The pandemic has cost you your health insurance. Now what?
There are many stories of tragedy during this COVID-19 pandemic. Not only are people losing their lives, but many are also losing their livelihoods.
Along with that job loss comes the loss of health insurance in many cases. A new study by the Urban Institute estimates almost 4-million Texans may lose health insurance because of the pandemic. That could mean a massive hit to emergency rooms and healthcare facilities at the exact time when they do not need anything else put on their plates.
There are options, however, for those people who have lost their health insurance, but the time is now to act if you are one of them. In most cases, you must make a switch to another insurance program within 60 days of losing your coverage from your employer.
The first and typically most expensive option is COBRA coverage. That is an extension of the insurance you were getting through your employer. The difference is you are paying the entire monthly premium instead of your employer covering all or part of it. The reason Texas Employers for Insurance Reform exists is to work to enact policies that lower health insurance premiums for employers because if that happens, the cost of COBRA coverage becomes less expensive as well.
There is a deadline to enroll for COBRA coverage. You must enroll within 60 days of the end of your employer-provided health insurance, and that coverage will typically last 18-36 months. One thing to remember, if you terminate coverage early, you cannot enroll again.
Of course, the thought of paying a bill that could be well over $1000 a month, or even higher for family coverage, through COBRA seems impossible if you are out of work and existing on unemployment. Your priority is for things like housing and food. Affording a massive insurance bill on top of that is something that many people will not be able to do.
The more affordable option is enrolling in the Marketplace, which is coverage provided by the Affordable Care Act, or Obamacare. This coverage can still be expensive, especially if you are out of work, but it should be far more affordable than COBRA.
Typically, enrollment in the Marketplace would not be allowed because the open enrollment period has long since passed, but the pandemic has changed that. Certain qualifying life events may allow you to enroll in coverage outside of the Marketplace open enrollment period. Losing employer-sponsored health insurance or losing other types of health coverage such as Medicaid and the expiration of COBRA benefits are qualifying life events and allows you the opportunity to take advantage of the special enrollment period. There are deadlines to enroll for this coverage as well. If you know your employer-provided insurance is ending a few weeks from now, you can enroll up to 60 days before it ends. You also have up to 60 days after coverage ceases to enroll.
As far as the cost, it depends. The factors include which plan you choose and what subsidies are available to you. Around 80 percent of those enrolling do qualify for a subsidy, which can significantly reduce the initial sticker shock and make these plans more affordable even if you are only living on unemployment. If you make up to 400 percent of the federal poverty limit, you could qualify for a subsidy. Eligibility and the subsidy amount is calculated based on income and family size.
The bottom line is, health coverage is essential and something you and your family need, especially during this time. You must investigate all the possibilities out there.
When you shop on the Marketplace, you can also find out if your family qualifies for no cost or low-cost programs like Medicaid and CHIP. To shop for coverage through the Marketplace, go to Healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325). If you need assistance with the application, local help is available online here: https://localhelp.healthcare.gov/#/.
Bill Hammond is the President of Texas Employers for Insurance Reform, an organization dedicated to making health insurance more affordable for employers and their employees.