As coronavirus leaves many service workers without jobs, they are forced to struggle with the new reality of life in the COVID-19 pandemic.
President Donald Trump said “it doesn’t seem fair” people at a certain income level can’t get Medicaid, but he doesn’t plan to open a “special enrollment period” that would help people who lost jobs because of the coronavirus sign up for their health insurance under the Affordable Care Act.
What should a person suddenly jobless and without health care benefits do? And how can the administration prevent another health crisis within the pandemic?
Here are answers to other questions about individual health coverage amid the COVID-19 crisis:
I’m suddenly unemployed. Why can’t I sign up for health insurance?
You might be able to – it depends on where you live, your circumstances and whether Trump changes his mind about those special enrollment periods.
These sign-up periods were reserved for people who had major life changes, such as marriage or the birth of a child. But COVID-19 is life-changing for most of us, especially those out of work or ill.
You may be eligible to sign up for an ACA plan, but you must have lost employer-provided insurance. In many states, you will be able to sign up for Medicaid. Even if you didn’t have insurance, if you live in these places you can sign up for a plan that is probably subsidized: California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington state, as well as the District of Columbia.
“I understand the reality of why they shouldn’t have an open enrollment that could affect the market in the future, but my heart still wants to help everyone,” said Ronnell Nolan, CEO of Health Agents for American, an insurance broker trade group.
How would a special enrollment period help?
Consumers in those 11 states and the District of Columbia can visit their respective insurance exchange for details on how to sign up for coverage.
“In the past, the only time people could sign up for an ACA plan was either during open enrollment or when a qualifying event occurs,” said Les Masterson, Insure.com’s managing editor. “During the COVID-19 pandemic, certain states are allowing any resident to sign up for an ACA plan, regardless of whether or not they previously had insurance.”
Even some states that use the federal marketplace asked the Trump administration to provide an open enrollment period.
In a letter March 25 to Health and Human Services Secretary Alex Azar, Arizona Gov. Doug Ducey urged a special enrollment period to ease circumstances for consumers. Ducey, a Republican, cited the “substantial paperwork burden” for consumers who have been laid off and have a limited time to sign up for insurance under the ACA’s “qualifying event” window.
The special enrollment period in eligible states will allow consumers to sign up for ACA plans without providing such documents. These periods are open for a limited time. In Vermont, for example, consumers must sign up for coverage by April 17.
Can I get Medicaid coverage?
Unlike Affordable Care Act plans, eligible consumers can sign up for Medicaid year-round.
A total of 36 states and Washington, D.C., expanded Medicaid coverage under the Affordable Care Act. Most adults in those states who earn up to 138% of the federal poverty level – $17,236 per individual or $35,535 for a family of four – can sign up for coverage year-round.
Consumers in 14 states that chose not to expand coverage have more limited options under this program for low-income families. COVID-19 cases rapidly increased in Florida, which does not offer expanded Medicaid coverage. Texas, where the governor and Legislature rejected expansion, has the highest uninsured rate in the nation.
Simply being out of work is not the only requirement for Medicaid. Having trusts or other investments that earn income may make you ineligible.
Are there options other than Medicaid or ACA plans?
First, there is the option of continuing your company insurance for awhile. “Any disaffected person should start” by considering the program known as COBRA, said J.D. Piro, senior vice president for Aon U.S. Health Solutions’ legal consulting group.
He acknowledged that “the cost for that can be prohibitive.” COBRA costs so much because consumers have to pick up the full cost of the plan, including the amount the employer normally contributes.
In 2018, the Trump administration removed a 90-day limit on short-term health insurance plans that offer limited benefits and less expensive monthly premiums. These plans could be a good option for some, but insurers can deny coverage for medical conditions, which can be a huge limitation.
The ACA required individual plans sold on and off the marketplace to cover a group of set benefits such as emergency, maternity and mental health care.
Catastrophic insurance plans have lower premiums but are considered insurance against the costliest diseases or accidents because they have very high deductibles.
Is this politics, or would it really be hard to get all these people covered by insurance?
The Trump administration has said it wanted to repeal and replace the ACA since it took office. When HHS’ Azar announced the change in rules for short-term insurance plans, he said there were millions of “forgotten men and women left out by the current system.”
If the administration wanted to change who is eligible for Medicaid it would most likely require changes in the law by Congress, said Kathy Hempstead, a senior policy adviser for the Robert Wood Johnson Foundation.
“The current emergency makes it clear that coverage is critical. We need to do everything we can to get as many people covered as possible,” Hempstead said. “For that reason, not having a special open enrollment period on HealthCare.gov is a missed opportunity and creates more inequality between people that live in different states.”