Topics:health insurance guides
A special enrollment period is running from February 15, 2021 to May 15, 2021 in many states. If you don't have coverage, you can enroll in a health plan. Learn more about this special enrollment period.
That's the percentage of Americans who don't know their health insurance options if they were to lose their coverage according to a recent study by HealthInsurance.com.
If you're in that 54 percent, read on to learn more about your options for getting the coverage you need to defray health care costs. If you didn't have health insurance through your job and want to have coverage just in case, you'll also learn about health insurance options that may be available to you.
In addition to reviewing your health insurance options if you lost employer-sponsored coverage or didn't have any health coverage, I'll also summarize how legislation in response to COVID-19 has affected health care coverage:
Normally, you can only enroll in a health coverage during open enrollment. However, a qualifying life event triggers a special enrollment period. Because you lost your health coverage when you lost your job, you qualify for a special enrollment period. This allows you to enroll in a health insurance plan even though it may not be open enrollment. Special enrollment periods end 60 days after the qualifying event.
If your spouse has health insurance through their employer, you can work with their human resources department to be added to be added to your spouse's insurance plan during your special enrollment period.
You can also choose to extend your former employer's coverage through COBRA, buy private health insurance, or buy an Affordable Care Act plan through the health insurance marketplace.
If these plans aren't a good fit, you can explore alternatives. These options include short term health insurance, health care sharing ministries, and government-funded plans. To learn more about these, jump ahead to "I did not have health insurance through my former employer."
For more on Special Enrollment Periods, read "[Infographic] 5 Questions to Ask About Special Enrollment Periods".
COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It allows you to continue your employer coverage for 18–36 months. To be eligible for COBRA the following must apply:
If you're a dependent of someone who lost their job or now has reduced hours, you also qualify for COBRA coverage. Dependents are also eligible for COBRA if the employee becomes eligible for Medicare, in situations of divorce or legal separation, and if the employee passes away.
If you choose to enroll in COBRA continuation coverage, you'll take full financial responsibility for participating in the health plan. The employer contributions will become your responsibility.
"If someone loses their job because of COVID-19, they should first figure out when their health insurance will run out and what COBRA will cost them. COBRA is typically prohibitively expensive, but may be worthwhile if you have special or extensive health care needs or existing health care relationships you need flexibility to maintain," Deborah Gordon, The Health Care Consumer’s Manifesto author.
Your former employer is legally obligated to provide you information on COBRA and enrollment. You typically have 60 days from when you receive the election notice or lose coverage, whichever is later to decide whether to enroll in COBRA. COBRA can also be retroactive, so if you do not enroll and need medical care within the 60-day election period, you can enroll, pay past premiums, and have coverage.
You can enroll yourself or your dependents separately in COBRA. Each eligible person must make an election to be covered through COBRA.
For more information on COBRA, read the Department of Labor's helpful FAQ.
Insurers can offer plans that do not meet the Affordable Care Act guidelines. Because these plans don't have to cover everything Affordable Care Act plans do, you may be able to find a plan that offers the insurance coverage you need at a lower price. These plans can have a lot of variability, so you need to carefully review what's covered and what isn't along with the premiums and out-of-pocket costs.
Private insurers also offer off-exchange plans that do meet Affordable Care Act guidelines. These plans are not listed on your state's health insurance marketplace and are not eligible for premium-subsidies. However, they still offer comprehensive coverage. Working with an independent insurance agent can help ensure that you find a plan that meets your needs.
If you visit HealthCare.gov, you can view the Affordable Care Act plans (also called Marketplace plans) available in your area. Depending on your financial circumstances, you may be able to qualify for a subsidy on monthly premiums. Marketplace subsidies make the monthly premium more affordable by giving you an advance tax credit. If you took too much or too low of a subsidy, the balance is adjusted when you file your tax return.
Affordable Care Act plans do not have exclusions for pre-existing conditions and provide comprehensive coverage for health care services.
If you're in good health and are under 30, you may be able to opt for a catastrophic insurance plan. These plans have low premiums and high deductibles. These plans are designed for people who don't have medical concerns and mainly need coverage for emergency situations.
If you did not have health insurance through your former employer, you'll have to wait for the next open enrollment period to enroll in a typical health plan. However, some states have opened statewide special enrollment periods because of COVID-19 concerns. Do a quick Google search or check this helpful HealthInsurance.org article to see what your state has done.
If your state has opened a special enrollment period, review the options in the "I had insurance through my former employer." If not, the options below are still available to you.
Short-term plans can be bought year-round. These plans offer coverage for doctor visits and emergency room services. In some cases, they may even offer some coverage for prescriptions.
These plans are very limited because they do not cover pre-existing conditions. Once your current short-term plan ends, any medical issue that occurred within that time frame is a pre-existing condition when you renew or buy another plan. Some states do not allow short-term plans
If you just need some coverage to get you through, a short-term plan can be a great health insurance option. Just be sure to pick the longest term length you need in case any medical issues arise.
For expert advice on short-term health insurance, read
You can also buy indemnity health plans without needing an enrollment period. These plans offer set benefits for specified health care services. You'll be responsible for paying your health care provider and making claims with the insurance company.
