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E2 Visa Holder Health Insurance Rules

E2 Visa Holder Health Insurance Rules

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 and avoid government penalties.


The affordable health care act

The affordable health care act (ACA) was introduced in 2013. Sometimes referred to as Obamacare, it requires everyone living in the US to have appropriate health insurance in place or risk facing government penalties. ACA is a government initiative but does not constitute subsidised health care. If you need treatment while in the US the cost of that treatment is your responsibility.

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 cover in place.

Under the Affordable Care Act you are required to have minimal necessary coverage in place for your medical care. If you do no you risk facing a penalty fee of $325 or 2% of your income. 

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: 

  • 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

Employer healthcare

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.


Individual health plan

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 amount of US healthcare plans will offer the ‘minimum coverage’ necessary to avoid penalties but you can get advice from a government Marketplace who can compare cover and find a plan that suits you and your family. 


Temporary health cover

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 travelling to the US. This short-term cover 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 travelling 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.



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 who conscientiously oppose accepting insurance benefits. The sect must be recognised 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 recognised 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: You can’t afford coverage because 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 cover. 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 constitute minimum coverage you will 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 short period of time you may actually be except 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
  • Are 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
  • Are claimed as a personal exemption on a Form 1040NR or Form 1040NR-EZ.


When to enrol for health insurance

You can generally only sign up for a health insurance plan during the ‘open enrolment period’ and this is normally a short period at the end of each year.

There are some exceptions for this based around life events. If you experience a recognised life event this may trigger a 60-day time frame in which you can apply for a health insurance plan and get cover in place.

  • Loss of health coverage: this could be related to employment, individual, or student eligibility for health plans. It also covers loss of eligibility for Medicare, Medicaid, or CHIP.
  • Household changes: If a marriage or divorce forces you to lose coverage outside the normal enrolment period, if a baby is born or adopted outside the enrolment period, or if someone on the plan dies and your health plan is invalidated.
  • Recent immigrants: If you have recently immigrated to the US this qualifies you to enrol outside the standard period of enrolment.


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.

This article does not constitute direct legal advice and is for informational purposes only.

By Nita Nicole Upadhye

Nita Nicole Upadhye is the Founder & Principal Attorney at NNU Immigration. A recognized leader in the field of US business immigration law, Nita successfully acts for corporations and professionals, entrepreneurs, artists, actors, and athletes from across the globe, providing expert guidance on all aspects of US visa and nationality applications, and talent mobility to the USA.

Need legal advice?

For specialist advice on your query, get in touch with our team of US immigration attorneys.​

Need legal advice?

For specialist advice on your query, get in touch with our team of US immigration attorneys.

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For specialist advice on a US immigration or nationality matter for your business, contact our US immigration attorneys. 

For specialist advice on a US immigration or nationality matter for your business, contact our US immigration attorneys.