Navigating Health Insurance Options for Farmworkers

Health Insurance Options

Farmworkers can access health insurance in a number of ways, depending on income, immigration status, and eligibility for public and private insurance programs. Since health insurance options can vary significantly based on immigration status, this article is divided into four sections:

1. U.S. Citizens and Permanent Residents (Green Card Holders),
2. Workers with Temporary Protected Status (TPS), Parole, Asylum Applicants, or Similar Statuses,
3. Seasonal Agricultural Workers (H-2A Visa Holders),
4. Undocumented Accessing Care Regardless of Immigration Status.

While Pennsylvania-specific resources are highlighted, the article is designed to be broadly relevant by also including information about programs and services available across the U.S.

1. U.S. Citizens and Permanent Residents (Green Card Holders)

• Employer-provided coverage insurance:
  Some employers offer health insurance to their employees. While it varies from one employer to the next, most often, employers will discuss the health insurance option(s) they offer during the interview process or when an employee is hired. Eligibility for employer-sponsored coverage often depends on full-time employment, typically defined as working 30 or more hours per week, though this can vary. If employers offer a plan, farm workers are not required to accept it. When deciding on whether or not to enroll in the plan, you should consider the type of plan offered, services covered, and all the costs that will be your responsibility (i.e. share of monthly premiums, out-of-pocket expenses, deductibles, and coverage options for dependents). If the plan does not fit your needs, you are allowed to purchase health insurance on the Health Insurance Marketplace™ (see below), but you might not be eligible for cost savings. Check these steps to decide between job-based or marketplace coverage.
• Health Insurance Marketplace™ Plans:
  U.S. Citizens and green card holders can purchase health insurance through Health Insurance Marketplace™. This is an online platform where people can compare and purchase a plan. All plans must cover essential health benefits, including services for chronic conditions, preventive care, and emergency treatment, as required by the Affordable Care Act (ACA) of 2010. There are two types of health insurance marketplaces: some are managed by individual states, while others are administered by the federal government. For example, Pennsylvania has its own health insurance marketplace called Pennie. If you live in another state, the simplest way to find your state's marketplace is by visiting HealthCare.gov. Depending on your household income, individuals and families may qualify for financial assistance to lower monthly premiums and reduce out-of-pocket expenses, such as copayments and deductibles. For example, a family of four earning $50,000 annually could see their monthly premium reduced to $150 with the tax credit. One important thing to note is that the open enrollment period to purchase a plan is from November 1 – January 15 of each year. Outside of that enrollment period, people can buy a plan if they experience a qualifying event (e.g., birth of a new child, loss of insurance coverage from employer). For additional information on how to sign up for marketplace plans, see this article: Open Enrollment on the Health Insurance Marketplace for the Farm Population.
• Health insurance agents and brokers:
  You can buy a health insurance plan directly from the health insurance company or through an insurance broker. However, if you want to access the marketplace insurance plans and the savings, make sure to work with an agent or broker certified to sell marketplace plans. To find a certified health insurance navigator, visit the Healthcare.gov website. Certified health insurance navigators are trained professionals who provide free, one-on-one guidance to help individuals explore coverage options, determine eligibility for financial savings, and complete enrollment. Navigators are often available in multiple languages and can be located through the Healthcare.gov website.
• Medicaid and the Childrens Health Insurance Program (CHIP):
  These are public health insurance plans funded by the federal and state governments that provide free or low-cost coverage for individuals and families with limited income. These programs cover healthcare services such as routine checkups, dental care, vaccinations, and sometimes mental health services for eligible individuals. While Medicaid and CHIP are available to U.S. citizens, green card holders must wait five years before becoming eligible for Medicaid, except in specific cases like pregnancy and children’s coverage. States manage their own Medicaid and CHIP programs, meaning eligibility rules and benefits can vary. The easiest way to check if you qualify and apply for Medicaid or CHIP is by visiting Healthcare.gov or the Insure Kids Now Program, where you will be redirected to your state’s program. Many states, like Pennsylvania, have "no wrong door" policies: if your application on the Health Insurance Marketplace™ meets Medicaid or CHIP criteria, it will be sent to the correct state agency for processing.
• Federally Qualify Health Centers (FQHCs):
  Agricultural workers can access affordable medical services through FQHCs, which operate nationwide and provide care on a sliding fee scale based on income. FQHCs offer services such as primary care, dental care, mental health support, and preventive health screenings. They are a valuable healthcare resource for all farmworkers as they often provide enabling services such as outreach programs, interpreter services, and transportation assistance, making care more accessible and culturally responsive. FQHCs are also more likely to offer culturally competent care, which means they understand and respect the cultural backgrounds of the communities they serve. Many FQHCs employ patient navigators who assist with health insurance applications and guide individuals through the enrollment process. To find the nearest Federally Qualified Health Center anywhere in the U.S., use the HRSA Health Center Locator.

