How does the new U.S. health insurance law affect me?

“Does my new ACA-compliant domestic health plan protect me overseas?”

It depends on your plan, but probably not. Most domestic health plans still do not cover you overseas or even “out-of-network.” And networks have become much “slimmer” with new ACA health laws, not larger. While the ACA law includes new protections/provisions and benefits, it especially does not include Medical and Political Evacuation or Emergency Transportation when overseas. Nor will your domestic plan pay to get you to a quality medical facility/hospital that can help you overseas or back at home. Most are not willing to reimburse for any medical treatment received overseas except in case of life-threatening injury. Your coverage may vary. The U.S. State Department still recommends travelers purchase international health or travel medical insurance (not trip cancellation travel insurance) prior to departure.

This page explains ACA/PPACA health laws and how they apply to international health insurance & overseas travel insurance.

For expats – Are you a bona fide resident of another country? Do you pass the IRS foreign earned income exclusion test? If so, then you are exempt from ACA and any “Minimal Essential Coverage” insurance plan will meet your needs.

Moving back to the USA for good? – U.S. law states that you have up to 60 days, from your U.S. arrival date, to get on an ACA policy by: OPTION 1 – Special Enrollment Period (SEP), or OPTION 2: Open Enrollment Period (OEP) that start policies on January 1st of each new year. Penalties are currently being waived.

“Is my overseas health plan ACA (affordable care act)-compliant?”

The ONLY medical insurance plans required to meet the ACA requirements are:

Insurance plans intended for U.S. domestic health coverage and…
Insurance plans intended to cover someone 12 months or longer in duration

There are differences between ACA requirements for individuals and for group (employer-provided) health insurance.

Will I be subject to fines/fees if I return to the USA?
If you do not remain overseas more than 330 days in a calendar year you MAY be subject to IRS fees for all or part of the year (These fines are currently being waived). You may also be eligible for various exemptions. We advise you to consult with a tax professional specializing in international tax laws.

We are always available to take your calls or speak with you on Skype at “goodneighborinsurance” if you don’t see your question answered here.

Questions and Answers

Example 1: On a long term / career insurance plan with worldwide coverage.

Question: “Our family is from California and we live and work in Thailand. We are on the _____ plan long-term. We intend to return to the U.S. for 2 months this coming summer and don’t have a U.S. health insurance plan (since we don’t live there). Will our plan still cover our family in case we have an emergency and need to go to urgent care/the doctor?”

Answer: Yes, you are fully covered in the U.S. according to your policy up to the limits set in your plan detail. Furthermore, as long as you are making one trip, less than 3 months total, you will avoid the Individual Shared Responsibility Penalty, as long as you are still considered an expatriate by the IRS.

Example 2: On a long term / career insurance plan with worldwide coverage

Question: “We plan to come home to Georgia for a family wedding and to see aging parents. We currently live in Ghana and have insurance through Good Neighbor Insurance. Are we still covered in the U.S. for our trip even though our current plan is not PPACA-compliant?”

Answer: Yes, because you are not residing in the U.S., you do not need an ACA-compliant plan even when traveling in the U.S. for under three months.

Example 3: On a short term team / travel insurance plan

Question: “If we send a team this coming summer on a non-compliant plan, and someone falls and breaks their hip, will the plan continue to cover their expenses back in the U.S. for treatment?”

Answer: Yes, with this additional information:

The medical condition has to be a ‘new’ medical condition and not a pre-existing or on-going medical condition.
The new medical condition must be first treated overseas prior to coming back to the U.S.
On most travel insurance plans, when back home, your U.S. domestic insurance will be your primary insurance and your travel insurance plan will be secondary insurance. While overseas your travel insurance is your primary insurance. Some of our travel plans will continue coverage for those without U.S. insurance.

Example 4: Travel / short term insurance for coverage in the U.S. and throughout the world

Question: “Do we need to be looking for a short-term overseas insurance plan that is ‘ACA-compliant?’ And if we are coming to visit America do we need a short-term plan that’s ACA-compliant?”

Answer: No. There are no ACA-compliant short-term / travel insurance plans, for inside or outside the U.S., that meet ACA requirements.

All short term plans are for 364 days or less than a year’s coverage. One may reapply for the same travel/short term plan but only have coverage for under a year.
If you are going to be residing in the U.S. then you should consider a long term domestic ACA compliant policy or group health insurance through your employer.

International career / long term plans - Regarding ACA compliance:

To get on one of these plans one must live overseas. Thus, they are not ACA-compliant, nor do they need to be.

Even though most long term/career plans include a coverage period for time spent in the U.S., they are not required to be ACA-compliant because they are for those expatriates residing or continuing to reside outside the USA.

International travel / short term plans - Regarding ACA compliance:

No short-term travel insurance plans are “ACA-compliant” since they provide insurance protection for outside the USA.

While some provide “door-to-door” coverage, incl. your travel within the USA (as part of your overall travel to reach your overseas destination), they are all for less than 1-year terms, so are not restricted by ACA guidelines. These plans may be renewable at the end of your term. Some of our travel plans include coverage in the U.S. as long as the medical condition is ‘new’ (Not a pre-existing condition), and was initially taken care of overseas, Usually the cover for treatment in the U.S. is 90 days, (but always check your policy’s benefit) from the time the medical condition occurred.

Short term U.S. domestic insurance plans - Regarding ACA compliance:

Since short term plans have less than 1-year purchase time per policy, they do not fall under the ACA requirements. However, those in the USA have 60 days to get on an ACA-compliant plan or share plan, although you may also apply for a Short Coverage Gap exemption.

THE INFORMATION OFFERED ABOVE IS THE MOST ACCURATE AND PUBLIC INFORMATION WE HAVE AT THE MOMENT (OF PUBLICATION) AND IS OFFERED “AS IS” WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. WE CANNOT GUARANTEE THIS INFORMATION TO BE ERROR-FREE, IN TERMS OF IT’S CORRECTNESS, ACCURACY, RELIABILITY, OR OTHERWISE. WE ENCOURAGE EVERY CLIENT TO DO THEIR OWN DUE DILIGENCE IN REGARDS TO POLICIES, APPLICABLE LAWS, ETC. AS IT AFFECTS THEIR PERSON AND ORGANIZATIONS.

Under no circumstances, shall Good Neighbor Insurance be held liable for any indirect, special, incidental, consequential or other damage, including, but not limited to, loss of health or profits, which result from the use of, or the inability to use, the information published on this site, which is published solely for informational purposes to educate, inform and assist clients and organizations make informed, timely decisions regarding their health insurance needs.