Q. I was laid off right before open enrollment ended, and now do not have any income/insurance. Was I still required to sign up for insurance by the end of open enrollment? What if I can’t afford it? I am looking for a new job, but it is going to take some time. What happens when I do get a job and receive health benefits again?
A: Losing your employer-sponsored insurance because you were laid off counts as a qualifying event, so your open enrollment goes for 60 days from the date your old policy ended (even if you have the option to elect COBRA). If you want to purchase a new ACA-compliant plan, you’ll need to complete your enrollment within that time frame.
The penalty for being uninsured no longer applied after the end of 2018, but being uninsured is perilous in and of itself, and once your special enrollment period ends, you won’t be able to sign up for coverage again until the fall (with a plan effective the following January) unless you become eligible for a new employer’s plan.
Depending on where your income ends up, you may qualify for premium subsidies in the exchange (these actually extend well into the middle class; a family of four can get premium subsidies in 2019 with an income as high as $100,400).
Medicaid may be an option for you, depending on where you live. If you’re in a state that has expanded Medicaid, coverage is available if your income is up to 138 percent of poverty level (above that level, premium subsidies are available up to 400 percent of the poverty level). If your state has not expanded Medicaid, eligibility is significantly more restricted. (Here are Medicaid eligibility guidelines for each state.) Contact your state Medicaid office or the exchange to see if you could qualify for Medicaid until you get another job.
If you’re in the coverage gap because you’re in a state that hasn’t expanded Medicaid, you’ll have an opportunity to enroll in a subsidized health insurance plan through the exchange later in the year if you find a job that puts your income at or above the poverty level (assuming the job doesn’t come with health insurance and you need to purchase your own coverage). This was a rule change that took effect in 2015.
Normally, a change in income does not count as a qualifying event. But for people who are in states that haven’t expanded Medicaid and are ineligible for Medicaid or premium subsidies because their income is below the poverty level, HHS made an exception to the rule. As of 2015, people in that situation are allowed to enroll in a subsidized exchange plan as soon as their income reaches 100 percent of the poverty level, regardless of when that happens during the year.
If you’re unable to afford an ACA-qualified plan while you’re between jobs, you might want to consider a short-term health insurance plan. These temporary health insurance plans are not regulated by the ACA, so they still use underwriting, don’t cover pre-existing conditions, impose caps on benefits, don’t have to cover preventive care, etc. But they’re better than nothing and they’re far less expensive than an ACA-qualified plan.
If you get coverage on your own – either Medicaid or a private plan – and then get a new job that provides health insurance benefits, you’ll be able to cancel the interim insurance and switch to your employer’s plan once you’re eligible for coverage. Coverage in the individual market is issued on a month-to-month basis; there are no annual contracts, so you can cancel at any time, although the only available termination date is typically the last day of the month.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.