Guide to
Health Insurance
and Health Care
Services
for Immigrants in New York City
Photo is of a model used for illustrative purposes only.
WELCOME
New York City is home to vibrant immigrant communities from all corners of the world. All of us–whether long-time
residents or new to the City–need access to health care to keep our communities healthy and strong. There are
many ways for residents to get affordable health care in our city, regardless of immigration status.
This GUIDE TO HEALTH INSURANCE AND HEALTH CARE SERVICES FOR IMMIGRANTS IN NEW YORK CITY is
designed to help you nd health insurance options and health care resources for immigrants in New York City. It
tells you how to get health insurance and other health care services. Even if you don’t have health insurance and
need care, you can still get it in NYC. There are a number of coverage and care options available depending on your
immigration status.
All New Yorkers are eligible for and are entitled to health care services regardless of their immigration status.
KEY HEALTH INSURANCE TERMS
Obtaining health coverage for many immigrant New Yorkers can be confusing.
Before learning about the various coverage options described in this guide, there are a few key terms that you
should know to help you choose the option that best ts your and your family’s health care needs.
Health Care – the prevention or treatment of illness by doctors and other medical professions.
Health Insurance – a way to pay for health care. It protects you from paying the full costs of medical services
when you see a doctor.
Public Health Insurance – health insurance plans provided through federal programs such as Medicaid and
Medicare as well as state health insurance programs such as Child Health Plus and the Essential Plan for those
persons who meet program eligibility requirements.
Private Health Insurance – health insurance plans provided through an employer or union as well as purchased by
an individual directly from an insurance company.
NY State of Health Marketplace – The state’s ofcial health insurance marketplace, visit nystateofhealth.ny.gov. You
can compare private health insurance options and apply for nancial help that could lower the cost of your health
coverage. You may also qualify for health insurance coverage such as Medicaid, Child Health or the Essential Plan.
In-Person Assistors (Navigators, Certied Application Counselors, Certied Marketplace Facilitated Enrollers) –
individuals who work with community organizations to provide free help for individuals and small businesses to
assist them in choosing and signing up for health insurance coverage through the New York State of Health Market-
place.
i
HEALTH INSURANCE AND YOUR IMMIGRATION STATUS
Remember, by law all New York City residents have the right to:
Equal treatment in health care services no matter where you are from or what language you speak.
Hospital treatment if you have a medical emergency, regardless of ability to pay.
Free language assistance, if you need it. All health and social service providers must arrange for interpretation in
your preferred language.
Condential access to city services and public and private health insurance. Your immigration status will be kept
private. When you apply for health insurance, information about your immigration status will be used only to
determine eligibility for benets and not for immigration enforcement. Your immigration status is not reported to
the US Immigration and Customs Enforcement (ICE) or US Citizenship and Immigration Services (USCIS).
ii
TABLE OF CONTENTS
Comprehensive Health Insurance Coverage 1 - 2
Covers a range of health services, like doctor visits, hospital care, and prescription drugs
Limited Health Insurance Coverage 3
Covers limited health services, like family planning or emergency care
Free or Lower Cost Health Care Services 4
Ways to get affordable health services, even if you don’t have insurance
Pharmacy Assistance and Other Care Services 5
Programs that provide nancial assistance and discounts when you go to the pharmacy
Where to Apply for Health Insurance and Get Low-Cost Health Care 6
Where to apply for health insurance
Immigration Terms for Health Insurance 7 - 8
Select Immigration categories relating to health insurance eligibility
We hope this guide helps you get the coverage and care you need when you need it.
iii
COMPREHENSIVE HEALTH INSURANCE COVERAGE
1
*Refer to pages 7 - 8 for
“Immigration Terms for Health Insurance”
.
PROGRAM BENEFITS REQUIREMENTS ELIGIBLE IMMIGRANTS* WHERE TO GET IT
MEDICAID Free health insurance
for low-income adults
& children; can also
pay medical bills for
care received up to 3
months before
application
• NYS resident
• Lower-Income
• Qualied immigrants (No
5 year Ban)
• PRUCOL, including
DACA
• All pregnant women,
including undocumented
women
• Certain temporary residents
(e.g. student with valid visa)
For most:
NY State of Health
Online:
nystateofhealth.ny.gov
Phone: 1-855-355-5777
In-Person:
Call 311 to get help from
someone in your
community (ask for
“navigator” or “enroller”)
Some people:
NYC Human Resources
Medicaid Ofces (If 65 and
older, or if person
living with a disability)
Online:
nyc.gov/html/hra/html/
services/medicaid_ofces.
