Many Americans who lose their jobs during a pandemic would be eligible either for Medicaid or for subsidized private plan coverage in the ACA marketplace. | Image: highwaystarz / stock.adobe.com
We all have plenty to fear from the coronavirus: serious and life-threatening illness, sudden loss of job or income, physical separation from loved ones.
If there’s any silver lining, it will come through social solidarity. With a highly contagious disease circulating, the health of each of us is the health of all us. After a slow start, federal and state governments are moving swiftly to provide guidance and relief: free coronavirus testing, paid sick leave, increased unemployment insurance, and, probably soon, loans to small businesses and cash relief to individuals.
To slow the spread of the disease, it’s essential that Americans have access not only to coronavirus testing but to affordable care should they become ill – just as many may lose job-based insurance. To that end, the Affordable Care Act is on standby, as the financial help it provides to those who lack access to job-based insurance or Medicare is based on income.
Many Americans who lose their jobs will be eligible either for Medicaid or for subsidized private plan coverage in the ACA marketplace. The tips below will help you seek and find coverage if you need it, or get your costs reduced if you’re already covered through the marketplace and your income drops.
Need coverage? Here’s where to start.
To make use of the information below, these websites are starting points:
Apply for Medicaid: State Medicaid websites
Medicaid expansion states: Medicaid expansion map
Coverage of COVID-19 testing, treatment
While Americans’ ability to get tested for the coronavirus has to date been extremely limited, that is likely to change soon as multiple state and commercial test producers come online. The Families First Coronavirus Response Act, created by House Democrats and signed by President Trump on March 18, makes testing and associated office visits free for all Americans – that is, those with employer-sponsored or ACA-compliant individual market insurance, Medicare, Medicaid, or no insurance at all.
Treatment (beyond testing) for those who require it is covered according to the terms of your own insurance. Currently, the deductibles and copays or coinsurance stipulated by your plan apply, though advocates are calling for the government to pick up this tab too.
How can you get ACA coverage if you lose your job?
If you lose your job – and your employer-sponsored health insurance with it – you become eligible for a special enrollment period in the ACA marketplace. You can apply through HealthCare.gov if you’re in one of the 38 states that use the federal website. Twelve states and Washington D.C. run their own ACA exchanges. You can also get assistance from a licensed broker through this site. You can also get started via the HealthCare.gov Help Line, 1-800-318-2596, or by calling the help line posted on each of the state-based exchanges.
If your estimated income for the year – including expected unemployment insurance – is below 400% of the federal poverty level ($49,960 for an individual, $67,640 for a couple, $103,000 for a family of four), you probably qualify for advanced premium tax credits – aka premium subsidies – a federal subsidy that picks up much or most of the monthly premium for plans offered on the exchange. This ACA subsidy calculator can give you a sense of how large your premium subsidy might be.
To get a quick sense of how much you may pay for coverage in the ACA marketplace, and what plans are available at what prices, you can use the “See plans and prices” preview tool if you’re in one of the 38 states using HealthCare.gov. Most state-based exchanges have similar tools. If you answer about a half-dozen questions about income, age, family size etc., you will see what’s available. Unlike in an actual marketplace application, you maintain anonymity in this preview.
In the 36 states (and the District of Columbia) that have implemented the ACA Medicaid expansion, you should qualify for Medicaid if you lose your job – or you’re a freelancer who loses much of your income – and your monthly income going forward is below 138% of the federal poverty level ($1,468 for an individual, $3,013 for a family of four*). Apply through your state Medicaid office or website.
Important note for those whose income falls abruptly, e.g., to zero: While the ACA marketplace (HealthCare.gov for 38 states, state-based exchanges in 12 states and D.C.) calculates subsidy eligibility and Medicaid eligibility on the basis of yearly income, state Medicaid departments determine Medicaid eligibility on the basis of monthly income.** Accordingly, if your earnings before layoff or loss of work were substantial, and your income going forward is zero or below the Medicaid threshold, you should apply for Medicaid through a state office or website, not through the ACA marketplace.
3/26 Update: It’s been reported that the enhanced unemployment benefits in the COVID-19 relief bill that passed the Senate by a 96-0 vote last night will not count in determining eligibility for Medicaid and CHIP but will count toward determining ACA marketplace subsidies. That’s all the more reason to try your state Medicaid office first if you may be eligible for Medicaid, as the ACA exchanges may not be able to count the income for one purpose and discount it for the other.
If you are currently insured through the ACA marketplace and your income drops, you can report a qualifying life event through HealthCare.gov (in 38 states) or through your state-based exchange (in the other 12 states and D.C. ). With a reduced income, you may pay less for your monthly premium, or you may newly qualify for cost-sharing reduction (or more CSR if you already have it). You may also be newly eligible for Medicaid – which is usually zero-premium – if you are in one of the 36 states (or D.C.) that have enacted the ACA Medicaid expansion.
If you bought an ACA-compliant plan outside the marketplace for 2020 and your income drops, you may be eligible for a special enrollment period to switch to subsidized marketplace coverage, if your income qualifies you. Explore via HealthCare.gov or your state-based exchange.
Coverage if you are uninsured
If you are uninsured and did not lose your insurance within the last two months, normally you would not be able to obtain ACA-compliant insurance until 2021. To date, however, 10 state-based marketplaces have opened emergency special enrollment periods for anyone who is uninsured, open either through April 15 or early April.
There is a good chance that the federal government will follow suit for the 38 states using the federal exchange, HealthCare.gov, though that hasn’t happened yet. If you are uninsured, also remember that testing for the coronavirus, where available, will not cost you anything.
If you’re not eligible for ACA-compliant coverage
With all of the options presented above, it’s worth noting that a portion of the population will not have access to a special enrollment period – or they will be ineligible for ACA marketplace subsidies and find the full cost of coverage unaffordable. For these individuals, short-term health insurance plans may be an option.
These lightly regulated plans exclude coverage for pre-existing conditions, are not required to cover essential health benefits covered by ACA-compliant plans. They’re also not required to cover coronavirus testing. Short-term plans are also not currently sold in all states. Check the availability of short-term plans in your state.
Get covered if at all possible
If this all sounds complicated, it sometimes is. But affordable insurance is available to most Americans, and with the tools above you will likely find your way. In many cases, application and enrollment can be completed within an hour.
Again, in-person help is available, either from a licensed agent or nonprofit assisters chartered by the ACA. You can find the latter through the “Get Help” tabs at HealthCare.gov and the state exchanges.
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* While the marketplace uses Federal Poverty Level totals for the year in which open enrollment occurs (2019 for 2020), Medicaid uses current-year numbers (2020) at present.
** Thanks to John Graves for highlighting this point.
Andrew Sprung is a freelance writer who blogs about politics and policy, particularly healthcare policy, at xpostfactoid. His articles about the rollout of the Affordable Care Act have appeared in The Atlantic and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Digital Media Award. He holds a Ph.D. in English literature from the University of Rochester.