Many Indian families living in the US face a major conflict regarding caring for their elders who are in India.
To be with them in India means that the families have to give up on life in the US to relocate to India; to sponsor their parents to the US on a green card opens them to the challenges of obtaining reliable, quality health insurance for the new immigrants.
Employees in the US are generally not permitted to add parents to their group health insurance plans at work. Parents who immigrate are unable to obtain individual health insurance policies especially if they are over 65. Medicare, a free US government health care program, covers all US citizens over the age of 65 and private insurance companies don't have the incentive to compete against Medicare. The insurance market for senior immigrants is so small and the risk pool so great that for decades insurance companies refused to even offer plans to this demographic.
Obamacare has changed all of these by a single stroke. By law now, permanent residents must have health insurance whose generous benefits (including not discriminating against patients because of pre-existing conditions) are mandated by the Affordable Care Act. The law provides for any lawful permanent resident to shop for and buy insurance on health exchanges operated either by a state or the federal government.
The main question is whether the parents should be added to the Obamacare plans of their sponsoring children or should go it alone. Most immigrant parents don't earn in the US and can be claimed by the children who sponsor them to be dependents on the ACA form if they already have coverage through the ACA. The IRS publishes strict rules about all the tests a "dependent" has to meet before he/she can be claimed as one. The dependent parent doesn't have to live all year with the sponsoring child either. For example, parents who still maintain a residence in India can spend 4 months a year in India and live for the remaining 8 months with their sponsoring children in the US. Check out the various qualifying conditions including several examples. The ACA uses the same rules as the IRS to define qualifying members of a household for the purposes of obtaining health insurance.
If the sponsoring family's income is low enough as defined by federal guidelines, parents can be easily added to the family's Obamacare household - and significant tax subsidies may be collected. For example, a family of three US citizens (two adults and a child) earning $79,000 a year and currently enrolled in an Obamacare Silver Plan in Dallas paying about $550 a month can add a new permanent resident parent from India to the same plan for an additional $175 a month once all subsidies kick in. All 4 members of the family will then have the same high-quality care.
If the sponsoring family's income is higher than the guidelines, or the family has insurance through work, the new immigrant parent can get an estimate for ACA coverage and obtain it through the exchange. Running numbers for two senior citizen parents who just got green cards (an 81-year old male and a 71-year old spouse) in the same market, we see that the Obamacare Silver Plan in Dallas is about $1,300 a month with a $5,600 annual deductible. Subsidies almost never apply because these come in the form of tax credits. It is safe to assume that the new immigrants will not earn enough money to pay income taxes in the first place. Also, these immigrants do not need to qualify for the strict IRS rules for dependents - as they will be buying ACA coverage "on their own".
The $1,300 per month cost is indeed pricey. But sponsoring families can rest knowing that their parents can benefit from world class US coverage without worrying that a huge hospital bill can wipe out their hard-earned savings. See the story of Mohan Iyer as profiled in a KQED news story.
Parents can potentially qualify for Medicaid as well - not in Texas, but in those states that opted for Medicaid expansion (like NY, CA, MA, OH and others). And doing so does not invite the "public charge" penalty - see this excellent post from the National Immigration Law Center.
Obamacare, despite all of its drawbacks, provides a relatively elegant way for senior parents to re-unite with their sponsoring families in the US by effectively removing the burden of health care as a topic of discussion.
To be with them in India means that the families have to give up on life in the US to relocate to India; to sponsor their parents to the US on a green card opens them to the challenges of obtaining reliable, quality health insurance for the new immigrants.
Employees in the US are generally not permitted to add parents to their group health insurance plans at work. Parents who immigrate are unable to obtain individual health insurance policies especially if they are over 65. Medicare, a free US government health care program, covers all US citizens over the age of 65 and private insurance companies don't have the incentive to compete against Medicare. The insurance market for senior immigrants is so small and the risk pool so great that for decades insurance companies refused to even offer plans to this demographic.
Obamacare has changed all of these by a single stroke. By law now, permanent residents must have health insurance whose generous benefits (including not discriminating against patients because of pre-existing conditions) are mandated by the Affordable Care Act. The law provides for any lawful permanent resident to shop for and buy insurance on health exchanges operated either by a state or the federal government.
The main question is whether the parents should be added to the Obamacare plans of their sponsoring children or should go it alone. Most immigrant parents don't earn in the US and can be claimed by the children who sponsor them to be dependents on the ACA form if they already have coverage through the ACA. The IRS publishes strict rules about all the tests a "dependent" has to meet before he/she can be claimed as one. The dependent parent doesn't have to live all year with the sponsoring child either. For example, parents who still maintain a residence in India can spend 4 months a year in India and live for the remaining 8 months with their sponsoring children in the US. Check out the various qualifying conditions including several examples. The ACA uses the same rules as the IRS to define qualifying members of a household for the purposes of obtaining health insurance.
If the sponsoring family's income is low enough as defined by federal guidelines, parents can be easily added to the family's Obamacare household - and significant tax subsidies may be collected. For example, a family of three US citizens (two adults and a child) earning $79,000 a year and currently enrolled in an Obamacare Silver Plan in Dallas paying about $550 a month can add a new permanent resident parent from India to the same plan for an additional $175 a month once all subsidies kick in. All 4 members of the family will then have the same high-quality care.
If the sponsoring family's income is higher than the guidelines, or the family has insurance through work, the new immigrant parent can get an estimate for ACA coverage and obtain it through the exchange. Running numbers for two senior citizen parents who just got green cards (an 81-year old male and a 71-year old spouse) in the same market, we see that the Obamacare Silver Plan in Dallas is about $1,300 a month with a $5,600 annual deductible. Subsidies almost never apply because these come in the form of tax credits. It is safe to assume that the new immigrants will not earn enough money to pay income taxes in the first place. Also, these immigrants do not need to qualify for the strict IRS rules for dependents - as they will be buying ACA coverage "on their own".
The $1,300 per month cost is indeed pricey. But sponsoring families can rest knowing that their parents can benefit from world class US coverage without worrying that a huge hospital bill can wipe out their hard-earned savings. See the story of Mohan Iyer as profiled in a KQED news story.
Parents can potentially qualify for Medicaid as well - not in Texas, but in those states that opted for Medicaid expansion (like NY, CA, MA, OH and others). And doing so does not invite the "public charge" penalty - see this excellent post from the National Immigration Law Center.
Obamacare, despite all of its drawbacks, provides a relatively elegant way for senior parents to re-unite with their sponsoring families in the US by effectively removing the burden of health care as a topic of discussion.
No comments:
Post a Comment
Thank you for your note. Please consider signing up for email or RSS updates on our home page www.relocationtoindia.com