By: Dr. Andrea Kratzke Nelson and Dr Max Jacobs
Between the health risks of a pandemic and the economic climate which has led to a huge rise in unemployment, it can be difficult to advise patients where to turn for health insurance. While every case is different, here are some places to start to make sure everyone is able to afford and receive the care they need.
In a hurry? This tool from HealthCare.gov provides healthcare options based on state and income.
1) For anyone who has lost their job-based insurance
COBRA: The Consolidated Omnibus Budget Reconciliation Act makes coverage available for anyone who was working for a company with twenty or more employees with job based insurance. COBRA provides the continuation of the same health insurance plan a patient had previously been on, without an employer covering the cost. In exchange for not having any drastic changes in coverage, premiums tend to be higher.
COBRA is meant primarily as a bridge between insurance options, and does a good job as such. But if it seems unlikely that another job-based insurance plan will soon take its place, looking for a plan through the ACA Marketplace will be more cost-effective.
For more information, visit dol.gov
Marketplace: Normally, one can only sign up for insurance through the hexsalth insurance marketplace once a year during open enrollment (Nov 1st -Dec 15th). However, there are “qualifying events” which allow patients to purchase insurance throughout the year. Anyone who has lost their job-based health insurance qualifies for Special Enrollment Period. That means that a health insurance plan can be purchased. This special enrollment period only lasts for 60 days starting from when the job-based insurance was lost, so it is important to act quickly!
How to sign up: HealthCare.gov.
2) For those without insurance/ are under-insured
Most options for health insurance coverage are linked to income level and location.
ACA –President Trump has opted to not reopen the federal health insurance marketplace created by the Affordable Care Act to everyone. However, eleven states run their own marketplaces and they have opened up a Special Enrollment Period to ANY residents of their state.
These states are California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington.
Medicaid: For those whose income is near or below the poverty line, they may be eligible for Medicaid. Originally created in 1965, Medicaid is a program states can run electively which provides health care insurance-like coverage to pregnant women, children, and sometimes parents of children who are at or below the poverty line. At this time, all states, regardless of whether or not they have “expanded Medicaid,” have these levels of protections.
In those states which did expand Medicaid, eligibility for insurance-like coverage extended to any adult earning less than 133% of the poverty level and further increased the maximum income level of eligibility for the preexisting categories. It is important to note that because Medicaid is state-run, it can be called by state- or county-specific names.
If someone meets the criteria for Medicaid, they can enroll at any time and do not have to wait until an open enrollment period. To see if you are eligible, this tool from HealthCare.gov lists healthcare options based on state and income. To enroll, visit https://www.healthcare.gov/get-coverage/
3) Special populations
In 1997, the Children’s Health Insurance Program (CHIP) expanded Medicaid-like coverage for children in families with incomes too high to qualify for traditional Medicaid, but who could not afford private coverage. In order to be eligible for CHIP, someone must be: under 19 years of age, uninsured (determined ineligible for Medicaid, and not covered through a group health plan or creditable health insurance), a citizen or meet immigration requirements, a resident of the state, and eligible within the state’s CHIP income range. Similar to Medicaid, CHIP is run through the state, and to apply one must visit their state’s healthcare platform.
For those receiving disability income from Social Security or the Railroad Retirement Board, with end stage renal disease, or with Lou Gehrig’s disease (ALS), Medicare can provide coverage, regardless of the person’s age. Otherwise, anyone over the age of 65 is eligible for certain Medicare benefits. To learn more, visit https://www.medicare.gov/
Women who are pregnant are eligible to be covered under state Medicaid programs if they are at or below the poverty level.
4) For those who still need help
Not everyone who needs healthcare coverage qualifies for these programs. For those that do not, seeking medical care at a facility that provides low or no-cost health care is the most straightforward solution. While there is a huge range of private nonprofit healthcare facilities, some standardization of excellence is provided by the federal government through the creation of Federally Qualified Health Centers. Federally Qualified Health Centers are community-based health care providers that receive funds from the Health Resources and Services Administration’s Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay, and operating under a governing board that includes patients. To learn more about FQHCs and find one locally, visit https://www.fqhc.org/what-is-an-fqhc
Local counties often provide their own safety net healthcare system that provides emergency care and hospital services regardless of ability to pay. Depending on the system, they might also provide access to reduced priced medications and primary care services, but this is far from universal. Research into local resources is needed to make an informed decision about the options available in an area.