"An indemnity plan may pay a maximum of $3,000 per day for a day in the hospital or maybe $5,000 a day, some only pay $300–$400 per day. So you have to really understand how they work. It can be a great value, but education is crucial," says Eric Wilson, Principal of Wilson & Associates.
Understand what the fixed payments are for claims and check what services are covered. You'll also want to pay attention to coverage exclusions. Like short term health insurance, indemnity plans typically do not cover pre-existing conditions.
Another alternative to health insurance are health insurance ministries. Health care sharing ministries are usually connected to religious groups and expect members to live religious, low-risk lifestyles and be healthy. These are attractive, especially to people in good health, because the monthly premiums are usually lower than health insurance.
Laura Handrick, Choosing Therapy contributing HR professional, shares her experience with a health care sharing ministry:
"After extensive research, we chose a health share instead of insurance. The costs of these programs run 50–75 percent less than traditional healthcare. For just over $400 per month, we have access to low-cost medications, free telehealth, and affordable medical visits. Catastrophic health issues are covered, often at higher rates than traditional insurance."
While these ministries can offer valuable coverage, realize that health care sharing ministries aren't technically insurance. They do not have the same legal obligations as insurers. Do thorough research because covered services vary.
For more information on health care sharing ministries, read HealthInsurance.org's health care sharing ministry overview.
The government funds several programs to help specific demographics access health care. Most people become eligible for Medicare when they turn 65. However, there are other eligibility criteria that allow people to qualify sooner with certain diagnoses like End-Stage Renal Disease.
Medicaid eligibility is primarily determined by income. In some cases, you may qualify because of disability or significant medical needs. Check your state's Medicaid policies even if you think you won't qualify. Some states have expanded Medicaid to increase access.
"Some people may qualify for Medicaid, the public insurance program for lower-income people. In some areas, not as many doctors or health care providers accept Medicaid, but, to cover you in a gap, it may be worth signing up. It is usually free or very low cost if you qualify, and the benefits are mandated and comprehensive," says Gordon.
The Children's Health Insurance Plan (CHIP) provides health insurance for children who do not qualify for Medicaid, Medicare, or have other insurance options. If you don't qualify for Medicaid coverage, you may be able to get coverage for your children through this program.
Telemedicine services are not health insurance. However, if an insurance plan isn't an option for you, buying a telemedicine subscription can make it easier and more affordable to receive non-emergency medical diagnoses and medical advice.
Telemedicine apps work differently. Some are subscription-based and allow a certain number of virtual visits per month. Others are fee-based and charge a set fee for each virtual visit. As you compare telemedicine services and costs, be sure to check that the application's security is HIPPA-compliant.
Telemedicine is especially helpful right now as clinics and hospitals have instituted protocols and restrictions to prevent the spread of COVID-19. Having access to medical professionals through telemedicine can help offer you peace of mind.
For more on telemedicine, review:
Several pieces of legislation have been passed in response to COVID-19 including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act.
"A key focus of the CARES Act is the adoption of a variety of measures designed to expedite the approval and availability of drugs and devices needed to fight the pandemic, to shore up the financial positions of hospitals and other healthcare providers facing unprecedented demands, and to temporarily relax restrictions that may make it more difficult for patients to obtain access to needed testing and care," says Roger Milliner, MetroPlus Health Plan Chief Growth Officer.
Federal legislation has responded to the many different types of needs created by the current crisis throughout the United States. States have also taken independent action to respond. We'll focus on federal changes specifically related to health care and health insurance.
These governmental changes have made accessing telemedicine easier.
"The CARES Act expands telemedicine so that healthcare providers and consumers can speak over the telephone, Skype, or Facetime to conduct a medical appointment. Telemedicine allows for diagnosis and a treatment plan to be developed over the phone, and the doctor can order labs or prescriptions as needed. This ease and efficient use of technology is typically a much more cost-effective solution that can help people who are uninsured receive reasonably priced treatment.” says Jan Dubauskas, healthinsurance.com Vice President.
The CARES Act also expanded how Health Savings Accounts (HSAs) can be used to include telemedicine, over the counter drugs, and menstrual products.
Some insurers also made adjustments to cover telemedicine visits the same way they cover in-person visits on plans that did not include coverage for telemedicine.
As far as handling COVID-19 health expenses, the Families First Coronavirus Response Act and the CARES Act have made managing those costs easier for people with and without health insurance.
"The CARES Act will make payments to certain providers if they agree to treat all COVID-19 patients with a preferred payment schedule as in-network patients, keeping costs down for patients whose coverage is out of network," says Dubauskas.
Even with these legislative measures in place, your hospital may not qualify for or seek these incentives. If you get an unexpected bill, ask questions about the CARES Act and what payment options exist. In some cases, it may be helpful to seek a lawyer's advice.
"In the worst case, if you don’t qualify for lower-cost insurance and you can’t afford to buy private coverage, you can wind up with a hefty medical bill if you get sick with COVID-19 or otherwise. In that case, negotiate! Ask for a payment plan. Seek forgiveness for the medical debt. No matter what, though, get care if you need it, and sort out the finances when you can," recommends Gordon.