Many people sponsor their elderly relatives for green cards, allowing them to permanently live in the U.S. However, many of these persons are above the age of 65. A common issue that arises for such individuals is securing proper health insurance coverage. We have described several options to the best of our knowledge and experience. Of course, this is not a complete list of all the options available to you. However, this list should cover most of the options available.

New immigrants to USA are NOT eligible for benefits like Medicare.

Medicare has several parts: Part A, Part B, Part D, etc.
Part A covers major things like hospitalizations, surgeries, etc.
Part B covers other outpatient benefits like visits to the doctor's office, lab visits, X-ray procedures, etc. There are different levels of coverage within Part B (from A to J).
Part D covers prescription drugs and other such items.

Regular residents of the U.S. (citizens, permanent residents, etc.) can get Medicare Part A if they have worked in the U.S. for at least 40 quarters (10 years for most people) and are above the age of 65. This rule was made in 1996 during the Bill Clinton administration, as part of the Welfare Reform Act.
New immigrants are not extended Medicare Part A benefits. If immigrants are permanent residents for 5 years, continously resided in the U.S. for that duration, and are 65 years of age or above, they can BUY Medicare coverage from the U.S. Government.

Part B has to be purchased by everyone - even those who are U.S. citizens, born in U.S., or have worked in U.S. all their life. This is commonly referred to as Medicare Supplement Insurance. (Again, the eligibility to buy this depends on the same criteria as in Part A.)

In short, new immigrants can't get Medicare benefits. And even after being eligible to purchase Medicare along with other supplemental insurance, the monthly costs are around $600 to $1,000 per month per person.

New immigrants can't get other federal or state benefits like Medicaid, MediCal, etc. Before they immigrate to the U.S., you (the sponsor) will need to sign an affidavit of support, form I-864 certifies that you will be taking care of all their expenses, and the immigrants will not be a burden on the government. I-864 is a legally binding contract that can be enforced and must be taken seriously. In particular, pay close attention to Part 8 of form I-864.

Almost all such insurance products are available based on the maximum income criteria. You may argue that these new immigrants have no income in the U.S. However, for the purposes of calculating income for sponsorship and insurance, the sponsor's income is also included in the equation. By submitting your sponsorship, you have already certified that you are above the poverty level. If someone has somehow managed to get any benefit like Medicaid by not revealing all the facts, in the case of a large claim, the government can investigate and can actually send the bills (plus penalty and interest) to the sponsor for reimbursement. This voids the purpose of trying to utilize anything like Medicaid and may also adversely affect your ability to sponsor others in the future. In addition to that, the new immigrant (beneficiary) may potentially face deportation.

Even in the circumstances where the sponsor's income drops below the required level that would otherwise make people eligible for Medicaid, new immigrants can not apply for Medicaid until they have resided in the U.S. for at least 5 years. (This law was passed during the Bush Administration in 2007).

Many people have recently inquired about it whether their newly immigrated elderly relatives would be able to get free healthcare, Medicare or Medicaid etc. under the Obama's Healthcare Reform that is currently being worked on in 2009. Unless specifically addressed and explicitly changed, anything described here regarding the eligibility for Medicare, Medicaid etc. is NOT going to change. And so far, nothing has been mentioned or scheduled for changing any of the eligibiilty requirements for family sponsored immigrants or the responsibility of their sponsors. Therefore, it would be improper to have any hopes regarding this matter.

As most people in U.S. who have been here for long time will get Medicare benefits at the age of 65, regular domestic health insurance companies like Aetna, Cigna, Blue Cross, Assurant Health, Humana, and Unicare (and thousands of others) don't sell health insurance to anyone older than 65.

For example:
Texas: Any of the Texas health insurance companies like Unicare, Aetna, Blue Cross Blue Shield of Texas, Humana, Assurant, etc., don't sell health insurance to anyone older than 65.
Virginia: In some parts of Virginia, Anthem provides health insurance to those who are 65 and older if they are not eligible for Medicare. But the monthly premium for a couple of that age is around $1,500 to $2,000.
Massachusetts: Blue Cross provides HMO plans to anyone above the age of 65. But again, the monthly cost for a couple of that age is around $1,500 to $2,000.

For those below the age of 65, depending upon your state and upon how long you have been living in the U.S., you might be eligible for some For those below 65, depending upon your state, and depending upon how long you have been living in U.S., you might be eligible for some domestic health insurance plans. Again the monthly premiums for elderly people are very high and beyond what most people are willing to pay out of their pockets.