shtml
Phone: 1-718-557-1399
MEDICAID BUY-IN
FOR WORKING
PEOPLE WITH
DISABILITIES
Free health insurance • NYS resident
• Moderate to
Lower-Income
• Age: 16-64
• Working
• Be disabled
• Qualied immigrants
(No 5 year ban)
• PRUCOL, including
DACA
NYC Human Resources
Administration Medicaid
Ofces
Online:
nyc.gov/html/hra/html/
services/medicaid_ofces.
shtml
Phone: 1-718-557-1399
CHILD HEALTH
PLUS (CHP)
Free or lower-cost
health insurance for
children
• NYS resident
• No income
requirements
- Lower-income
families pay
nothing
- Middle-income
families pay
a little
- Higher-income
families can pay
full price
• All children under 19,
including undocumented
immigrant children
NY State of Health
Online:
nystateofhealth.ny.gov
Phone:
1-855-355-5777
In-Person:
Call 311 to get help from
someone in your
community (ask for
“navigator” or “enroller”)
COMPREHENSIVE HEALTH INSURANCE COVERAGE
*Refer to pages 7 - 8 for
“Immigration Terms for Health Insurance”
.
2
PROGRAM BENEFITS REQUIREMENTS ELIGIBLE IMMIGRANTS* WHERE TO GET IT
ESSENTIAL PLAN Free or low-cost health
insurance for lower-
income adults
• Age: Adults 19-64
• NYS resident
• Lower-income
(people who make
over the Medicaid
limit)
• Qualied immigrants (No 5
year ban)
• Most PRUCOL (not DACA)
• Certain temporary residents
(e.g. student with valid visa)
NY State of Health
Online:
nystateofhealth.ny.gov
Phone: 1-855-355-5777
In-Person:
Call 311 to get help from
someone in your
community (ask for
“navigator” or “enroller”)
PRIVATE HEALTH
INSURANCE (NY
STATE OF HEALTH
MARKETPLACE)
Choice of health
insurance plans;
nancial help is
available
• NYS resident
•For nancial help:
- Middle-income
to low-income
- Not eligible for
Medicaid or
Medicare
- No job-based
coverage
- Income limit
• Lawfully present
immigrants, which
includes most
qualied immigrants
and most PRUCOLs (not
DACA)
NY State of Health
Online:
nystateofhealth.ny.gov
Phone: 1-855-355-5777
In-Person:
Call 311 to get help from
someone in your
community (ask for
“navigator” or “enroller”)
FULL-COST
PRIVATE HEALTH
INSURANCE
(OUTSIDE OF THE NY
STATE OF HEALTH
MARKETPLACE)
Health insurance
purchased at full price
directly from an
insurance company
None • All immigrants, including
undocumented
immigrants
Directly from insurance
company
MEDICARE Health insurance for
people 65 and over or
who have a disability
or end-stage renal
disease
• Residents and
their spouses
who have worked
10 years or more
in the US
• Age:
- 65 or older
- Any age if have
a disability
or endstage
renal disease
• Qualied immigrants Social Security
Administration (SSA)
Ofces
Online: ssa.gov ssa.gov/
medicare/apply.html
Phone: 1-800-772-1213
In-Person:
Visit your local Social
Security ofce.
Get help:
Call 311 to get help from a
Health Insurance
Information Counseling
and Assistance (HIICAP)
program counselor
3
LIMITED HEALTH INSURANCE COVERAGE
*Refer to pages 7 - 8 for
“Immigration Terms for Health Insurance”
.
PROGRAM BENEFITS REQUIREMENTS ELIGIBLE IMMIGRANTS* WHERE TO GET IT
MEDICAID FOR
THE TREATMENT
OF AN EMERGENCY
MEDICAL
CONDITION
(ALSO KNOWN
AS EMERGENCY
MEDICAID)
Helps eligible
undocumented and
temporary immigrant
New Yorkers pay for
medical costs when they
have an emergency
Note: All hospitals
must treat you if
you have a medical
emergency,
regardless of your
ability to pay
• NYS residency
(temporary lawful
residents do not
have to meet the State
residency
requirement)
• Low-income
• Undocumented and
temporary immigrants
without NYS residency (e.g.
tourists).
