The solution to the gaps in Au Pairs health coverage can be simple: ACA plans

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In 2016, Isis Mabel from Mexico wanted to improve her English. On the advice of an aunt, she signed up with an au pair agency to come to the United States to live with a family and take care of the children. The job typically pays around $ 200 per week in addition to accommodation and meals. She said she gave the agency $ 360 and was told it would cover costs such as visa fees and health insurance.

It was all explained “super fast,” she said, without any details on what the insurance would cover. When she arrived in the United States, she recalls, a representative of the au pair agency recommended that she take out additional sports coverage, as even an accident caused by jumping can be considered sports-related. Mabel chose to purchase the additional policy for an additional $ 180.

Isis Mabel came to the United States in 2016 to work as an au pair. She got basic health coverage through her au pair agency, but was unaware that she could buy full health coverage on the Affordable Care Act market. (Kenneth Sipin)

In August 2017, her contraceptive implant was removed because it had expired, which she assumed was covered by her insurance, given that birth control coverage is part from Mexico universal health system. Instead, she said, she received a bill for about $ 4,500. Her insurance did not cover contraception or other reproductive health care, she said.

According to the State Department, 14 au pair agencies operate in the United States. These private companies are required to provide their au pairs with basic health coverage under State Department regulations. But some of the plans are for emergency or travel insurance, excluding many types of necessary care, according to Natalia Friedlander, staff lawyer at the Rhode Island Center for Justice, a non-profit public interest law center. After an au pair she employed had problems with health coverage, Friedlander looked at the insurance offered by around half of these agencies in 2020 and her center posted online information to help au pairs find full coverage.

She found that agencies might not mention that au pairs are eligible to register for full coverage in the Affordable Care Act markets or that many au pairs are eligible for grants to help them out. pay their premiums. By not registering au pairs could end up with huge medical bills if they need care.

A State Department spokesperson said these 14 agencies are subject to same regulation that other groups which sponsor visitor exchange programs and must require that au pairs “have insurance in force which covers exchange visitors in the event of illness or accident during the period they are participating in the sponsor visitor exchange program ”. Criteria set out in federal regulations include medical benefits of at least $ 100,000 per accident or illness, a deductible limit of $ 500 per accident or illness, and a maximum coinsurance limit of 25% of the cost of covered benefits – but they don’t. state that the full coverage required for Americans must be provided.

The regulations also do not suggest that au pairs or other exchange visitors be informed about access to ACA market plans. Mabel and two other former au pairs, who worked in the program from 2014 to June this year, told KHN that no one ever mentioned ACA to them when they signed up for work or after they arrived at the United States.

KHN has contacted each of the 14 State Department au pair agencies about the insurance plans they offer to their employees. Only one responded.

Terence Burke, spokesperson for Cultural Care Au Pair, said the insurance offered to his au pairs exceeds regulations put in place by the State Department to cover medical expenses and other travel cover, and provides for a emergency evacuation of the country if necessary, another State Department requirement. .

“Au pairs with Cultural Care receive detailed information on what is and what is not covered by their insurance coverage. Knowing this information, au pairs are always free to supplement or add to the insurance coverage they must have in accordance with US Department of State regulations and may choose to enroll in an ACA exchange to complete. their medical coverage, ”he wrote in an email.

At least two of the agencies offering some of the oldest programs in the United States are owned by companies that also offer insurance. Cultural care provides through Erika Insurance, and the two companies are part of EF Education First, a Swedish company. Au Pair in America provides through Cultural Insurance Services International, both owned by the British company American Institute for Foreign Study.

Friedlander found that the insurance plans offered to many au pairs prior to their arrival excluded certain categories of care deemed essential under the ACA. Many did not cover routine or preventive services, or care for pre-existing conditions, mental health, and maternal and reproductive health, she said. Some plans are advertised as “comprehensive,” “exceptional” or “worry-free,” although they do note the exclusions of coverage.

Also, she said, the insurance coverage summaries or guidance documents she reviewed did not mention ACA market plans as an option.

Au pairs with J-1 visas are classified as foreign nationals living in the United States on nonimmigrant visas because they are not on the path to citizenship. AC covers these non-immigrants. According to a spokesperson for the Centers for Medicare & Medicaid Services, the federal agency that oversees ACA markets, “We encourage organizations that facilitate J-1 visa exchange programs to communicate the opportunity to s ” enroll in quality and affordable health care through the market. Holders of a J-1 visa are considered legally present and are therefore eligible to enroll in a qualified health plan through the market, and for financial assistance, if they are otherwise eligible.

CMS noted, however, that anyone seeking grants to help cover the cost of the premiums should plan to file a federal income tax return for this year.

If the insurance that au pairs have purchased through their agencies does not meet the minimum coverage requirements under the ACA, Friedlander said, they are free to enroll.

But the registration window is strict: people have 60 days after arrival in the United States to subscribe to ACA plans outside of the annual open enrollment period.

Friedlander said that when she first looked at insurance for her au pair, “I assumed she would have full coverage.” She said she was surprised to see great limitations.

Having previously worked in a non-profit organization related to health insurance, Friedlander first investigated whether the au pair could enroll in ACA coverage. It took some effort as ACA market navigators did not know J-1 visa holders, but she managed to get her au pair enrolled. She has since enrolled two of her other au pairs.

But for many au pairs, ACA coverage is not an obvious option. They are generally not English speaking, very young and live with their employers, which makes them dependent on their host families. “It’s a situation where they really depend on agencies to provide them with the information they need to know while in the United States,” Friedlander said.

For Mabel, her medical bills changed her experience in the United States. What she owed to the hospital and doctor, she noted, would have been enough to purchase return tickets to Mexico to have her implant removed. To save money to pay off her debt, she said, she stopped doing anything outside of work. “Basically, the goal of the exchange, to go around, it stopped there, it’s over, because I have acquired this responsibility,” she said. She was able to pay it back in two years, she said.

“It was my biggest mistake, financially speaking, of my entire life,” she said.

Estefania Weinbach, from Colombia, said that in 2016, two years after arriving in the United States to work as an au pair, she experienced a sharp pain in her abdomen that made her feel like she was stabbed. In an emergency room, she was diagnosed with endometriosis and told she needed surgery in a few weeks, she recalls.

She said that a representative from her au pair agency told her that the operation would be covered in her home country and that she was advised to return immediately. Weinbach refused. The agency told her the insurance would cover surgery costs up to $ 7,000, she said, and she found a doctor willing to perform the operation for that payment. But it was a “very traumatic experience”, an experience that made her feel “everything is against you”.

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