Confused about health insurance for child on the marketplace

[PokuPoku 29]

We just got married so I'm (american citizen) am wanting a healthcare plan to cover my wife and her child. I'm going through the healthcare marketplace to do it. I submitted the application and it said we are eligible but her child isn't? But "May be eligible for Medicaid based on this month's household income".

Kinda confused by what this means. So if I enroll in a plan, our daughter won't be able to use our plan for free check-ups and such? Is medicaid/chip even available to her as a non-citizen or green card holder? Do I just need to call the marketplace, or is there something else to it? The "next steps" section for her says "Wait for more information from your state agency about Medicaid coverage. You may need to provide more information to the state.". So maybe I just wait?

[TBoneTX 46,615]

I'd begin researching the Medicaid rules on the state's website right now.  If it's like most bureaucratic processes, expect onerous documentation requirements.  Call the agency with questions.  But be proactive -- children get sick a lot, and the child should be covered somehow.

 

If income to qualify for Medicaid is too high, check for an agency program called CHIP.

Edited March 19 by TBoneTX

[JeanneAdil 6,768]

you just married (3/17/25) under the k1/K2 so she has no green card yet and you shouldn't wait for the green card to enroll her

 

You have no plan at work to add wife?

 

Issues with medicaid and CHIP is they are for low income families and you need to have 125% of poverty level income for the AOS process

 

Several companies like Blue Cross. Blue Shield,  CIGNA,  AETNA offer family plans 

[PokuPoku 29]

  On 3/19/2025 at 2:58 PM, JeanneAdil said:

You have no plan at work to add wife?

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I'm self employed, so no.

  On 3/19/2025 at 2:58 PM, JeanneAdil said:

Issues with medicaid and CHIP is they are for low income families and you need to have 125% of poverty level income for the AOS process

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I was over it in 2024 but I estimated my income will be a little lower this year because of how the economy is doing and that seems to have put me just under 125% poverty for 2025, but I have a lot of money in stocks and CDs. My income is extremely hard to estimate.

[JeanneAdil 6,768]

  On 3/19/2025 at 3:12 PM, PokuPoku said:

I'm self employed, so no.

I was over it in 2024 but I estimated my income will be a little lower this year because of how the economy is doing and that seems to have put me just under 125% poverty for 2025, but I have a lot of money in stocks and CDs. My income is extremely hard to estimate.

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you will need joint sponsor / immigration is not good as accepting assets as seen here on VJ 

[PokuPoku 29]

  On 3/19/2025 at 3:44 PM, JeanneAdil said:

you will need joint sponsor / immigration is not good as accepting assets as seen here on VJ 

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eh, wouldn't it mostly be based on my previous year's income? That was $48k. The healthcare thing is based on my estimated 2025 income, which I expect to be lower.

Also, looks like CHIP availability in my state is $38k, which is higher than 125% poverty income (household of 3).

I'd like a family plan that covers all of us, but current situation looks like it would just cover me and my wife, and we'd need to apply for CHIP for our child? confused by how that all works.

[MMRF 25]

Make sure your state allows new immigrants on Medicaid. Most don't.

[spicynujac 54]

I'm in the same boat as OP (self employed, no health insurance).

Is there a possibility for your wife to work somewhere at least part time that would provide health insurance for your family?  Health care in the USA is extremely expensive and is tied to the workplace, due to arcane rules put in place in the 70s.  So your best bet is getting it from the workplace, if you can.

Plenty of places don't require a lot of experience and provide health insurance for part time workers (Starbucks, Trader Joes, etc.)  This is probably what we will do when we have kids (that's also the time I most need the wife at home so I realize it's a catch-22!)

[PokuPoku 29]

  On 3/20/2025 at 2:43 AM, spicynujac said:

I'm in the same boat as OP (self employed, no health insurance).

Is there a possibility for your wife to work somewhere at least part time that would provide health insurance for your family?  Health care in the USA is extremely expensive and is tied to the workplace, due to arcane rules put in place in the 70s.  So your best bet is getting it from the workplace, if you can.

Plenty of places don't require a lot of experience and provide health insurance for part time workers (Starbucks, Trader Joes, etc.)  This is probably what we will do when we have kids (that's also the time I most need the wife at home so I realize it's a catch-22!)

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That would take months, probably. We're still waiting for her SSN (its been 10 or 11 weeks now) and who knows how long work authorization would take.

I'm just going to call the healthcare marketplace tomorrow to see if I can get answers since its all really confusing and I probably need very specific help with my specific situation.

[Boiler 46,531]

Making quite some assumptions and based on the info provided.

 

OCare is set up for the normal situation which is not a new Resident, so defaults where applicable to Medicaid, not seemingly applicable,

 

K1 the first thing you get is a SSN, I did not do a K2 but I did not think they get a SSN pursuant to entry.

 

CHIP I know nothing about, no doubt varies by State.

 

Welcome to America

[PokuPoku 29]

So I believe I understand it now. My step daughter 99.99% chance won't be eligible for CHIP/medicare, BUT, to be eligible for the marketplace, she must first be denied by the state for chip/medicare. She is required to be denied from that before she can be part of our family plan. The requirement for kids to join a marketplace plan is to be denied a chip/medicare plan, which she will since she hasn't lived in the country for long enough.

 

It all makes sense to me now, I believe. I just had to piece together all of this.