In 2025, over 2 million domestic workers in the United States — including nannies, house cleaners, caregivers, and home cooks — are doing vital work without access to reliable health coverage. Whether you’re documented or undocumented, there are legal ways to get health insurance, and this guide explains them step-by-step.
Who Is a Domestic Worker?
A domestic worker is someone employed in a private household to provide services such as:
- Childcare (nannies, babysitters)
- Housekeeping or cleaning
- Elderly or disability care (home health aides)
- Cooking, laundry, or other household tasks
Many domestic workers:
- Are women (over 90%)
- Are immigrants (both documented and undocumented)
- Work part-time or informally (without contracts)
Because of these factors, many are left out of employer-based insurance or government assistance.
💡 Can Domestic Workers Get Health Insurance?
Yes — domestic workers can get health insurance in multiple ways, depending on:
- Your immigration status
- Household income
- State of residence
- Whether you file taxes
Even undocumented workers can access some care.
🔍 1. For U.S. Citizens or Legal Residents
If you are a citizen or have legal residency, you qualify for:
✅ 1.1. ACA Health Insurance (Obamacare)
You can buy a plan through HealthCare.gov or your state’s exchange.
- Based on income
- Premiums may be as low as $0/month with subsidies
- Coverage includes dental, vision, maternity, mental health, and emergencies
📝 To Apply:
- File taxes
- Provide income documentation (even cash income is accepted)
- Show ID or residency documents
✅ 1.2. Medicaid
If your income is below the federal poverty level (FPL), you may qualify for free Medicaid.
📝 2025 Medicaid Income Limit (example):
For a single person: under ~$20,000/year
For a family of 2: under ~$27,000/year
(Varies by state)
🔍 2. For Undocumented Domestic Workers
Even if you don’t have legal papers, you still have some options:
✅ 2.1. Emergency Medicaid
Covers ER visits, labor/delivery, and urgent care — available in all 50 states.
✅ 2.2. State Health Programs
Some states offer limited coverage regardless of immigration status:
- California – Medicaid access now includes all low-income adults
- New York – Emergency + pregnancy Medicaid for undocumented immigrants
- Illinois – Covers undocumented seniors and pregnant women
✅ 2.3. Community Health Clinics
Visit FindAHealthCenter.HRSA.gov — these clinics provide:
- General care
- Dental services
- Vaccinations
- Mental health care
💵 Often free or on a sliding scale, no insurance needed.
🧾 3. If You’re Paid in Cash — Can You Still Apply?
Yes! Even if you get paid in cash or under the table, you can still get coverage IF you:
- File taxes (report cash income)
- Use Form 1099 if considered an independent contractor
- File as self-employed (this qualifies you for ACA subsidies)
📝 Why File Taxes?
You become eligible for Obamacare subsidies, EITC, and Social Security benefits later.
🧍 Real Example: Maria, a Nanny in Florida
Maria is a part-time nanny, paid in cash. She started filing taxes as self-employed, making $21,000/year. She applied on HealthCare.gov, got a $0/month premium, and now has full coverage including birth control, wellness visits, and mental health therapy.
💡 Tips to Help Domestic Workers Apply for Insurance
- Keep income records, even for cash jobs
- File taxes yearly to qualify for subsidies
- Use a certified enrollment assistant to guide you
- Ask your employer if they’d consider paying part of your premium
- Visit nonprofit groups that support domestic workers (see below)
🏥 Organizations That Can Help
- National Domestic Workers Alliance (NDWA)
domesticworkers.org
Offers policy help, legal aid, and care connections. - HealthCare.gov Assistance Center
1-800-318-2596 – Free help applying in 150+ languages. - Migrant Clinicians Network (MCN)
migrantclinician.org – Support for mobile and undocumented workers.
📋 Summary: Insurance Options by Status
| Status | ACA Plan | Medicaid | Emergency Medicaid | Community Clinics |
|---|---|---|---|---|
| U.S. Citizen | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| Green Card Holder (5+ yrs) | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| Undocumented Immigrant | ❌ No | ❌ No | ✅ Yes | ✅ Yes |
| Cash Paid / No W-2 | ✅ Yes* | ✅ Yes* | ✅ Yes | ✅ Yes |
*Only if income is reported on taxes
🛡 Final Advice for Domestic Workers
Your health matters. Whether you’re caring for kids, homes, or the elderly — you deserve care too. You don’t need to be rich or documented to protect your health. Start by checking what programs you qualify for and file taxes to unlock more options.
💡 Start at: HealthCare.gov