• Rural Health Clinics (RHCs):
  These are healthcare facilities that provide primary care services only to those living in rural areas where there is a shortage of health professionals. RHCs provide primary care and laboratory services and may offer dental services such as cleanings, X-rays, fillings, dentures, and tooth extractions. While not required to offer services on a sliding fee scale, many do and also accept Medicaid and commercial insurance. There are about 5,200 RHCs across the country and 70 in Pennsylvania. To find contact information for your state's rural health office, visit the Rural Health Information Hub.

2. Workers with Temporary Protected Status (TPS), Parole, Asylum Applicants, or Similar Statuses

• Employer-provided coverage insurance:
  Eligibility for employer-sponsored health insurance is typically based on employment status and work authorization rather than specific immigration status. Therefore, if an employer provides health insurance benefits to its employees, workers with TPS or similar statuses who are authorized to work should have access to these benefits. It's important for employees to ask about available health insurance options during the hiring process or through their employer's human resources department. For more details, visit Guide for Immigrant Coverage, which outlines the types of documentation required, explains eligibility criteria and offers resources for applying.
• Health Insurance Marketplace™ Plans:
  Workers with TPS, parole, or pending asylum status—who have work authorization and Social Security Numbers—are eligible for Marketplace™ coverage. Coverage and access to savings are similar to what is described above in the section for citizens and green card holders.
• Medicaid and the Children’s Health Insurance Program (CHIP):
  These programs follow state and federal guidelines to provide free or low-cost health insurance to eligible individuals and families based on income and specific residency status. Adults with TPS status, parole, or asylum applicants typically qualify only for emergency Medicaid, covering urgent conditions like childbirth or severe injuries. However, children of workers with these statuses are often eligible for CHIP, which includes services such as regular checkups, vaccinations, and dental care. For example, in Pennsylvania, CHIP offers comprehensive coverage for eligible children, often without waiting periods. To learn more about Medicaid and CHIP eligibility in your state, visit the Medicaid Program Website or the Insure Kids Now Program.
• Federally Qualified Health Centers (FQHCs):
  FQHCs are an important healthcare option for workers with TPS, parole, or asylum statuses, offering affordable services on a sliding fee scale. They provide primary care, dental services, mental health support, and preventive screenings. As described in Section 1 (U.S. Citizens and Permanent Residents), FQHCs often provide enabling services such as interpreter support, transportation assistance, and outreach programs, making them accessible to diverse farmworker communities. Many centers also have patient navigators to assist with insurance applications. To locate the nearest FQHC, visit the HRSA Health Center Locator.
• Rural Health Clinics (RHCs):
  RHCs serve rural communities with limited access to healthcare professionals and offer primary care and basic laboratory services. Some RHCs also provide dental care. While RHCs are not required to offer services on a sliding fee scale like FQHCs, many still do and accept Medicaid and commercial insurance. For more details on the role of RHCs, see Section 1: U.S. Citizens and Permanent Residents. To find an RHC near you or contact your state's rural health office, visit the Rural Health Information Hub.

