The E2 visa allows individuals who want to invest significant capital in the US to move to the country with their family. There is no national health service in the US, so all immigrants will need to take out some form of health insurance. It’s important that you are aware of the E2 visa health insurance rules to ensure you and your family can access the care you need.

 

The Affordable Care Act

 

The Affordable Care Act (ACA), sometimes referred to as Obamacare, was introduced in 2010. It requires everyone living in the US to have appropriate health insurance in place. While the federal tax penalty for not having health insurance was eliminated effective January 1, 2019, some states have enacted their own individual mandates with associated penalties. Regardless of penalties, having health insurance is crucial to avoid the high costs of medical care in the US.

 

Eligibility for health insurance

 

If you are a lawfully present immigrant in the US, you are required, and should be able, to obtain health insurance for you and your family. Most people who enter the country on an E2 visa will need to put this coverage in place.

Under the ACA, you are required to have minimum essential coverage in place for your medical care. If you do not, you risk facing a penalty fee. However, it’s important to note that the federal tax penalty for not having health insurance was eliminated, effective January 1, 2019. While there is no longer a federal tax penalty, some states (such as California, Massachusetts, New Jersey, Rhode Island, and Washington, D.C.) have enacted individual mandates and may apply a state tax penalty if you lack health coverage for the year.

 

If you are a foreign worker entering the US on an E2 visa, you must have one of the following in place to avoid a penalty in states with individual mandates:

 

• A health insurance plan in the new health insurance marketplace
• A qualifying individual health insurance plan
• An employer-based health insurance plan

 

 

Insurance options for E2 visa holders

 

Since the Affordable Care Act was introduced, US employers with at least 50 full-time employees are obligated to offer a health insurance plan to full-time staff. In many cases, employers will pay part of the premium, and this is a common employee benefit in the US.

If your employer does not have a workforce of over 50 and they do not provide health insurance for employees, then you are required to purchase an individual plan from the open health insurance marketplace. The vast majority of US healthcare plans will offer the ‘minimum coverage’ necessary to avoid penalties, but you can get advice from a government Marketplace that can compare coverage and find a plan that suits you and your family.

If you are entering the US on an E2 visa for the first time, you should consider buying visitor health insurance before leaving your home country and traveling to the US. This short-term coverage can ensure you are prepared for any treatment that you need in the initial period before your employer or individual marketplace insurance is in place.

 

Insurance for family of E2 visa holders

 

Your spouse and any children accompanying you to the US will also need to be sufficiently covered by a health insurance plan. If they are traveling with you, they should also put temporary visitor health insurance in place. If you will be in the US before them, it may be advisable to consider purchasing a family health insurance plan from the insurance marketplace ready for their arrival.

 

Exemptions

 

There are some people who are exempt from the US health insurance rules. You can claim exemption on the following grounds:

 

• Religious Conscience: You are part of a religious sect that conscientiously opposes accepting insurance benefits. The sect must be recognized by the Social Security Administration according to criteria set out in law.
• Health Sharing Ministry: If you are a member of a health care sharing ministry, you are exempt.
• Indian Tribes: You are part of a recognized Indian tribe or qualify for health services through an Indian care provider.
• Low Income: Your income falls below the minimum threshold for filing a tax return.
• Affordability: If the minimum amount you must pay for the premiums is more than a percentage of your household income, you may be exempt.
• Hardship: You encountered hardship that means you can’t get coverage. These are detailed in regulations issued by the Department of Health and Human Services.
• Incarceration: You are in a jail or another correctional facility.

 

 

Individual Shared Responsibility Payment

 

If you or your family do not take out cover that constitutes minimum coverage, you may be required to make an individual shared responsibility payment when you file your federal income tax return.

You will be required to submit a payment for any months that you did not have minimum essential cover in place or were protected by a coverage exemption.

If you are a foreign national living in the US for a short period of time, you may be exempt from having to pay this shared responsibility payment as you do not qualify as a resident alien for tax purposes. This may be the case even if you have to file a tax return. For more information on the specifics of when and how you qualify as a resident alien, you should contact the IRS.

You may be exempt from the individual shared responsibility payment if you are:

 

• A non-resident alien
• A dual-status alien in the first year of US residency
• A non-resident alien or dual-status alien and file a joint return with your US spouse
• Filing a Form 1040NR or Form 1040NR-EZ
• Claimed as a personal exemption on a Form 1040NR or Form 1040NR-EZ

 

Since the federal penalty for not having health insurance was removed in 2019, only certain states may still enforce a penalty. It is important to check with state authorities if you are moving to a state that still mandates health insurance coverage.

 

When to Enroll for Health Insurance

 

Health insurance in the US typically follows an open enrollment period, which is a specific time of year when individuals can sign up, renew, or change their health insurance plan. This period is usually at the end of each year, covering policies for the following year.

There are exceptions that allow individuals to enroll outside of open enrollment, known as Special Enrollment Periods (SEPs). SEPs are triggered by life events such as:

 

• Loss of health coverage – This includes losing employer-based insurance, individual plans, or eligibility for government programs like Medicare, Medicaid, or CHIP.
• Household changes – If you get married, divorced, have a baby, adopt a child, or experience the death of a dependent, you may qualify for a special enrollment period.
• Recent immigration to the US – Newly arrived immigrants, including E2 visa holders, may qualify for immediate enrollment in an individual health plan outside of the normal enrollment window.

