Health Insurance

Healthcare in the U.S. is very expensive, therefore health insurance is critical. Upon arrival in the U.S., you should obtain health insurance as soon as possible. This page describes health insurance options available to Ukrainians.

Free Health Insurance for Low-Income Residents

Eligibility for Medicaid and RMA

Ukrainians admitted in the United States on humanitarian parole, including the Uniting for Ukraine program, who do not have any income or have very low income, are eligible for government-funded free health insurance.

Most low-income Ukrainian parolees will be eligible for health insurance for low-income residents called Medicaid. Some states (AL, FL, GA, KS, MS, NC, SC, TN, TX, WI, and WY) limit Medicaid eligibility to certain groups of people, such as children, pregnant, elderly or disabled people. If you live in one of these states and are not eligible for Medicaid, but have no or low income, you can get Refugee Medical Assistance (RMA) insurance available to refugees or humanitarian parolees ineligible for Medicaid. It provides the same or similar coverage as Medicaid but is given only for the first 12 month after arrival.

The upper income threshold for Medicaid/RMA varies by state. In most states, it is 138% of federal poverty level for adults, and higher for children.

Medicaid Coverage

Medicaid insurance covers all necessary medical services, including routine doctor visits, urgent care visits, emergency room visits, treatment of chronic conditions, diagnostic procedures, surgeries and hospitalization, labor and delivery and prescription medication. All these services are covered at no cost to you. Coverage of dental and vision services varies by state.

When applying for Medicaid, you can request retroactive coverage of medical services for three preceding months.

Medicaid Health Plans

Medicaid insurance services are administered by private insurance companies, often the same ones that sell private insurance plans. That’s why after your Medicaid application is approved, you will need to enroll in a specific health plan. If your county has multiple Medicaid health plans, you will be allowed to choose one, and if there is only one available plan, you will be enrolled in it automatically. Once you are enrolled in a plan, you will receive a plan card with your member ID, and will be able to use the plan website to find a doctor/clinic, order necessary medical services, etc.

PCP Requirement

Medicaid health plans often require you to have an assigned primary care physician (PCP) – your family doctor or pediatrician for children, who is your first go-to person with any new medical problem. In order to see a specialist or get a medical procedure done, you need a referral from your PCP. If your plan requires PCP referrals, make sure you choose a PCP you like who is geographically close and has reasonable availability.

Emergency Medicaid

Every low-income United States resident is eligible for Emergency Medicaid – health insurance for emergencies, such as if you suddenly experience a critical health issue, are hospitalized or need to undergo an unplanned surgery. Emergency Medicaid also covers labor and delivery.

There is no immigration status limitation for Emergency Medicaid, even illegal immigrants are eligible. The only requirements are to be a resident of the U.S. (i.e. to live in the U.S. as opposed to being a tourist), and to have low income consistent with general Medicaid eligibility requirements. If you satisfy these conditions and have to visit an emergency room or are hospitalized while not having health insurance, ask the hospital to fill out an application for Emergency Medicaid to have your emergency treatment covered.

Private Health Plans

If your income does not make you eligible for Medicaid, you can purchase a private health insurance plan. People with humanitarian parole, TPS or pending asylum with EAD granted, are eligible to purchase a private health plan on the health insurance marketplace.

Cost of Private Health Plans

The cost of private health insurance can vary from zero to a few thousand dollars per month, depending on your family size, income and the chosen plan. Most states offer health insurance subsidies to families whose income is low (but higher than the threshold for Medicaid). If you are low-income, you can typically purchase a subsidized health plan for under $100 per month.

Vision and dental plans are purchased separately, but they are rather inexpensive – $0-60 per month.

Open Enrollment and Special Enrollment Periods

You may buy a new health plan or change a plan only during the so-called open enrollment period – from November 1 to January 15. Choose a plan carefully because you will be stuck with that choice for the rest of the year.

