US Medical Care for Foriegn Visitor

September 10, 2021 9:00 AM

My wife's parents are foreign citizens currently living in their home country, and one of them has has a serious preexisting condition that appears to have been successfully treated (it's early), but at a minimum will need regular follow up visits with a doctor. At some point soon they want to visit the US on a visitor's visa, and I have a lot of logistical questions about providing healthcare in this scenario.

We live in Minneapolis, MN, if that's relevant. Also, the eventual plan is for them to immigrate, once my wife gets her citizenship and can sponsor them, so a secondary goal is getting a head start on arranging continuity-of-care for that.

1. What kind of services or specialists are available to help navigate this scenario? Any recommendations?
2. Are foreign visitors eligible for Obamacare exchange plans? My uninformed reading of this government website makes me think they would ("Individual with Non-immigrant Status") but this random website (that seems out of date and appears to be hocking inferior travel medical insurance) says they wouldn't.
3. If visitors are not eligible for Obamacare exchange plans, is it possible to get travel medical that covers preexisting conditions?
4. What are the logistics of getting foreign-language medical records transferred to the US? Do we have to get them translated?
5. Are there any state-level programs we should consider? I recall Minnesota used to run a "high-risk pool" plan, but it looks like Obamacare eliminated those.

posted by cosmic.osmo to Health & Fitness (15 answers total)

The only part I can answer is health care coverage during their visa trip. They would need to get emergency travel insurance from their health care provider in their home country that will cover the timeframe of the trip. It's usually pretty inexpensive, and many times it requires payment upfront for medical bills with reimbursement after submittal of the claims when they get back home. I have this and have used it often in the past.
posted by wile e at 9:07 AM on September 10, 2021 [1 favorite]

Are foreign visitors eligible for Obamacare exchange plans? My uninformed reading of this government website makes me think they would ("Individual with Non-immigrant Status")

If your wife's parents are coming as visitors, they will almost certainly come via the Visa Waiver Program with an ESTA, or with a B-1/B-2 visa. (I am assuming they are not some diplomats, NGO officials or some other complicated status).

While the list of visa statuses is clearly not exhaustive, it doesn't mention B-1/B-2 visas, and the list of non-immigrant visas mentioned seem to be for those who would be in the US for a longer, albeit definite time -- H-1/H-2A/H-2B visas are for individuals working in the US; student visas are for, well, students; U visas are for victims of abuse who are working with law enforcement; T visas are for victims of human trafficking.

It seems unlikely that B1/B2 visa holders would be eligible, but since that's almost certainly what visa status your wife's parents will visit under, that's what I would research further. (When it comes time for them to immigrate to the US, they will have different visas so the situation will change.)
posted by andrewesque at 9:30 AM on September 10, 2021 [1 favorite]

Response by poster: My understanding is that travel medical insurance usually does not cover preexisting conditions, etc., so my thinking is it would be a poor fit for the parent with the preexisting condition. There may be a need for a check up with a specialist during their stay in the US. And if that doesn't go well, I suppose treatment.

We'd get a typical travel medical plan for the other parent, though.
posted by cosmic.osmo at 9:36 AM on September 10, 2021

A health insurance broker can answer this for you and it will cost you nothing, or almost nothing.
posted by SLC Mom at 10:08 AM on September 10, 2021

Under ESTA they can visit for up to 90 days in a row. If the pre-existing conditions really require more frequent check ups and/or ongoing care (as opposed to taking well dialled in medications with less frequent check ups) they are arguably not well enough to go on long trips, even if these trips are to visit family.

What makes this even more complicated is that most public health insurance programs in Europe expressly limit cover of overseas medical expenses. Typically, they will only cover costs in countries with reciprocal agreements such as other EU countries and are normally limited to emergency care, not ongoing treatment. Medical cover for other destinations can be extremely expensive for older travellers, especially if it is supposed to cover the US because your healthcare is so overpriced.

So they should probably also research exactly what kind of travel cover is available to them in their home country because these policies are really specific to the country of residence and are designed to pick up where the ‘standard’ local coverage ends.
posted by koahiatamadl at 10:21 AM on September 10, 2021 [1 favorite]

With respect to medical records, bring them with (that is, acquire a copy from their usual providers, and bring a new copy every time they visit). Anything else will be prone to error and/or very expensive on the US end (administrative fees, translation fees, etc.).

...in some parts of the country (IME, California) immigrants are common enough that there are specialized insurance programs specifically designed to cover non-immigrant relatives that visit frequently, and those programs are so common they're literally advertised on the sides of buses. There may be similar programs (less well-advertised) in MN, probably found in Hmong and Somali communities.
posted by aramaic at 10:49 AM on September 10, 2021

Response by poster: I just checked, and they have multiple entry B-1/B-2 visas.

