Health Insurance and Medicare Eligibility for Immigrants

Our recent conversation about a 66-year-old Green Card holder denied health insurance coverage due to presumed Medicare eligibility highlights the complexities of health insurance for immigrants. This article will dive into the specific issue of Medicare eligibility for Green Card holders and explore available options for obtaining health insurance coverage.

Medicare Eligibility for Non-Citizens

Medicare is a government health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). Non-citizens, including Green Card holders, may be eligible for Medicare under specific circumstances:

A permanent legal resident who has worked in the United States continuously for at least 40 quarters (10 years) and paid Medicare taxes is eligible for premium-free Medicare.
A permanent legal resident who has been a resident for at least five years, is at least 65 years old, and has not worked long enough to qualify for premium-free benefits can enroll in Medicare by paying monthly premiums.

In the case described in the post, the father does not qualify for Medicare because he has not worked in the United States for the required period.

Health Insurance Options for Non-Citizens Not Eligible for Medicare

Immigrants who do not qualify for Medicare have several options for obtaining health insurance coverage:

1. Employer-Sponsored Health Insurance: If the individual is employed by a company that offers health insurance, they may be eligible for coverage through their employer.

2. Affordable Care Act (ACA) Health Insurance: Individuals and families can purchase health insurance through the ACA marketplaces. Plans are available at varying levels of coverage and cost, and subsidies may be available to make coverage more affordable.

3. Medicaid: Medicaid is a joint federal and state health insurance program for low-income individuals and families. Eligibility criteria vary by state, but some states may offer coverage to non-citizens who meet certain requirements.

Resolving Coverage Issues

If an individual is denied health insurance coverage due to an incorrect assumption of Medicare eligibility, they should take the following steps:

1. Contact the Insurance Company: Call the insurance provider and provide proof that the individual does not have Medicare coverage, such as a letter from Social Security or Medicare.

2. File an Appeal: If the insurance company refuses to adjust the claim, the individual can file an appeal. The process varies by insurance company, but typically involves submitting a written appeal with supporting documentation.

3. Contact State Insurance Regulator: If the appeal is denied, the individual can contact the state insurance regulator for assistance in resolving the issue.

Understanding Medicare eligibility and health insurance options for non-citizens is crucial for ensuring access to affordable healthcare. By providing information and guidance, we empower individuals to navigate the complex healthcare system and make informed decisions about their coverage.