3. Seasonal Agricultural Workers (H-2A Visa Holders)

• Employer-Provided Coverage:
  Federal law requires employers to provide workers' compensation or equivalent insurance for work-related injuries and illnesses to H-2A visa holders. This coverage is strictly tied to employment and does not extend to non-work-related medical needs. Employers are required by law to inform H-2A workers about their workers’ compensation coverage. If workers have questions or are unsure of what is available, they can ask their employer, check their work contract, or contact their state's labor department. Additional information about workers' rights and benefits can be found at Farmworker Justice and the U.S. Department of Labor H-2A Program.
• Health Insurance Marketplace™ Plans:
  H-2A visa holders are eligible to purchase health insurance through gov or, if available, their state health insurance marketplace, as is available in Pennsylvania. While their employer must provide workers' compensation, H-2A workers can use the marketplace to buy health plans that cover non-work-related medical needs, such as preventive care or treatment for illnesses. Depending on income, they may qualify for premium tax credits to help lower the cost of insurance. Workers can explore their options at healthcare.gov or through certified health insurance navigators. These are trained professionals who provide free, one-on-one guidance to help individuals explore coverage options, determine eligibility for financial savings, and complete enrollment. Navigators are often available in multiple languages and can be located through the Health Insurance Marketplace™ website. Arriving in the U.S. on an H-2A visa qualifies as a change in residence that grants a Special Enrollment Period, allowing enrollment outside the standard Open Enrollment Period. It is important to remember that before leaving the U.S., H-2A workers should contact their insurer's customer service to disenroll from their health insurance plan and avoid ongoing charges. Enrolling in health insurance does not affect their ability to renew their visa in the future. For more information on choosing a health plan and understanding premium tax credits, see Section 1 (U.S. Citizens and Permanent Residents) in this article.

• Federally Qualified Health Centers (FQHCs):
  Seasonal agricultural workers can access affordable medical services through FQHCs, which operate nationwide and provide care on a sliding fee scale based on income. For more information on FQHCs, including the services they offer, refer to Section 1 in this article.
• Rural Health Clinics (RHCs):
  RHCs can be a valuable healthcare option for seasonal agricultural workers, especially in rural areas with limited access to healthcare providers. These clinics offer primary care and laboratory services, with some providing dental care. While they are not required to offer services on a sliding fee scale, many do and also accept Medicaid and commercial insurance, making them a practical choice for workers seeking affordable care. To find contact information for your state's rural health office, visit the Rural Health Information Hub.
• Independent Healthcare Providers:
  In areas without access to FQHCs or RHCs, H-2A workers can seek care from independent healthcare providers, such as private clinics or urgent care centers. Some providers accept self-pay patients and offer sliding-scale fees or delayed payment plans. Workers or their advocates may need to call individual practices to learn about available options and pricing.

4. Accessing Care Regardless of Immigration Status

Farmworkers without formal immigration status face the most barriers to accessing and paying for health care. Their options vary based on the state they live in.

• Employer-Provided Coverage:
  While employers cannot offer traditional health insurance to farmworkers without formal immigration status, some support their workers by offering alternative assistance. This includes providing healthcare stipends, paying for a portion of medical expenses, or connecting workers with local healthcare providers or non-profits. Employers should consult with a tax professional to understand the financial and legal implications of providing health care stipends or paying for a portion of medical expenses. Employers can also collaborate with FQHCs to set up mobile clinics or health screenings on-site.
• Federally Qualified Health Centers (FQHCs):
  FQHCs are the most reliable option for those seeking care regardless of immigration status. These centers offer primary care, dental services, mental health support, and preventive care on a sliding fee scale. An agency in each state is funded to provide care to migrant farmworkers. For example, in Pennsylvania, Keystone Rural Health Center and Berks Community Health Center are well-known for serving the farmworker community, including those without formal immigration status. To locate a nearby Federally Qualified Health Center, visit the HRSA Health Center Locator. FQHCs operate nationwide and are open to everyone, regardless of immigration status.
• Rural Health Clinics (RHCs):
  RHCs can be a helpful healthcare resource, particularly in rural areas with limited medical access. These clinics offer primary care and basic laboratory services, with some providing dental care as well. While they are not required to offer services on a sliding fee scale, many do and also accept self-pay options. To find contact information for your state's rural health office, visit the Rural Health Information Hub.
• Independent Healthcare Providers:
  In areas where FQHCs or RHCs are not accessible, individuals, regardless of their immigration status, can seek care from independent healthcare providers. Some clinics, private practices, and urgent care centers accept self-pay patients, offer discounts, or set up sliding-scale fees based on income. In some cases, they may allow delayed payments. Finding these providers can be challenging, so workers or their advocates may need to call individual practices to ask about available options.
• Emergency Medicaid:
  Everyone, including those without formal immigration status, hasthe right to access emergency medical services in the United States. Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to provide emergency care to anyone needing it, regardless of their immigration status or ability to pay. In an emergency, individuals in need of care should not hesitate to call for an ambulance or go to the nearest emergency room. After receiving emergency treatment, they may be eligible to apply for Emergency Medicaid, which can cover the costs of the emergency care provided. Applications for Emergency Medicaid are typically made after the emergency services have been rendered, and if approved, coverage is retroactive for those services. Many hospitals offer financial assistance programs to help patients manage medical bills. These programs are often available to all patients, regardless of immigration status. It is important for farmworkers or their advocates to inquire about such programs during or after their hospital visit to understand the options available for financial support.

