Au Pairs: Special Enrollment Period to Sign Up for Free/Low-Cost Health Insurance
Updated on April 10, 2021.
If you are an au pair on a J1 visa with a valid DS-2019, living anywhere in the United States, you may be eligible for free or low-cost, comprehensive health insurance that covers primary care, prescriptions, pre-existing conditions, sports injuries, mental health care, vaccinations, COVID-19 care, emergency room visits, surgeries, and other medical expenses.
Note: This announcement applies to au pairs who do not already have affordable, comprehensive health insurance (see FAQ 1).
To enroll in free or low-cost health insurance for 2021, you must sign up before August 15, 2021*. The deadline was originally December 15th, 2020, but President Biden extended it twice because of COVID. If you are currently in the United States, and you do not sign up by the Special Enrollment deadline, you may not be able to get coverage in 2021. If you are arriving in the United States after August 15, 2021, see FAQ 6.
The Affordable Care Act, a law passed in 2010, requires states to offer health insurance to their residents and to make healthcare affordable for low-income residents through subsidies. J1 visa holders (nonimmigrant residents) are eligible for coverage under the Affordable Care Act.
If you will make less than $12,760 per year ($245.38 per week) in 2021, you are likely eligible for free health insurance. If you will make more than $245 per week in 2021, you may still be eligible for low-cost health insurance (typically less than $25 each month).
If you sign up for health insurance, you will be covered until December 31, 2021. In November and December, you will have the option to extend your coverage into 2022.
For more information and to sign up, go to https://www.healthcare.gov/. You may be told to go to a state website to sign up. The government has set up a free helpline at 1-800-318-2596, which you can call 24/7.
If you do not speak English, help is available in Chinese, French Creole, French, German, Gujarati, Hindi, Italian, Japanese, Korean, Polish, Portuguese, Russian, Spanish, Tagalog, and Vietnamese. Call 1-800-318-2596 for more information.
Frequently Asked Questions
1. Don’t all au pairs already have health insurance through their agencies?
Some of the basic medical plans offered by au pair agencies are not comprehensive “health insurance,” but are instead travel insurance with emergency medical coverage.
These non-comprehensive travel insurance plans do not cover common activities and illnesses, such as routine and preventive care, expenses for pre-existing conditions, behavioral and mental health care, pregnancy costs and birth control, illness resulting from epidemics or pandemics, accidents due to risky activities, and physical therapy. These are considered essential health benefits, and each plan offered under the Affordable Care Act must cover these types of care.
If you already have comprehensive health insurance that covers all of the essential health benefits, and you pay less than 10 percent of your income for the health plan, you are not eligible for subsidies for health insurance purchased through healthcare.gov or through your state.
On the other hand, if your medical plan doesn’t cover all of the essential health benefits, you may be eligible for subsidies to get free or low-cost health insurance.
To confirm, you can call your insurance company (for example, CISI, Erika Travel Insurance, or United HealthCare) and ask: “Is my health plan considered qualified health coverage and meets minimum essential guidelines under the Affordable Care Act?” If the answer is “no,” then you do not have have health insurance for the purposes of applying for subsidized coverage.
If you have any other questions, please contact the healthcare.gov hotline.
2. If I sign up, will all of my medical care be free?
In the United States, generally people pay a monthly cost for health insurance as well as fees for services they use. For more information about these costs, read about premiums, deductibles, and out-of-pocket costs. If you make less than $245 per week, you may be eligible for free health insurance (you will not have to pay premiums). But depending on what health plan you enroll in, you may still have to pay a deductible and out-of-pocket costs for various services. Regardless, your cost for medical services will be much lower with a health insurance plan than without one.
3. What services are covered?
Health insurance plans offered under the Affordable Care Act must cover the following services for adults:
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Preventive and wellness services and chronic disease management
- Outpatient care (ambulatory services)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services, like blood tests
- Birth control, pregnancy, and newborn care
These services are covered even for pre-existing conditions (illnesses or injuries you already have when you sign up). Keep in mind that you may still be charged for getting medical care (see FAQ 2).
