Important Facts about Medicare and ACA Insurance for Non-Citizens

Introduction

Navigating health insurance can be challenging, especially for individuals who do not possess US citizenship. However, understanding the nuances of Medicare and ACA (Affordable Care Act) insurance can help ensure you have adequate coverage and avoid costly surprises. This blog will delve into a specific case involving ACA insurance denial and provide valuable insights for non-citizens seeking health coverage.

Understanding Medicare Eligibility

Medicare is a federal health insurance program primarily designed for individuals aged 65 and over, younger people with disabilities, and individuals with End-Stage Renal Disease (ESRD). Generally, US citizenship is not a requirement for Medicare eligibility. However, for non-citizens, eligibility depends on specific factors such as the type of visa held and the duration of residency in the US.

ACA Insurance and Non-Citizens

The Affordable Care Act (ACA) established health insurance marketplaces where individuals and families can purchase health insurance plans. Non-citizens with legal residence in the US may be eligible for ACA insurance if they meet certain income requirements and other eligibility criteria.

Case Study: Denied Coverage Due to Medicare Assumption

In the case described in the post, a 66-year-old non-citizen was denied coverage for an MRI scan by BlueCross Blue Shield (BCBS). BCBS assumed that the individual was eligible for Medicare due to his age. However, since the person was not a US citizen, they were ineligible for Medicare.

Resolving the Denial

Resolving such denials requires providing concrete proof of ineligibility for Medicare. This may include:

Attestation Form: Some health insurance marketplaces have attestation forms that non-citizens can complete to declare their ineligibility for Medicare.
Proof of Residency: Providing documentation of non-US citizenship, such as a Green Card or visa, can support the proof of ineligibility.
Contacting the Marketplace: Individuals who purchased their ACA insurance through a health insurance marketplace may need to contact the marketplace to resolve the issue.

Additional Considerations

Stand-Alone Health Insurance: If an individual does not qualify for Medicare or ACA insurance, they may consider purchasing a stand-alone health insurance policy. However, these policies can be more expensive than ACA plans.
Seek Professional Assistance: Navigating the complexities of health insurance can be overwhelming. Consider seeking guidance from licensed insurance agents or healthcare professionals for personalized advice.

Conclusion

Understanding the complexities of Medicare and ACA insurance for non-citizens is crucial for obtaining adequate health coverage. By addressing concerns promptly and providing the necessary documentation, individuals can resolve insurance denials and ensure they have the protection they need. Remember to stay informed, advocate for your rights, and seek professional assistance when necessary.