A Review of Healthcare Options for Older Immigrants

This past fall, approximately 17,000 Medicare enrollees nationally had their Medicare suspended because of their immigration status.  The people affected are technically still on Medicare, but Medicare will not cover their healthcare services while their benefits are suspended.  

To be enrolled in a Medicare Advantage or Medicare Prescription Drug Plan, an individual must reside within the Plan’s service area and be either a U.S. citizen or be lawfully present in the U.S. Last year, the federal government announced individuals would be involuntary disenrolled from Medicare Plans due to their unlawfully present status. When they previously qualified for Medicare coverage based on either their own or another’s work history, they were lawfully present.  However, if the Social Security Administration learns an individual has an undocumented status, they will not be eligible for Medicare coverage.  Many people in this situation only learned that their Medicare coverage was suspended when they tried to access care and learned that they no longer had coverage.  Again, people in this situation are disenrolled from their Medicare Advantage Plan or their Medicare Prescrition Drug (or Part D) Plan. They must reestablish their immigration status before their suspension can be ended. More information about this issue can be found here.

PHLP wanted to take this opportunity to remind readers about healthcare for older immigrants through Medicare, Medicaid, and Pennie (Pennsylvania’s Marketplace coverage).

Immigrant Eligibility for Medicare

To be eligible to enroll in Medicare, an individual must either be a U.S. Citizen or lawfully present in the United States.  Whether there is an additional waiting period for non-citizens to qualify for Medicare depends on whether they have enough work credits to qualify for premium-free Part A:

Non-citizens who qualify for premium-free Part A:

• No waiting period/length of residency requirement to qualify for Medicare
   

Non-citizens who don’t have enough work credits to qualify for premium-free Part A:

• Must be lawful permanent residents (LPR/green card holder), and
• Have five years of continuous residence in the United States immediately prior to Medicare enrollment.  The Social Security Administration determines whether someone has met the 5-year continuous residency requirement.
   

Justice In Aging’s thorough issue brief on this topic can be found here.  People with questions about Medicare eligibility for immigrants can call the PA MEDI program at 1-800-783-7067.

Immigrant Eligibility for Medicaid

Medicaid can also potentially be a resource for older adults seeking healthcare coverage, although the rules about when someone may qualify can be challenging to navigate.

• Adults seeking Medicaid coverage generally must be in a “qualified” status for five years before they are eligible for Medicaid coverage or for the Medicare Savings Programs.  Qualified status typically refers to having a legal permanent residence status (green card holder). Certain immigrants, such as refugees/asylees and other humanitarian immigrants, are considered to have qualified status and are not subject to the five-year waiting period. Women who are lawfully present and who are pregnant are also not subject to the five-year waiting period.
• Older adults (59+) with little to no income and very little resources may be eligible for state-funded Medicaid coverage with no waiting period, so long as they are lawfully present in the United States.
• Emergency Medical Assistance is available to immigrants who would otherwise qualify for Medicaid but for their immigration status if they have a serious medical condition and an urgent need for care. This includes people who have an undocumented status. People who get Emergency Medical Assistance get very limited Medicaid, only to address their emergency medical condition and only for a limited time.
   

People with questions about immigrant eligibility for Medicaid should reach out to PHLP’s Helpline by emailing staff@phlp.org or calling 1-800-274-3258.  PHLP’s “Healthcare for Immigrants: A Manual for Advocates in Pennsylvania” can be found here.

Pennie as an Alternative Healthcare Coverage Option

Immigrants who do not qualify for premium-free Part A and have to wait to enroll in Medicare as a result, and immigrants who are subject to the five-year bar for Medicaid, can seek coverage through Pennsylvania’s Health Insurance Marketplace (also known as Pennie) as an alternative.  Lawfully present immigrants can qualify for financial assistance to pay for health care plans available through Pennie depending on their income.

More information about Pennie can be found here. People who need help getting Pennie coverage or who have questions about financial assistance available can contact the Pennsylvania Health Access Network (PHAN) at 1-877-570-3642

Public Charge

The U.S. Department of Homeland Security recently issued a final public charge immigration rule that largely restores the public charge policy in place prior to the Trump administration.  The new regulation clarifies what is and is not considered in a public charge determination.  Receipt of Medicare, Marketplace subsidies, and Medicaid benefits (except for long-term care Medicaid coverage for a long-term skilled nursing facility stay) is NOT considered in a public charge determination.  This means that older immigrants should not be afraid to access Medicaid coverage, Home and Community-Based Services, the Medicare Savings Programs, Medicare, and Extra Help, and Marketplace subsidies. 

“Public charge” is a term used by U.S. immigration officials.  Some people who apply for a green card or a visa to enter the U.S. must pass a “public charge” test.  In those cases, immigration officials consider whether the person is likely to become primarily dependent on the government to meet their basic needs.  Many immigrants are not subject to this test.  Only two kinds of government benefits are considered as part of this test under the final rule – monthly cash support (through SSI or TANF) and long-term institutional healthcare in a facility paid for by the government.  Only use of these benefits by the applicant is considered – immigration officials cannot consider benefits used by other family members.  In addition to looking at receipt of these specific government benefits, immigration officials must also look at the person’s circumstances as a whole when making a public charge determination, including whether the immigrant has someone to support help them.  More information about public charge can be found here and here.