4. Does coverage include dental care?
You will have the option to enroll in a dental plan when you sign up for health insurance. The dental plan may cost a monthly fee.
5. Can I go to any hospital or doctor? How do I know what is covered?
When you sign up for health insurance, you will get detailed information about which services are covered and how much. Your new health insurance company will help you find out which doctors and services are included in your health plan.
6. I am arriving in the United States after August 15, 2021. Can I still sign up?
After you arrive in the United States, you always have 60 days to sign up for health insurance, even if it is outside the usual deadline to apply. Arrival in the United States creates a “special enrollment period.” For example, if you arrive on January 1, 2022, you have until March 1, 2022 to sign up.
If you do not sign up within 60 days of arrival or by August 15th, 2021, you will likely not be able to sign up for health insurance until 2022.
7. Do I need a Social Security Number?
You may need a Social Security Number to enroll. Call the Affordable Care Act hotline at 1-800-318-2596 for more information. You may be able to sign up without providing a Social Security Number as long as you get a Social Security Number within a certain amount of days.
If you recently arrived in the United States and need time to get a Social Security card, you have 60 days from your arrival to sign up for health insurance.
8. How can I verify my income?
When you apply, you will need to provide an estimate of your annual income and submit proof of income. If you do not have a W-2 or a letter from your employer (host family), but you are otherwise eligible for coverage, you will be able to apply with other documents. For example, you may be asked to provide copies of a bank account statement or copies of checks you received from your host family, together with a letter explaining how your income was calculated.
For more information, create an account on healthcare.gov (you may be directed to an insurance marketplace run by your state) and contact a customer service representative.
9. Will I owe money on my taxes if I sign up? What if I don’t estimate my income correctly?
If you receive a subsidy to pay for health insurance, you must submit a Form 8962 when you file your taxes for that year (for example, in January-April 2022 for taxes on income earned in 2021). See Q24. You will get a packet explaining how to fill out the Form 8962 when it is time to file your taxes.
If your income for the year is higher than the income you reported when you signed up for health insurance, you may owe money back when you file your taxes. See Q4. For example, if you receive a full subsidy after applying for health insurance based on income of $195.75/week, but then you earn $500/week in 2021, you will owe money on your taxes based on the difference between the subsidy you received, and the subsidy you would have gotten if you had reported your income accurately.
For the purposes of signing up for health insurance, there is no difference if you have a W2 or have your income withheld, or if you simply pay the full amount of your taxes owed at the end of each year.
10. I am being told that I am not eligible to enroll because I make too little money and that I need to sign up for Medicaid.
American citizens and permanent residents who make under a certain income limit need to enroll in a program called Medicaid. J1 visa holders who are in the United States for fewer than five years are not eligible for Medicaid. However, even though you are not eligible for Medicaid, you should still be eligible for low-cost health insurance if you meet the visa and income requirements.
You can find more information about the Medicaid exception and other information about eligibility for immigrants on this page. If you are told that you cannot sign up for health insurance because you make too little money, please call 1-800-318-2596 for help and explain your situation.
11. How can I protect myself against retaliation for signing up for health insurance?
If you sign up for health insurance, you will get documents in the mail, including a health insurance ID, tax forms, and other notifications. Your host family may ask why you are receiving these documents in the mail.
That said, it is illegal to retaliate against or fire an employee for signing up for free or subsidized health care.
12. How can host families support au pairs?
Host families can support au pairs by helping them navigate the health insurance exchanges, providing employer letters to verify income, paying monthly premiums for better-quality health plans and dental plans, scanning passports and other records that need to be uploaded, and assisting with tax paperwork at the end of the year.
This post does not constitute legal advice and does not form an attorney-client relationship. Please access the resources at healthcare.gov or at your state of residence, or contact an insurance agent to determine your eligibility and for help accessing health insurance.
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