How to buy health insurance during the COVID-19 crisis

For many Americans who've lost jobs due to the coronavirus pandemic, affordable health insurance may be possible through special enrollment periods.

Loss of health coverage – including job-related benefits – triggers a special enrollment period during which you can buy ACA-compliant individual health insurance. | Image: Antonioguillem / stock.adobe.com

Can you buy health insurance now?

The COVID-19 pandemic has caused millions of Americans to lose their jobs, and in many cases, that means losing health insurance as well. About half of all Americans get their health insurance from an employer’s plan, and it’s a cruel irony that so many people are losing their jobs in the midst of a time when we need health coverage more than ever. A Families USA analysis found that between February and May of 2020, at least 16 million Americans lost their employer-sponsored health insurance. And about 5.4 million of them became uninsured (as opposed to switching to another form of health coverage), resulting in the largest-ever increase in the uninsured rate.

But the good news is that loss of coverage triggers a special enrollment period during which you can buy ACA-compliant individual health insurance. You can buy your new coverage on- or off-exchange, although premium subsidies and cost-sharing reductions are only available through the exchange.

Loss of a job does not, in and of itself, trigger a special enrollment period. The special enrollment period only applies if you’re losing health coverage (the plan you had must have been minimum essential coverage – which all employer-sponsored plans are – and you can’t have voluntarily canceled the plan or lost it due to non-payment of premiums).

A drop in income that makes a person newly-eligible for financial assistance in the exchange will trigger a special enrollment period during which a person can switch plans – but that only applies if they already had minimum essential coverage in place before the income change.

But in several states and DC, people who are uninsured have an opportunity to sign up for health coverage now – despite the fact that open enrollment has closed and regardless of whether they have a qualifying event. These are unprecedented times, and states that run their own exchanges are doing whatever they can to make sure their residents are insured.

1. ACA-compliant coverage via a COVID-19 special enrollment period

The COVID-19 pandemic has changed nearly everything about normal life in the United States and around the world. So it’s no surprise that health insurance rules in some states have changed as well. (We’re keeping track of this state-by-state.)

If you’re uninsured, one important change to understand is that several states have opened up special enrollment periods due to the pandemic, but they’re only for people who don’t currently have minimum essential coverage. Some of these state-run enrollment windows have since closed, but as of mid-July, special enrollment periods for uninsured residents are ongoing in four states and the District of Columbia. (Without these special enrollment windows, uninsured people without a qualifying event would not be able to sign up right now, as open enrollment for 2020 health coverage ended in late 2019 or early 2020, depending on the state). Uninsured residents in Massachusetts, California, Vermont, New York, and the District of Columbia can still enroll in health coverage for 2020, regardless of whether they have a qualifying event or not. Those areas encompass about 20 percent of the US population.

Uninsured people who enroll in a plan through an exchange during a COVID-19 special enrollment period are able to get income-based premium subsidies and cost-sharing reductions – so the availability of financial assistance is the same as it is during a regular open enrollment period.

The COVID-related special enrollment periods in those four states and DC are scheduled to end between late July and mid-September, although there have already been several extensions and there could be more as time goes on (state-run exchanges have the flexibility to create special enrollment periods and push their deadlines out if they determine that it’s necessary).

Normally, special enrollment periods follow regular effective date rules (ie, apply by the 15th of the month for coverage effective the first of the following month), but the COVID-19 special enrollment periods have different rules that vary by state, including some that have even allowed retroactive coverage dates. This is very different from the normal rules for private health insurance, which usually cannot have a retroactive effective date unless the coverage is for a newborn or a newly adopted child.

But most states use HealthCare.gov, which is run by the Department of Health and Human Services (HHS). And the federal government has thus far refused to open a special enrollment period through HealthCare.gov – despite the fact that several states that use the federally run exchange have asked HHS to do so. Of the states that run their own exchange platforms, Idaho is the only one that did not open up a special enrollment period for uninsured residents. HealthCare.gov and Idaho’s exchange have, however, relaxed their documentation requirements for qualifying events. This allows people who have a qualifying event to sign up without having to provide all of the official documentation that’s normally required in order to prove eligibility for a special enrollment period.