Workers' Compensation for Farmworkers

Workers' compensation laws in the U.S. vary by state, and agricultural workers often face limited protections compared to workers in other industries. In some states, farm employers are legally required to provide workers' compensation insurance, which covers medical bills, lost wages, and disability benefits if a worker is injured or becomes ill on the job. However, many states either exempt small farms from this requirement or offer limited coverage. Even in states where workers’ compensation is not mandatory, farm employers can take proactive steps to support their employees.

• Voluntary Workers' Compensation Insurance:
  Employers can choose to purchase workers' compensation insurance even if not legally required. This protects both the worker and the business from the financial fallout of work-related injuries. The National Agricultural Law Center provides comprehensive resources on workers' compensation laws and options for agricultural employers across different states.
• Medical Stipends:
  If workers' compensation is unavailable, employers can provide health insurance, cover portions of medical bills, or offer stipends to help with healthcare expenses. Employers should consult with a tax professional to understand the financial and legal implications of providing health care stipends or paying for a portion of medical expenses.
• Safe Working Conditions:
  Preventing workplace injuries through proper safety training, personal protective equipment (PPE), and adherence to workplace safety standards can reduce the need for workers' compensation claims. Employers can inform farmworkers about how to report work-related injuries and access healthcare resources, ensuring transparency and trust. The Penn State Ag Safety and Health program offers a number of resources to help keep everyone on the farm safe.

For more information on workers' compensation for farmworkers, including state-specific requirements and guidance on obtaining coverage, visit Farmworker Justice.

How Farmers Can Support Farmworkers

Employers play a crucial role in helping farmworkers access health insurance and healthcare services.

• Offer Employer-Sponsored Insurance:
  • Employers who employ more than 50 or more full-time workers are required to offer health insurance to their employees who work at least 30 hours per week. Depending on the coverage offered, employers may benefit from tax savings for offering it. For more information, visit the IRS Affordable Care Act Information. Employers have several options to offer health insurance including traditional group health insurance, health reimbursement arrangements (HRAs), a direct payment, or a taxable stipend.
  • Employers who employ less than 50 full-time workers are not required by law to offer coverage. If they choose to offer coverage, one option may be the Small Business Health Options Program (SHOP). Employers may qualify for the Small Business Health Care Tax Credits if they employ less than 25 full-time workers, making an average of $56,000 or less per year.
• Provide Clear, Multilingual Materials: The Health Insurance Marketplace™ Plans, Medicaid, CHIP, and local health services help workers navigate complex healthcare systems and explore coverage options based on their eligibility, the Health Insurance Marketplace™ and the Insure Kids Now Program. In addition, this article is available in English and Spanish and was written for farmers and farm workers to help them navigate the Health Insurance Marketplace™.
• Provide Financial Assistance for Healthcare:
  If offering health insurance is not an option (for example, due to cost to the employer or workers' immigration status), employees can support their workers by offering healthcare stipends or reimbursements for specific medical expenses. Employers should consult with a tax professional to understand the financial and legal implications of providing such assistance.
• Expand Healthcare Access Literacy:
  Employers can host on-site information sessions, invite certified health insurance navigators to assist workers with enrollment, and partner with local health clinics to improve access to care. Health insurance navigators are trained professionals who provide free assistance with exploring insurance options and applying for financial savings through the Health Insurance Marketplace™ and other types of support. Employers can also provide translation services to reduce language barriers and ensure workers understand their healthcare options. To find a certified health insurance navigator, visit the Health Insurance Marketplace™ Navigator Directory.
• Proof of Residency:
  A common barrier for newly arrived farmworkers, particularly those who are not H-2A visa holders, is the inability to provide sufficient proof of residency when applying for health insurance, even when they are eligible. Some workers may have been at their location for too short a time, lack bills in their name, or reside on farms where the employer manages utility payments. Farm owners can play a critical role by assisting workers in documenting their residence. This can include:
  • Providing a letter on company letterhead confirming the worker's residence at the farm, including the start date of employment and physical address.
  • Offering housing agreements or proof of employment contracts specifying the living arrangement.
  • Assisting workers in obtaining alternative proof of residency documents, such as a mailed pay stub or official employment records.