 

If you experience a qualifying life event, you generally have 60 days from the event date to apply for a new health insurance plan.

 

Need assistance?

 

US health insurance rules are challenging to navigate but it is vital as an E2 visa holder that you have adequate cover in place for you and your family if applicable. Failure to do this could result in costly penalties.

As specialist US immigration attorneys, we can guide you through the complexities of the E-2 visa application process, providing expert guidance to ensure the petition, documentation and business plan are comprehensive and effective in demonstrating your eligibility.

For advice on your E-2 visa application, contact us.

 

FAQs

 

Do E2 visa holders need health insurance in the US?

E2 visa holders and their families should have health insurance since there is no national healthcare system in the US Without coverage, medical expenses can be extremely high.

 

Is health insurance required by law for E2 visa holders?

There is no federal penalty for not having health insurance since 2019 However, some states still require residents, including visa holders, to have coverage or face a state-level penalty.

 

Can an E2 visa holder get employer-sponsored health insurance?

If an E2 visa holder works for a US company with at least 50 full-time employees, the employer is required to provide health insurance Smaller employers are not required to offer coverage.

 

What if my employer does not provide health insurance?

If your employer does not offer a health plan, you must purchase one through the Health Insurance Marketplace or a private insurer to ensure you have medical coverage.

 

Can I buy short-term health insurance when I first arrive in the US?

Temporary visitor health insurance can be purchased before arrival to cover medical expenses until a long-term plan is in place.

 

Do my spouse and children need health insurance in the US?

Spouses and children accompanying an E2 visa holder should have health insurance They may be included in an employer-sponsored plan or purchase individual coverage.

 

What happens if I do not get health insurance in a state with a mandate?

States like California, Massachusetts, New Jersey, Rhode Island, and Washington DC may impose a penalty for not having insurance Check state regulations to confirm the rules where you live.

 

When can I enroll in a US health insurance plan?

Most people can only enroll during the open enrollment period at the end of the year However, recent immigrants and those with qualifying life events may apply at any time.

 

What is a Special Enrollment Period?

A Special Enrollment Period allows someone to buy health insurance outside of open enrollment due to life changes such as getting married, having a baby, or losing previous health coverage.

 

Can I keep my foreign health insurance while living in the US?

Some international health plans may offer coverage in the US, but they are often limited It is recommended to get a US-based health plan for better access to care.

 

How do I find the best health insurance plan for my family?

You can compare plans on the official Health Insurance Marketplace website or work with a licensed insurance agent to find a plan that meets your needs.

 

Can I switch my health insurance plan after enrolling?

Unless you qualify for a Special Enrollment Period, you can usually only change plans during the annual open enrollment period at the end of the year.

 

Do I need health insurance if I plan to stay in the US only for a short time?

Even if your stay is temporary, having health insurance is important to avoid unexpected medical bills Short-term health plans are available for visitors.

 

 

Glossary

 

 

Term	Definition
E2 Visa	A nonimmigrant visa allowing investors and their families to live and work in the US after making a substantial business investment.
Affordable Care Act (ACA)	A healthcare law that expanded health insurance access and set minimum coverage requirements for residents, including some visa holders.
Health Insurance Marketplace	A government-run platform where individuals can compare and purchase health insurance plans that meet ACA standards.
Employer-Sponsored Health Insurance	Health coverage provided by an employer to full-time employees, sometimes covering dependents as well.
Temporary Visitor Health Insurance	Short-term medical coverage for new arrivals in the US before enrolling in a long-term plan.
Minimum Essential Coverage (MEC)	The level of health insurance coverage required to meet ACA guidelines and avoid state penalties where applicable.
Individual Mandate	A legal requirement for individuals to have health insurance, which still applies in some states.
Special Enrollment Period (SEP)	A limited time outside the normal enrollment period when individuals can sign up for health insurance due to major life events.
Open Enrollment Period	A designated time each year when individuals can enroll in or change their health insurance plans.
State Health Insurance Mandate	A law in certain states requiring residents, including visa holders, to have health insurance or face penalties.
Health Sharing Ministry	A religious-based alternative to traditional health insurance where members share medical expenses.
Medicaid	A government healthcare program for low-income individuals, generally not available to E2 visa holders.
Medicare	A federal health insurance program for individuals aged 65 and older or with certain disabilities, usually not available to visa holders.
Qualifying Life Event (QLE)	A significant change in circumstances, such as marriage, birth, or job loss, that allows someone to enroll in health insurance outside the open enrollment period.
Individual Shared Responsibility Payment	A tax penalty for not having health insurance, which no longer applies at the federal level but may still exist in some states.
Resident Alien for Tax Purposes	A tax status based on substantial presence in the US, which can affect health insurance requirements.
Nonresident Alien	A foreign national who does not meet the substantial presence test for tax purposes and may not be subject to state health insurance mandates.