The takeaway point here is that if you’re uninsured, you’ll want to check to see if your state has a special enrollment period related to the COVID-19 pandemic (even though only four states and DC have ongoing COVID-19 special enrollment periods, about 20 percent of US residents live in one of those five areas). If so, it’s in your best interest to enroll in an ACA-compliant plan as quickly as possible. (Keep in mind that you’re technically considered uninsured if you have coverage under a short-term health plan, health care sharing ministry plan, or any other plan that’s not minimum essential coverage.) But if you’re in a state that uses HealthCare.gov, you’ll need to rely on the regular special enrollment periods that are always available. For many people, the loss of coverage special enrollment period is going to apply, but you’ll need to enroll within 60 days of losing your coverage.

2. Loss-of-coverage special enrollment period (and other SEPs that might apply to your situation)

If you’re in Idaho or a state that uses HealthCare.gov, or one of the states where a COVID-related special enrollment period has already ended – or if you already have coverage and want to pick a different plan – you’ll need to have a qualifying event in order to enroll in coverage. Our guide to qualifying events and special enrollment periods covers all of the details about how these work, including rules for effective dates and prior coverage requirements.

And if your income has taken a hit, know that if you enroll in a plan through the exchange during a special enrollment period, you may qualify for financial assistance (premium subsidies and cost-sharing subsidies). Use this subsidy calculator to estimate the size of your subsidy.

For most qualifying events, your coverage will take effect either the first of the next month, or the first of the month after that, depending on how late in the month you enroll. Typically, if you enroll during the first 15 days of the month, your coverage will take effect on the first day of the next month. Enroll after the 15th and coverage won’t kick in until the first of the following month.

But the effective date rules are different if your qualifying event is the loss of your existing health coverage. If you’re losing your coverage, you can enroll up until the last day you have coverage and your new plan will take effect the first of the following month. Since health plans usually terminate on the last day of a month, this means you can have seamless coverage in most cases, as long as you enroll by the day that your old plan ends, and assuming your old plan is ending on the last day of the month (if your plan is ending on a day other than the last day of the month, it will likely not be possible to have seamless coverage unless you’re able to qualify for Medicaid). So for example, if you’re getting laid off and your employer-sponsored coverage is going to end on July 31, you have until July 31 to enroll in a new plan (on- or off-exchange) and your coverage will take effect August 1.

(Note that some of the state-run exchanges that are offering special enrollment periods for people without health insurance (described above) have allowed coverage to be retroactive, depending on when you enroll. This is not normally an option, but the pandemic has changed the rules to some extent.)

It’s important to understand that in many cases, you’re only eligible for a special enrollment period if you already had some sort of minimum essential coverage in place before the qualifying event – this is obviously true if your qualifying event is loss of coverage, but it’s also true for several other qualifying events. You can read more about the rules for each type of qualifying event here.

Native Americans can enroll in plans through the exchange year-round, although the coverage doesn’t take effect until the first of the next month or the first of the month after that, depending on the enrollment date. As is the case with special enrollment periods, Native Americans must enroll by the 15th to have coverage effective the first of the next month.


Not eligible for an SEP or Medicaid (or CHIP, a Basic Health Program, Medicare, etc.)? You’ll have to wait until open enrollment to buy coverage, and the plan won’t take effect until January 1. But as described below, a short-term health insurance plan might still be an option, and it would allow you to have coverage this year.

3. Losing your income? Apply for Medicaid.

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Millions of Americans are facing a sudden drop in income as a result of the COVID-19 pandemic. But the majority of the states have expanded Medicaid under the Affordable Care Act, which allows residents with low income (up to 138 percent of the poverty level) to enroll in Medicaid.

Medicaid enrollment is year-round, as is CHIP (Children’s Health Insurance Program) enrollment. And CHIP eligibility extends to higher income levels than Medicaid. For both Medicaid and CHIP eligibility, income is calculated on a monthly basis, so they are available if your current income is within the eligible range – even if your income in the first few months of the year was much higher.