Key Considerations for Farmworkers

• Know State-Specific Laws:
  Workers should learn about workers' compensation, healthcare coverage, and labor protection laws specific to the state in which they are working. Contact state labor offices or advocacy organizations like Farmworker Justice for accurate, up-to-date information on legal rights and benefits.
• Document Workplace Injuries:
  In case of a workplace injury, workers should document what happened, when, and how the injury occurred. Promptly notifying your employer is essential to begin the claims process if you are eligible for workers' compensation or other legal protections.
• Explore Healthcare Programs:
  Depending on their eligibility, workers can access various programs, including Marketplace™ plans, Medicaid, CHIP, and Federally Qualified Health Centers. For detailed information on these options, refer to the sections above.
• Ask for Support from Employers and Community Organizations:
  Your employers can assist by offering to connect you with healthcare providers. You can also find local organizations and advocacy groups that may offer additional resources, legal aid, and healthcare navigation assistance.

Resources for Support

Farmworkers, farmers, and organizations can utilize the following resources for health insurance and healthcare guidance:

• Health Insurance Marketplace™: Explore health insurance plans and check eligibility for financial assistance.
• HRSA Health Center Locator: Find nearby clinics that offer affordable care on a sliding fee scale.
• Keystone Agricultural Worker Program: Health services and support specifically for agricultural workers in Pennsylvania.
• National Center for Farmworker Health: Resources and support focused on the health of farmworker communities.
• National Immigration Law Center – Health Care Coverage Maps: State-specific guidance on healthcare access for immigrant populations.
• National Immigration Law Center – Medical Assistance Programs for Immigrants: State-based programs available for immigrants.
• Spanish Health Insurance Marketplace™ Guides:
• Cómo Aplicar y Utilizar Seguro Médico – A comprehensive Spanish-language guide from Farmworker Justice.
• Inscripción Abierta en el Mercado de Seguros de Salud para la Población Agrícola – Spanish-language resource from Penn State Extension.
• Smart Choice Smart Use™ Health Insurance Literacy Tools:
• Smart Choice Workbook (English Only) – A resource developed by the University of Maryland Extension to help individuals make informed insurance decisions.
• Smart Choice Video (Spanish) – A short video explaining key health insurance concepts.

• Health Care Insurance Options for Farm Business Operations: This document includes information for farm business owners who want to help cover their employees
• Resources to Support Mental and Financial Well-being in Agriculture: Tools and services for supporting well-being in agricultural communities.

References

Farmworker Justice

HealthCare.gov. (2024). Health Coverage for Immigrants.

HealthCare.gov (2024). Special Enrollment Opportunities.

KFF. (2023). Explaining Health Care Reform: Questions About Health Insurance Subsidies.

National Agricultural Law Center. (2024). Workers' Compensation for Agricultural Workers.

National Center for Farmworker Health. (2024). Retrieved from NCFH Resources.

Please note that this article is for educational purposes only; it is not intended to be a substitute for professional health insurance navigators, tax professionals, and immigration lawyers. Always seek the advice of the relevant professional if you have specific questions about your situation.