There are exceptions to this rule when circumstances of your life change: for example, when you obtain immigration status, start a new job, lose a job, lose Medicaid coverage, have a change of income, move to a new state, or have a baby. Such an event triggers a special enrollment period for you: you may change a plan or buy a new plan within 60 days before or after the qualifying event.

How to Buy a Health Plan

Start shopping for a plan on the U.S. health insurance marketplace Healthcare.gov. Some states run their own local health insurance marketplaces available via dedicated websites. In this case, when you select your state on Healthcare.gov, you will be redirected to your state’s health insurance marketplace.

Below is the basic terminology you need to be familiar with when choosing a health plan.

Providers and Members

Provider is your doctor, clinic or hospital – they provide medical services to you. Rx provider is a pharmacy. Rx means “prescription.” Insurance companies often call pharmacies “Rx providers” because they provide prescription medication to you.

Member is you – a member of the health insurance plan.

In-network vs. Out-of-network

Every insurer contracts with certain healthcare providers (doctors and clinics) for favorable rates. These providers are called in-network providers, and a visit to them will typically cost you cheaper than a visit to an out-of-network provider with whom the insurer has no contract. You can find a list of in-network providers in your area on the health insurance company’s website. Choose an in-network provider whenever possible. If you are seeing a particular doctor, before switching to a new health plan, check that you doctor is in-network for that plan.

HMO vs. PPO vs. EPO

Private health plans can be of HMO, PPO or EPO type.

HMO plans require you to have an assigned primary care physician (PCP) who is your go-to doctor with every new problem. You cannot go straight to a specialist or have a procedure done – for the insurance to cover it, you must first visit your PCP and get a referral. With an HMO plan, you also must visit doctors that are in-network for the plan. Out-of-network visits will not be covered.

PPO plans give you more flexibility. You do not need to have a PCP and may make an appointment with a specialist right away. PPO plans also typically cover some portion of the cost when you visit an out-of-network provider – although visiting in-network providers is cheaper for you. More doctors typically accept PPO plans than HMO plans.

EPO plans are a middle ground between HMO and PPO. Like HMO plans, they cover only doctors in the plan’s network, but like PPO plans they do not require a PCP or referrals to specialists.

Premium, Deductible, Co-Pay and Out-of-Pocket Maximum

Insurance Premium is the amount you pay for your health insurance monthly. As discussed above, depending on your income, family size and plan, it can be from zero to a couple thousand dollars. When you get health insurance from your employer, the employer typically covers a portion of your monthly premium.

Deductible is the amount you pay out of pocket for medical services before the insurance kicks in. There are plans with zero deductible, and there are plans with up to $7,000 deductible. High-deductible plans typically have lower premiums.

Co-Pay is the amount or percentage of cost you pay for each medical procedure covered by the insurance. For example, a 10% co-pay means that once you have reached your deductible, you will pay only 10% of the cost of each treatment, and the insurance will cover the remaining 90%.

The insurance provider will periodically send you Explanation of Benefits – a report which will state what medical services you used, how much the doctor or facility charged for the visit, how much the insurance covered, and how much you paid.

Out-of-Pocket Maximum (OOM) is the maximum amount per year you will pay out of pocket. For example, if your OOM is $4,500, that means, once you have paid that amount in deductible and co-pays, the insurance will cover 100% of your further treatments until the end of the year.

Let’s compare two sample plans:

The Kaiser plan is HMO, so you will have to select a PCP and will pay $35 for a PCP visit and $65 for a specialist visit. You can only go to the Kaiser network. If you reach $5,550 in total out-of-pocket expenses, medical services for the rest of the year will be free for you.

The Anthem plan is PPO, so you do not have to choose a PCP. You can visit a specialist right away and can go to doctors in or out of network. You will pay the first $1,700 in medical services out of pocket. After that, you will pay 15% of the cost of services when you visit in-network doctors and 50% of the cost of out-of-network doctors. Once you reach $3,700 in out-of-pocket expenses, medical services for the rest of the year will be free for you.