Medicaid coverage can also be immediate, or backdated to the first of the month or even a previous month, depending on the state and the circumstances. (States can seek federal approval to eliminate prior month retroactive coverage availability, and some have done so under the Trump administration). So you won’t have to wait for your Medicaid coverage to take effect.

In states that have not expanded Medicaid, coverage is not available based solely on income; low-income residents have to also meet other criteria, such as being pregnant, caring for minor children, being elderly, or being disabled. But if you’re facing a loss of income, you’ll want to check with your state’s Medicaid program to see if you might be eligible for coverage.

When your income picks back up in the future and makes you ineligible for Medicaid, that will trigger a loss-of-coverage special enrollment period during which you can enroll in a private individual market plan or an employer-sponsored plan if one is available to you. Note that in order to qualify for the additional federal Medicaid funding that’s being provided to states to address the COVID-19 pandemic, states cannot take action to terminate Medicaid coverage until after the COVID-19 emergency ends. Your Medicaid coverage can be terminated if you request it — perhaps because you become eligible for a new employer’s plan, or your income increases enough to make you eligible for premium subsidies in the exchange — or if you move out of state. But otherwise, your Medicaid coverage should continue until the end of the COVID-19 emergency period. If you request a termination or move out of state, however, your Medicaid coverage will end and that will trigger a special enrollment period during which you can sign up for a private plan.

This federal poverty level calculator will help you determine whether you meet the Medicaid eligibility level for your state. Your eligibility for ACA subsidies also depends on your income and percentage of the federal poverty level (FPL).

4. The short-term fix

For millions of Americans who aren’t eligible for an SEP or Medicaid, buying a short-term medical plan offers the fastest way to get some level of coverage in place. Short-term plans aren’t ACA-compliant, but can still provide protection from catastrophic medical expenses – and you can purchase the plans at any time during the year.

That means you could buy a short-term plan today and – if you’re approved through the underwriting process – you could have coverage in force as soon as the next business day.

Short-term coverage is temporary, but federal regulations now allow short-term plans to have initial terms of up to 364 days, and total duration, including renewals, of up to three years. Many states have their own rules, however, that limit short-term plans to shorter durations than the federal rules allow.

Many short-term health plans have voluntarily agreed to waive cost-sharing for COVID-19 testing (in Washington state, they’re required to do so), and the insurers that offer “enhanced” short-term plans in Idaho are also waiving cost-sharing for COVID-19 treatment. But the general rules that the federal government imposed to require insurers to fully pay for COVID-19 testing do not apply to short-term plans, so their actions on this are voluntary rather than mandated (unless a state takes action to further regulate short-term plans). And although many ACA-compliant health plans have agreed to temporarily waive cost-sharing for COVID-19 treatment (as opposed to just testing, as required by law), very few short-term plans have agreed to take this step.

And the basic rules of thumb for short-term plans still apply: Pre-existing conditions are generally not covered at all, and insurers will tend to look back at your medical records if and when you have a claim, to make sure that the claim isn’t related to any condition you might have had before enrolling. Short-term plans are also not required to cover the ACA’s essential health benefits, which means that some of the treatment you might need for COVID-19 (or other conditions) might not be covered at all by the plan. Many short-term plans do not, for example, cover outpatient prescription drugs. Others place limits on how much they’ll pay for inpatient hospital care.

5. NY, MN, and MA residents with fairly low income can enroll year-round

New York and Minnesota have Basic Health Programs (the Essential Plan and MinnesotaCare), both of which offer year-round enrollment and are available to residents with income up to 200 percent of the poverty level.

Massachusetts has a program called ConnectorCare, which is available to residents with income up to 300 percent of the poverty level. ConnectorCare enrollment is available year-round, but only for people who are newly eligible or who haven’t enrolled previously.

If you’re in one of these states and have an eligible income, you may still be able to sign up for coverage regardless of what time of year it is.


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.

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