Most working-age Americans get their health insurance through their employer. Which means a job loss during the coronavirus pandemic could mean losing your health insurance.
In past economic crises, options for buying affordable health insurance were limited. But provisions in the Affordable Care Act, along with actions taken recently by Congress and some states, mean more opportunities for getting coverage. Here’s a guide to the options, which differ depending on your circumstances.
I just lost my job-based coverage, but I’d really like to keep it.
You can keep your coverage for as long as 18 months under the federal law known as the Consolidated Omnibus Budget Reconciliation Act (COBRA). But only if you’re willing to pay as much as the total amount of your premium (monthly fee) — both what you normally pay and what your employer had contributed toward your premium.
Although particular circumstances vary, COBRA coverage tends to be more expensive than coverage in the Obamacare marketplaces. It may be a particularly desirable option for anyone in the middle of treatment for an acute or chronic condition because it will allow you to keep seeing the same doctors. Your employer may also be willing to subsidize some of the monthly cost for a period.
I just lost my job, and my income is close to zero.
In 36 states (plus the District of Columbia), you most likely qualify for the federal-state health insurance program known as Medicaid. Because of Obamacare, most states now allow all residents to qualify for Medicaid if their household’s monthly income is below a certain threshold — around $1,400 for a single person or $2,950 monthly for a family of four.
For somewhat complicated reasons, the best way to apply for Medicaid if you’re in this situation is to go directly to your state Medicaid agency, not the Healthcare.gov site.
Medicaid coverage typically has no or very low premiums and has very low copayments when you go to the doctor or fill a prescription. But it tends to cover fewer doctors than work-based insurance coverage does.
If you live in a state that has not expanded its Medicaid program, qualifying for coverage may be harder. You may need to be a parent or meet other qualifications. Your child may qualify for coverage even if you don’t.
If your monthly income is low enough to qualify for Medicaid but you expect your annual income to be higher than the above income thresholds, you could also choose to buy an Obamacare marketplace plan, probably with substantial subsidies. See below.
I just lost my job with benefits, but my family still has some income.
If you have recently lost your job-based coverage, you can qualify for a special enrollment period to buy insurance on the Affordable Care Act marketplaces. Coverage there is subsidized on a sliding scale according to income, and there are several choices of plans in most markets.
To look at your options, Healthcare.gov is a good first stop. Some states list insurance options on their websites, but the federal site will point you in the right direction.
Depending on which state you live in, you may need to provide documents showing that you recently lost your job. You may also need to provide proof that your income is now lower than it was when you filed your last tax return, if it has fallen.
I currently buy Obamacare insurance, but I’m making less money than usual.
The subsidies people get for insurance in the Obamacare marketplace are calculated at the beginning of the year, based on estimated income for that year. But if you bought insurance and your income changes, you can go back to the marketplace and adjust. You may need to provide documents proving the income change, like a termination letter or a recent paycheck.
At the end of the year, your subsidies will be settled once you file your taxes. If you miscalculated and received too much in subsidies, you will have to repay the difference then.
I didn’t buy health insurance this year, but I’d like some now in case I get the coronavirus.
Normally, you can sign up for insurance only once a year unless something major in your life changes, like a job loss, a divorce or a move to a new insurance market. But because of the coronavirus pandemic, some employers and states are loosening those rules. So far, 11 states and the District of Columbia are allowing uninsured residents to sign up for Obamacare plans now, regardless of why they are uninsured. The states are California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington, and you can go to their insurance marketplace websites.
Some employers are doing the same, so it may be worth checking with your company’s human resources department if you’re still employed and eligible for work-based coverage.
I bought a short-term health plan this year, but now I’d like a more comprehensive one.
Short-term, limited-duration health plans are less likely to cover testing and treatment for coronavirus than more comprehensive plans offered through Medicaid, the Obamacare marketplaces or most workplaces. If you bought a plan like this and want to switch to a broader one, your options are similar to those for people with no insurance. If you are in a state with a special enrollment period, you can sign up for Obamacare insurance now. If your employer offers a special enrollment period, you may also be able to enroll in that type of coverage.
But if you’re in a state that hasn’t changed its normal policy, you will be eligible to enroll in new coverage only if you have a qualifying life event like a divorce or if your income is low enough that you qualify for Medicaid.