They won't travel if they have active medical issues. We're mostly being cautious to make sure we have our bases covered (also return travel could be inconvenient with COVID restrictions). The situation would be they'd be cured to the point where no active treatment is necessary or recommended, but being monitored for recurrence (which will probably be the situation for the rest of their life).

They're not coming from a European country or another country with a very comprehensive public health insurance.

A couple people have mentioned buying travel coverage in their country. Is that required, or can we get it in the US? IIRC, I think the last time they came I got them coverage through Travelex, since that's usually what I used when I traveled.
posted by cosmic.osmo at 10:50 AM on September 10, 2021

I’m in the UK, but here you can definitely get travel insurance that covers pre-existing conditions (example) YMMV, you have to fill out a questionnaire and they then tell you how much it would cost, so it’s possible it would be prohibitively expensive, but I wouldn’t rule that out on an assumption.
posted by penguin pie at 12:06 PM on September 10, 2021

Be careful with travel insurance. Travel insurance that "covers" pre-existing conditions is usually just emergency travel insurance that is not invalid for people with pre-existing conditions. It's not travel insurance that actually covers the cost of ongoing, planned treatment.

If we're talking about a handful of doctor's visits during a 3-6 month visit then the simplest solution is for them to pay out of pocket for those visits. Healthcare providers often charge private citizens much less than insurance companies, and insurance purchased on state exchanges is not particularly cheap if it's not subsidized, so this may end up costing less than "real" health insurance. You find the provider you're interested in visiting, say you will be paying out of pocket, and ask them the price. There is a good chapter about this in An American Sickness. If you go this route, however, be sure to discuss the cost of any labs you need with the provider first.

You should of course also get emergency insurance to cover unplanned healthcare needs before setting foot in the United States.
posted by caek at 12:18 PM on September 10, 2021 [1 favorite]

Money Saving Expert has a good discussion of travel insurance and pre-existing conditions, and lots of links to possible providers. It's a UK site, so the coverage assumes a lot of UK context (e.g. the NHS is a thing, etc.) but some of the links will sell insurance to people who live anywhere.
posted by caek at 12:27 PM on September 10, 2021 [1 favorite]

My grandfather was diagnosed with lung cancer while living in India, got initial treatment there, then came here thinking he was cured. Spoiler alert: he was not.

I am fairly sure that my parents paid for his radiation and chemo out-of-pocket, at least at first. I think my dad was able to get him on his health insurance as a dependent at some point. I don't know how the visa situation worked, because he was definitely here for longer than 90 days. This was in the 1990s.

In your situation, I'd probably contact the Case Management Department at your nearest largeish hospital. University of Minnesota? Academic places often have people who travel for care and will have some familiarity with this kind of situation.
posted by basalganglia at 6:05 PM on September 10, 2021 [2 favorites]

Further to the eligibility question, this site says that you must "live in the United States" to be eligible, where "live in the United States" means "you’re considered a 'resident' of the United States for tax purposes". This is almost certainly not the case for someone on a visitor visa.
posted by Johnny Assay at 7:24 PM on September 10, 2021

Minor clarification: I think it's true that holders of the most common visitor visas (B-1 and B-2) are not residents for tax purposes. But holders lots of classes of visitor visas are residents for tax purposes. The examples I can think of (H-1B, L-1, J-1, E-2, etc.) are all working visitor visas, but I don't know if it's generally true that visa-holding tax residents are all on working visas. My point being: you can be on a visitor visa while also being resident for tax purposes, and it's worth checking if this applies to you.
posted by caek at 9:40 PM on September 10, 2021

On the off chance your parents-in-law live in the UK, here's the MoneySavingExpert information about travel insurance with pre-existing conditions. Cost is difficult to judge as it depends on the pre-existing condition but it could well be more than £1000 for three months in the States.
posted by plonkee at 2:20 AM on September 11, 2021

OK, the challenge you have here is that there's two different kinds of insurance for someone coming into the US. Travelers Insurance is for someone who is visiting for up to a year. For someone who will be here more than a year, they will need what is called "global medical insurance" to cover the gap until they're eligible for something like Obamacare. Unfortunately, you can be rejected for certain pre-existing conditions. (Others just jack the price up.)

I work for a company that is a broker for both kinds of insurance and depending on what country your family member is coming from they may be able to talk you through options. DM me if you would like contact info.
posted by rednikki at 11:09 AM on September 12, 2021