Note: Undocumented
pregnant women may
be eligible for Medicaid
and all undocumented
children are eligible for
Child Health Plus
See page 1
Most people:
NY State of Health
Online:
nystateofhealth.ny.gov
Phone: 1-855-355-5777
In-Person: Call 311 to get
help from someone in your
community (ask for “navigator”
or “enroller”)
Some people:
NYC Human Resources
Medicaid Ofces (If 65 and old-
er, or if person with a disability)
Online:
nyc.gov/html/hra/html/services/
medicaid_ofces.shtml
Phone: 1-718-557-1399
FAMILY PLANNING
BENEFIT PROGRAM
(FPBP)
Provides free and
condential reproductive
health services
• NYS resident
• Moderate or
lower-income
• No Medicaid
• Can have Child
Health Plus or
private insurance
• Qualied immigrants
• PRUCOLs, including
DACA
Approved FPBP Provider
Online: nyc.gov/famplan
Phone: 1-800-541-2831
FAMILY PLANNING
EXTENSION
PROGRAM (FPEP)
Pays for birth control
and reproductive health
services after pregnancy
• NYS resident
• Have no other
insurance
• Undocumented
immigrants
Automatic enrollment after
pregnancy ends if already
enrolled in Medicaid
MEDICARE SAVINGS
PROGRAM
Helps pay for Medicare
premiums, coinsurance,
and deductibles
• NYS resident
• Low-income
• Have Medicare
• Qualied immigrants, (No
5 year ban)
• PRUCOL, including
DACA
NYC Human Resources
Administration Medicaid Ofces
Online: http://www1.nyc.gov/
site/hra/locations/medicaid-loca-
tions.page
Phone: 1-718-557-1399
4
PROGRAM BENEFITS REQUIREMENTS ELIGIBLE IMMIGRANTS* WHERE TO GET IT
HHC OPTIONS Lower costs for all services
provided at NYC Health +
Hospitals facilities, which
may include hospital stays,
emergency and clinic visits
• No other insurance
• Moderate or lower-
income (sliding scale
fee based on income
and family size)
• All immigrants, including
undocumented
immigrants
At a NYC Health Hospitals
facility
To nd a facility near you,
visit: nychhc.org/hhc
FEDERALLY
QUALIFIED
HEALTH
CENTERS (FQHCs)/
COMMUNITY
CLINICS
Lower costs for all
services provided at the
health center, which may
include primary care,
vision, dental and mental
health services
• No other insurance
• Moderate or
lower-income
(sliding scale fee
based on
income
and family size)
• All immigrants, including
undocumented immigrants
At health center, after
receiving care
To nd a health center near
you, visit: chcanys.org
NYC HEALTH
DEPARTMENT
CLINICS
Provides immunizations,
STD testing and TB testing
at low-cost
None • All immigrants, including
undocumented immigrants
At NYC Health Department
clinics
To nd a NYC Health
Department clinic near you,
visit: nyc.gov/health or call 311
HOSPITAL
FINANCIAL
ASSISTANCE/
CHARITY CARE
Lower costs
for hospital stays,
emergency and clinic
visits at all hospitals
in NY
• NYS resident
• No other insurance
• Moderate or
lower-income
(sliding scale fee
based on income)
• All immigrants, including
undocumented
immigrants
At hospital, after receiving
care
AIDS DRUG
ASSISTANCE
PROGRAM (ADAP)
Helps pay for
medications, primary
care, and home care
for people with HIV/
AIDS. Also helps pay
private health
insurance premiums and
copays
• NYS resident
• Clinically
symptomatic HIV
or AIDS diagnosis
• Middle-income to
low-income
• No Medicaid
• All immigrants, including
undocumented immigrants
NYS Department of Health
For more information, visit
health.ny.gov/diseases/aids/
general/resources/adap/
eligibility.htm or call
1-800-542-2437
FREE OR LOWER COST HEALTH CARE SERVICES
*Refer to pages 7 - 8 for
“Immigration Terms for Health Insurance”.
PROGRAM BENEFITS REQUIREMENTS ELIGIBLE IMMIGRANTS* WHERE TO GET IT
ELDERLY
PHARMACEUTICAL
INSURANCE
COVERAGE (EPIC)
Financial help to pay
for medications and
premiums for persons in
a Medicare Part D plan
(Medicare prescription
drug coverage)
• NYS resident
• Annual income up to
$100,000 if married
and $75,000 if single
• Qualied immigrants NYS Department
of Health
Online: health.ny.gov/health_
care/epic
Phone: 1-800-332-3742
BIGAPPLERX Lower costs for
medications not covered
by insurance
None • All immigrants, including
undocumented
immigrants
BigAppleRX.com
Phone: 1-888-454-5602
You can get BigAppleRX
discounts with your IDNYC
card. Learn more and make
an appointment at www.nyc.
gov/idnyc
5
PHARMACY ASSISTANCE AND OTHER CARE SERVICES
*Refer to pages 7 - 8 for
“Immigration Terms for Health Insurance”
.
All immigrants, regardless of their immigration status who do not have health insurance, can purchase and
obtain health care services at full cost. Health care services are available at private clinics and doctors’ ofces
and include primary and specialty care, vision, dental, urgent care, mental health or behavioral health services.
Costs are set by the provider and availability of services depends on a person’s ability to pay and can be
obtained at any clinic or doctor’s ofce in your area.
GET COVERED
• Free or low-cost health insurance options are available through the NY State of Health Marketplace
including Medicaid, Child Health Plus, Essential Plan and private insurance with nancial help for those
who qualify. Apply online at nystateofhealth.ny.gov, over the phone at 1-855-355-5777, or in person by
calling 311 to nd an in-person enroller near you.