If you are working for an employer and get a group health insurance plan through them, you CANNOT add your parents as dependents on that insurance coverage. In the U.S., dependents are defined as your spouse and minor children, NOT your parents.

If you have your own small company, it may be possible to enroll your parents as employees and get health insurance for them. If your parents work full time in your company, you can pay them minimum wages to satisfy the health insurance criteria. Again, their monthly premiums would be around $1,500 to $2,000.

And God forbid, if your parents were to incur any major health issues and the claim amount was large, premiums for your entire group would substantially increase at the time of the next renewal. The insurance company may even drop your entire group from coverage. Remember, insurance companies are paying claims from the money they get as premiums. If your group is not profitable for them, they may drop the entire group. Group insurance for a company with 4-5 employees (or even 15-20 employees) doesn't work the same as group insurance for a company with 10,000 employees.

Domestic group health insurance

If your parents get employed by large companies such as CVS Pharmacy, Wal-Mart, Safeway, etc., they are likely to get reasonable health insurance coverage through their employers. However, before sponsoring your parents and putting them into such hard work and long hour jobs just to get health insurance, think carefully whether doing this is worth it at all.

Some elderly new immigrants come to the U.S. on green card but stay in the U.S. for a minimal period, just trying to maintain their green card status. Therefore, they are spending most of their time in their native home country. Even though as per USCIS definition, green card holders are permanent residents of USA, in such cases, their home country is really not the U.S. Such individuals are able to purchase many products that are popularly referred to as 'visitors insurance'. Actually, visitors insurance is a popular term that is used interchangeably. However, all visitors insurance gives the same temporary insurance for anyone who comes to the U.S. on any visa, or even new immigrants who are not U.S. citizens. In short, visitors insurance applies to anyone who can't get insurance from regular domestic health insurance companies in the U.S.

However, some elderly new immigrants stay in the U.S. all the time, making the U.S. their home country and only occasionally visiting their native country. Many of the visitors insurance products are not applicable to such individuals as they only provide coverage outside of their home country, which in this case would be outside of U.S. We have confirmed with the insurance companies that such people can't buy products like Inbound USA, Liaison International, Liaison Continent, Liaison Worldwide, Atlas America, Diplomat America, Diplomat LT WorldMed etc. But they may be able to purchase products like Patriot America, Patriot Platinum America, Protection America, Patriot GoTravel America , etc., because eligibility criteria is little different (If you are 65 years of age or older, you must not be without international insurance for 30 days in the U.S. If you are younger than 65 years, and if your home country is US, and if you have been staying in the U.S. for 6 months or more, you must have prior international insurance that didn't expire more than 60 days ago).

Of course, any such gap filling insurance would NOT cover any pre-existing conditions, general physical check-ups, etc. However, something is better than nothing when calamity strikes. You are essentially buying the insurance because there is no better option.

Keeping in mind this gap for new immigrants that want health insurance, several companies have created health insurance products specific to such people. For example, Inbound Immigrant and the Bridge Plan are two plans that cater to such individuals. You can continue to have such insurance products as long as you are not eligible for Medicare.

Of course, any such gap filling insurance would NOT cover any pre-existing conditions, general physical check-ups, etc. However, something is better than nothing when calamity strikes. You are essentially buying the insurance because there is no better option.

It is certainly better to purchase health insurance from U.S.-based companies. More details.

With India-based insurance plans, you generally don't get any health insurance card, PPO network, or renewal or refund. You have to first pay and file for reimbursement after going back to India, and reimbursement occurs in Indian Rupees. Furthermore, you have to call the assistance company in New Delhi every time you visit a doctor in the U.S. And most products from India are based on a fixed coverage plan for people above the age of 55; these plans are not comprehensive. More details about Fixed Vs. Comprehensive coverage plans. Some products may have severe restrictions, such as if you buy the $100,000 policy maximum, they will only cover $13,500 per illness. That is really a $13,500 policy and not $100,000 policy. Make sure to read the complete policy wording (not just the brochure) before making any purchase.

And apart from all the other factors, new immigrants may not even be eligible to purchase such products that are meant for tourists. Verify your specific situation with each company before purchasing any products through them.

Again, it is certainly better to buy insurance from U.S.-based companies. More details.

Moreover, such products may only insure you temporarily for 3 months or 6 months. (Indian Government and IRDA laws don't allow Indian insurance companies to insure Indians for a long time if they are not living in India.) After that, you are back to the same problem of getting insurance from a U.S.-based company. And of course, all the items described above for visitors insurance may still apply to these products.