Health Insurance for Green Card Applicants

Over the past year, the Trump administration has introduced new rules and financial requirements that make it more difficult for many to immigrate to the United States. These tighter restrictions generally affect all family-based applicants. Many of the new requirements revolve around the premise that immigrants not be dependent on the U.S. government for financial resources. Because medical expenses can be very costly, health insurance for green card applicants can make or break an application’s success.

Both the U.S. Department of State and Department of Homeland Security (through U.S. Citizenship and Immigration Services) have their own versions of a public charge rule. Although technically different, the rules are very similar in many ways. Public charge is one of the grounds of inadmissibility. In other words, it is a way to deny an applicant a green card. Based on these rules, immigration officers may deny green card applications for people who are likely to become a public charge at any time in the future. An applicant must be able to demonstrate that they have the financial resources or adequate insurance to cover reasonably expected medical expenses in the future.

Health insurance for green card applicants will generally be viewed as a favorable factor with respect to public charge rules. Not being covered with an insurance policy can be a negative factor in the totality of the circumstances. In some cases, health insurance may be essential to demonstrate you are not likely to become a public charge.
Applying for a Green Card Outside the U.S. (Consular Process)
The U.S. Department of State (DOS) is responsible for the consular processing path to a green card. They have established guidelines for consular officers to deny green cards to applicants that do not certain criteria.
Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System
President Trump issued an executive order in October 2019 that would essentially force consular officers to deny immigrant visas (green card) to foreign nationals who they determined will “financially burden the United States healthcare system.” Before issuing an immigrant visa, consular officers would require proof of one of the following:
  • The intending immigrant would buy health insurance within 30 days of entering the United States: or
  • The intending immigrant has sufficient financial resources to pay for any reasonably anticipated medical expenses.

For now, that presidential proclamation is halted by a federal court. In other words, a federal judge has prevented the government from implementing the new rule. However, the government could be allowed to implement the executive order in the future.
DOS Form DS-5540 Public Charge Questionnaire

That is not to say that medical issues and health insurance are not a factor for immigrant visa applicants. Consular officers may still evaluate an intending immigrant’s overall financial stability. If a consular officer determines that the applicant is likely to depend on the U.S. government for public benefits at any point in the future, the officer may deny at application. The ability for one to pay reasonably anticipated medical expenses is a factor. Thus, health insurance for green card applicants is extremely beneficial.

The U.S. Department of State expanded its definition of public charge in 2018 to include more situations that could lead to a denial. Consular officials may ask immigrant visa applicants to submit Form DS-5540. Known as the Public Charge Questionnaire, DS-5540 requests information about your health, financial status, and other factors so that consular officers may determine the likelihood that you may become a public charge. Applicants are encouraged to prepare the DS-5540 prior to the interview. Have the form and any supporting evidence ready to go if needed at the consular interview.

Your health is now a heavily weighted factor for the purposes of making a public charge determination. If you have serious medical conditions, particularly problems that are costly to treat, you could be expected to show proof that you have health insurance or the ability to pay for your medical expenses while you’re in the United States. Consequently, this is more likely to be a factor for older applicants (such as parents of U.S. citizens) than younger applicants.

Applying for a Green Card Inside the U.S. (Adjustment of Status)
U.S. Citizenship and Immigration Services (USCIS) is responsible for the adjustment of status path to a green card. They have established their own guidelines for USCIS officers to deny green cards to applicants that do not certain criteria.
USCIS Public Charge Rule
Most foreign nationals who adjust status to permanent resident status (green card holder) are also subject to a public charge rule. Adjustment of status applications go through USCIS (different than consular processing). While the USCIS public charge rule is different than the State Department’s version, they are very similar.
Having private health insurance is a heavily weighted positive factor in favor of a finding that you are not likely to become a public charge if:
  • The private health insurance is appropriate for the expected period of admission; and
  • You are not receiving subsidies in the form of premium tax credits under the Affordable Care Act (ACA), as amended, for this private health insurance.

On the other hand, the lack of private health insurance may be viewed as a negative factor, particularly if you have a significant medical condition that limits your ability to be self-sufficient. The combination of no private health insurance and a significant medical condition will be weighted as a very negative factor.
USCIS Form I-944 Declaration of Self-Sufficiency
Health InsuranceAs part of an adjustment of status application package, generally all family-based applicants must submit Form I-944, Declaration of Self-Sufficiency. The I-944 affidavit is the USCIS version of a public charge questionnaire. Applicants must disclose a variety of details regarding their household’s financial resources, including health insurance coverage.

A USCIS officer will review whether you have sufficient household income, assets, and resources to cover foreseeable medical costs Medical expenses include everyday considerations but may also include:
  • A medical condition that is likely to require extensive medical treatment.
  • A physical or mental condition that is likely to require institutionalization; or
  • Any medical condition that will interfere with your ability to provide and care for yourself, to attend school, or to work.

If you have assets and resources to pay for such medical costs, it is a positive factor in the totality of the circumstances. In other words, if you can show an ability to pay for such expenses based on insurance, you’ve greatly improved your chance of approval.
If applicants do not have health insurance coverage, they may provide evidence of assets that may be used to pay for reasonably anticipated medical costs. The rules and calculations for necessary assets get extremely complex.
Making Health Insurance a Positive Factor

At this point, health insurance is not an absolute requirement when submitting DOS Form DS-5540 or USCIS Form I-944. However, health insurance for green card applicants is always a positive factor. For applicants with higher anticipated medical expenses, it may be more important than ever. In other words, if you have known medical issues that will incur expenses, health insurance for green card applicants is very important.

There are options for obtaining short-term health insurance during this time. If it isn’t possible to get coverage from an employer or family member’s employer immediately, get a quote for plans from another insurance provider.
Even for individuals with a good household income, surprise medical expenses can be extremely costly. Health insurance demonstrates that you’ll be able to handle these costs if necessary.
Once you have health insurance, you will generally need to provide the following information:
  • For each health coverage policy, a copy of each policy page showing:
    • The terms and type of coverage and persons covered; and
    • Annual amount of deductible or annual premium of the health insurance including documentation of the amount of deductible or premium; and

  • Letter on the company letterhead or other evidence from the health insurance company stating the alien is currently enrolled in health insurance and providing the terms and type of coverage; or

  • The most recent Form 1095-B, Health Coverage; Form 1095-C, Employer-Provided Health Insurance Offer and Coverage (if available) with evidence of renewal of coverage for the current year.

A health insurance card is insufficient proof without evidence of the effective and expiration dates.
While having health insurance would generally be a positive factor for green card applicants, recent receipt of Medicaid benefits for applicants (age 21 or over) is likely a heavily weighted negative factor. If your family is using Medicaid, we recommend you speak to an immigration attorney before applying for a green card.

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