Immigrants’ perceptions of affordability of insurance and knowledge of insurance after health reform are unknown. We conducted face-to-face surveys with a convenience sample of 1124 patients in three Massachusetts safety net Emergency Departments after the Massachusetts health reform (August 2013–January 2014), comparing immigrants and non-immigrants. Immigrants, as compared to non-immigrants, reported more concern about paying premiums (30 vs. 11 %, p = 0.0003) and about affording the current ED visit (38 vs. 22 %, p < 0.0001). Immigrants were also less likely to report having unpaid medical bills (24 vs. 32 %, p = 0.0079), however this difference was not present among those with any hospitalization in the past year. Insured immigrants were less likely to know copayment amounts (57 vs. 71 %, p = 0.0018). Immigrants were more likely to report that signing up for insurance would be easier with fewer plans (53 vs. 34 %, p = 0.0443) and to lack information about insurance in their primary language (31 vs. 1 %, p < 0.0001) when applying for insurance. Immigrants who sought insurance information via websites or helplines were more likely to find that information useful than non-immigrants (100 vs. 92 %, p = 0.0339). Immigrants seeking care in safety net emergency departments had mixed experiences with affordability of and knowledge about insurance after Massachusetts health reform, raising concern about potential disparities under the Affordable Care Act that is based on the MA reform. © 2016, Springer Science+Business Media New York.

Immigrant Affordability Insurance Health reform

Safety-net Providers Information Seeking Behavior information seeking economics health care policy insurance Massachusetts health insurance human Insurance Coverage middle aged statistics and numerical data language Insurance, Health United States Young Adult Humans migrant psychology Adolescent male Emigrants and Immigrants female Socioeconomic Factors socioeconomics safety net hospital adult hospital emergency service Emergency Service, Hospital Health Care Reform Health Services Accessibility health care delivery