Immigrants who have been living legally in the United States for less than five years may find themselves without the security of health coverage. Sometimes an employer-sponsored health plan isn't available, and, in most cases, legal immigrants aren't eligible for Medicaid until they've been in the United States for five years.
In addition, legal immigrants over 65 struggle to find health coverage because they aren't eligible for Medicare for those first five years. If this sounds like you, the good news is that you can buy Individual health care coverage. Individual health plans offer coverage for you and your family.
Financial help–called a subsidy–is available to those who qualify. Subsidies are paid for by the United States Government and go toward your health plan coverage. Legal immigrants often qualify for large subsidies; all you need to do is enter some information about your income and household size to see if you qualify. This makes health coverage more accessible and provides further peace of mind.
See our plans & prices to find out if you qualify for a financial subsidy.
Risks of going without coverage
Paying out-of-pocket for every health care need is a financial risk and burden for individuals and families, especially if there are ongoing health issues. Since, in most cases, legal immigrants do not qualify for Medicaid or Medicare until they live in the United States for five years, Individual health care coverage is the best option during this time.
Five years may not seem like a long time to go without health coverage, but out-of-pocket spending could be a huge financial setback, depleting your savings or leading to debt. Medical emergencies without the security of health coverage could be emotionally and financially devastating.
What plans are available
There are different individual plan types and options available so you can find one to fit your family's needs. Priority Health offers two types of Individual and family plans: Health Maintenance Organizations (HMO) and Health Savings Accounts (HSA), which can be partnered with your HMO. Both plans will have:
- Premium: Health insurance premiums are the costs you pay, usually monthly, to keep your policy and coverage.
- Deductible: The amount you pay each year before your health plan starts to pay for certain services.
- Coinsurance: After you've met your deductible, coinsurance is the percentage of the cost for medical services you have to pay.
- Copay: The amount you pay at the time you receive a health care service or prescription.
- Out-of-pocket limit: Your annual maximum cost. The most you'll pay for health care services including copays, deductibles, and prescription drugs in one year. This does not include your monthly premium.
- Requires members to use providers within a specific network
- Less flexible but usually the most affordable
- Plans have a deductible and an out-of-pocket maximum
- You pay copays at the time of service; these costs are typically before you pay your deductible
- You pay 100% of the cost of your health care until you meet your deductible
- Since HSA deductibles are higher, this choice is better if you and your family are generally healthy and don't expect many health care needs
- Our banking partner helps you save for those moments when you do need medical care and have to pay out-of-pocket costs
- The out-of-pocket maximum adds a layer of financial protection for your family
Health plan perks and benefits
With a MyPriority health plan, there are many benefits available to you and your family with zero out-of-pocket cost, such as preventive health care services, an annual checkup, health screenings, and even your flu shot. Other benefits created with you and your family in mind are:
- Chronic condition management, which gives you access to medications, supplies and services to help you manage your condition at a low cost.
- Diabetes management to help you receive services, supplies, and treatments for no cost. Diabetes prescriptions and testing procedures are covered before deductible for a low reliable cost.
- On-demand mental health support through myStrength, a mental health and wellness online tool that helps you live your best life.
- Hearing exams and hearing aid discounts for you and your extended family.
- Right Price program to help you find the lowest price for prescription drugs.
- Free health savings account (HSA) if you are enrolled in a MyPriority HSA plan.
- Cost Estimator tools that help you know your costs and control out-of-pocket spending.
Health coverage and care go beyond looking out for you in an emergency; it helps prevent sickness and offer many tools to help you manage all your health care needs.
When to enroll in an individual health plan
You can enroll in an Individual and family health plan during the Open Enrollment Period (OEP) which runs from November 1 to January 15 every year. During this time, you can shop and enroll in a plan that is right for you and your family.
You may still qualify for a Special Enrollment Period (SEP) during the year if you have a qualifying life event. Examples of these qualifying life events include:
- Loss of job
- Change in citizenship
- Recent move
- Marriage and divorce
- Previous policyholder dies
In any of these cases, you will need to supply proof of your life event, like a marriage license or birth certificate. There are a limited number of days following these qualifying life events when you are eligible to enroll so make sure you start shopping as soon as you have a qualifying life event.
How to enroll
You can enroll in an Individual and family health plan through Priority Health, through the Marketplace or through an agent. You can enroll now through Priority Health and find out if you qualify for a subsidy, which helps with the cost of health coverage. Learn more about how to save on health coverage.
Don't wait to enroll in a Priority Health Individual and family health plan that will help bring peace of mind to you and your family.
Ready to shop?
We make choosing a plan easy.
- MyPriority Learning Center
- Five step guide to shopping
- MyPriority plan benefits
- Save on health coverage
- Find your perfect plan
- Five must haves in a plan
- Losing Medicaid eligibility
- Losing job-based coverage
- Virtual first plans
- Narrow Network plans
- Thinking about retiring early
- Coverage for immigrants