The Affordable Care Act Can Help Au Pairs Avoid Medical Debt

In 2016, Isis Mabel, of Mexico, was in her 20s and wanted to improve her English. On advice from an aunt, she enrolled with an au pair agency to come to the United States to live with a family and care for the children. The job typically pays about $200 a week on top of lodging and meals. Along with her application, the agency requested $360 from Mabel — a one-time charge that was to cover certain costs, including visa fees and health insurance, the agency explained.

That conversation was “super quick,” she says, with no details on what the health insurance would cover. When she arrived in the United States, she recalls, a representative of the au pair agency recommended she buy extra insurance to cover injuries that might result from participation in sports, from skiing to swimming in a pool — because even an accident caused by jumping could be considered sports-related, the agency said. Mabel opted to purchase that extra policy for another one-time fee of $180.

The summer after she started her au pair job, Mabel’s birth control implant expired and she had it removed — a procedure she assumed would be covered by her insurance, given birth control coverage is part of Mexico’s universal health care system.

Instead, she says, she got a bill for about $4,500. The health insurance she’d bought through the au pair agency didn’t cover contraception or other reproductive health care.

Her health plan was more like emergency travel insurance

According to the State Department, 14 au pair agencies operate in the U.S. These private companies are required to offer their au pairs basic health coverage under State Department regulations. But some of the plans amount to emergency or travel insurance — excluding many types of necessary care, according to Natalia Friedlander, a staff attorney at the Rhode Island Center for Justice, a nonprofit public interest law center.

After an au pair she herself employed had problems with health coverage, Friedlander examined insurance offered by about half those agencies in 2020; her center then posted information online to help au pairs find comprehensive coverage.

In her review, Friedlander discovered that agencies don’t always mention to au pairs that they are eligible to enroll in comprehensive coverage on the Affordable Care Act marketplaces, nor that they’d likely qualify for subsidies to help pay their premiums. By failing to enroll in ACA plans, au pairs can wind up with huge medical bills if they need care.

A spokesperson for the State Department says those 14 agencies are subject to the same regulations as other groups that sponsor exchange students and other visitor programs, and must require the au pairs to “have insurance in effect that covers the exchange visitors for sickness or accidents during the period of time that they participate in the sponsor’s exchange visitor program.”

The criteria…