are barred from enrolling in Medicaid or Medicare.

Six states (CA, IL, MA, NY, OR, WA) and the District of Columbia grant Medicaid benefits to income-eligible children regardless of immigration status, and certain exceptions exist for refugees, victims of human trafficking and spouses or children of military veterans.

In California, undocumented immigrants up to age 25 can be eligible for Medicaid benefits. 

Undocumented immigrants are not eligible for Medicare in any state. Medicare requires enrollees to be U.S. citizens or permanent legal residents. Medicare eligibility for spouses does not extend to those who are undocumented. 

Can Undocumented Immigrants Receive Emergency Treatment?

The Emergency Medical Treatment & Labor Act (EMTALA) requires any Medicaid-participating hospital to treat patients for emergency care regardless of documentation status or whether or not the patient is able to pay for the care. 

Can Undocumented Immigrants Participate in a Student Health Plan?

Many colleges and universities provide a health insurance plan for students. If an undocumented immigrant is accepted into the school, they are often eligible to participate in the school’s health care plan as well. 

Where Do Undocumented Immigrants Receive Care?

Undocumented immigrants who lack health insurance often receive care from community and non-profit health clinics that are run by volunteers and offer free or low-cost health services regardless of immigration status. 

What Immigration Documents Are Needed to Enroll in Health Insurance?

To qualify for Marketplace health insurance as a non-citizen, you must be lawfully present. That means you must have qualified non-citizen status with no waiting period, humanitarian status or circumstances, a valid non-immigrant visa or legal status conferred by other laws. 

Other non-citizens who may qualify for Marketplace health insurance include those who are:

• Asylees
• Refugees
• Cuban or Haitian entrants
• Paroled into the U.S. for at least one year
• Conditional entrants granted before 1980
• Battered non-citizens or their spouses, children or parents
• Victims of human trafficking
• Granted withholding of deportation
• Members of a federally recognized Indian tribe or American Indian born in Canada

Additionally, Compact of Free Association (COFA) migrants are also eligible for Marketplace insurance. These migrants hail from the Federated States of Micronesia, The Republic of the Marshall Islands and the Republic of Palau, for which the U.S. provides certain benefits in exchange for exclusive military use and positioning in those territories.  

Some of the documents that an immigrant may need when applying for Marketplace insurance include:

1. Permanent Resident Card (“Green Card”, or I-551)
2. Re-entry Permit (I-327)
3. Refugee Travel Document (I-571)
4. Employment Authorization Document (I-765)
5. Machine Readable Immigrant Visa (temporary I-551)
6. Temporary I-551 Stamp 
7. Arrival/Departure Record (I-94/I-94A)
8. Arrival/Departure Record in foreign passport (I-94)
9. Foreign Passport
10. Certificate of Eligibility for Nonimmigrant Student Status (I-20)
11. Certificate of Eligibility for Exchange Visitor Status (DS-2019)
12. Notice of Action (I-797)
13. Document indicating membership in a federally recognized Indian tribe or American Indian born in Canada
14. Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
15. Document indicating withholding of removal
16. Office of Refugee Resettlement (ORR) eligibility letter if under the age of 18
17. Resident of American Samoa card
18. Alien number (alien registration number of USCIS number) or I-94 number

Medicaid eligibility rules vary by state, but immigrants who are lawfully present are typically eligible for coverage. 

Medicare limits eligibility for immigrants to those with lawfully present status. Legal immigrants who are 65 or older may purchase Medicare coverage after residing legally in the U.S. for five years continuously. Legal immigrants under 65 may qualify with a disability but are held to the same standards of qualification as U.S. citizens.