• NYC HRA MEDICAID COVERAGE is available at Medicaid Ofces for people who are 65 and older,
former foster youth, or people living with a disability or visual impairment. In-person enrollment assistance is available through
the Facilitated Enrollment for Aged, Blind and Disabled program for people who are 65 and older, or living with a disability or
visual impairment. For a list of participating locations, call 1-347-396-4705 or visit nyc.gov/hilink.
• MEDICARE is available online at ssa.gov/medicare/apply.html or at a local Social Security Ofce.
Call 1-800-772-1213 (TTY users call 1-800-325-0778) for more information.
• NYS DEPARTMENT OF HEALTH programs are available online at health.ny.gov/health_care/
GET LOW COST CARE
• NYC HEALTH + HOSPITALS facilities near you: nychhc.org/hhc (HHC Options Program).
• FEDERALLY QUALIFIED HEALTH CENTERS near you: chcanys.org.
• NYC HEALTH DEPARTMENT CLINICS near you: nyc.gov/health or call 311
Photo is of a model used for illustrative purposes only.
LAWFULLY PRESENT: a term used to describe immigrants that have a valid non-immigrant status and are able to purchase
coverage through the NY State of Health.
• (e.g., students or foreign workers)
• All immigration statuses in purple below
QUALIFIED IMMIGRANT: a term used to designate who is eligible to receive public benets for Permananent ResidentAlien
.
• Lawfully permanent resident – Green Card Holder, Permanent Resident Alien
• Lawfully residing active duty service member & families
• Refugees & Asylees
• Immigrant whose deportation or removal is being withheld
• Cuban or Haitian entrant
• Amerasians
• Trafcked immigrant (T visa)
• Immigrant granted parole in U.S. for more than 1 year
• Battered immigrant spouses and children of U.S. citizens/legal permanent residents
PRUCOL – PERMANENTLY RESIDING UNDER COLOR OF LAW
: The United States Citizenship and Immigration Services
agency does not determine whether an alien is PRUCOL and does not grant PRUCOL status. PRUCOL is a public benets
eligibility status applied to certain immigrants for the purpose of determining Medicaid eligibility. A person who is considered
PRUCOL must meet Medicaid’s income and other eligibility requirements.
• U, K3 / K4, V, and S visa holders
• Approved Visa and applicants for adjustment of status
• Granted withholding of removal under CAT
• Paroled for less than 1 year
• Temporary Protected Status (TPS)
• Deferred Action (non DACA)
• Order of Supervision
• Deferred Enforced Departure
• Granted stays of deportation or removal
• Temporary resident INA 210 / 245A
• Family Unity Beneciary
• Applicants for Special Immigrant Juvenile Status
• Applicants for Asylum / Withholding under INA or CAT
• Applicants for Temporary Protected Status (TPS)
• Applicants for Record of Admission under 249 (registry alien)
• Applicants for Adjustment under LIFE Act
• Applicants for Legalization Programs under SAW-Seasonal and Agricultural Workers and
IRCA-Immigration Reform and Control Act
IMMIGRATION TERMS FOR HEALTH INSURANCE:
7
The following terms are a sample of immigration categories that determine what health insurance and low-cost
care individuals may be eligible for.
Please speak to a trained enroller to learn about all your coverage and care options.
Disclaimer: The information contained in this brochure is for general informational purposes only. Program availability and eligibility
is subject to change, and additional rules and requirements may apply. Consult an insurance or legal professional or the program
sponsor about your specic circumstances and to nd out if you qualify.
Many thanks to Empire Justice Center (empirejustice.org) for allowing us to include information from their Health Coverage Cross-
walk (http://www.empirejustice.org/assets/pdf/publications/reports/health-coverage-crosswalk.pdf), a comprehensive resource that
breaks down the complicated rules related to immigrant eligibility.
PRUCOL not considered Lawfully Present: those immigrants that have limited access to coverage due to their
immigrant designation
• Noncitizens who can show continuous residence since on or before 1/1/1972 (registry aliens)
• Immediate Relatives with approved I-130 (petition for Alien Relatives)
• DACA-Deferred Action for Childhood Arrivals
• Request for Deferred Action (non DACA cases) pending for 6 months or more and not denied
• DAPA - Deferred Action for Parents of US Citizens and Permanent Residents
UNDOCUMENTED: individuals that do not have ofcial documents needed to enter, live in, or work in the United
States legally.
• Entered the country without inspection (EWIS)
• Visa overstays
8
© Copyright 2016. The City of New York, Human Resources Administration/Department of Social Services.
For permission to reproduce all or part of this material contact the New York City Human Resources Administration.
Bill de Blasio
Steven Bank
s
NYCHRA
@NYCHRA
