Info for those who recently lost employer-sponsored health insurance
“Loss of a job doesn’t have to mean loss of health insurance coverage,” said Virginia Insurance Commissioner Scott A. White. “In light of the rapidly evolving coronavirus (COVID-19) developments, it’s especially important to have health insurance now because most comprehensive health insurance plans, as well as Medicare and Medicaid, are providing increased benefits and coverages related to coronavirus testing and treatments that may be cost-prohibitive for individuals without health insurance.”
Health insurance coverage options are as follows:
- Virginians can apply for an individual plan through the health insurance marketplace under the federal Affordable Care Act (ACA). Although open enrollment runs from November 1 – December 15 each year, special enrollment periods (SEP) are available for people who may have recently lost their employer-sponsored health insurance coverage or certain other qualifying life events. You can apply for the SEP within 60 days before you know your coverage will end and within 60 days from the date you lost coverage. To learn more, visit Health.Care.gov. Keep in mind that your coverage may not begin immediately. Marketplace plans go into effect the first day of the month after your job ends.
- If you have already lost your job, you may be able to extend your health insurance coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA) for up to 18 months after you lose your job. Typically, employers with at least 20 full-time employees are required to offer COBRA coverage. If you opt in to coverage through COBRA, your health plan and health benefits remain the same, but you would be responsible for the entire cost of your coverage, plus an administrative fee. In most cases, you have 60 days to enroll upon receiving notice of eligibility for COBRA coverage. Once you opt in to COBRA coverage, you cannot switch to a plan through a health insurance marketplace until ACA open enrollment begins in November or until COBRA coverage ends in 18 months.
- Since losing your job is a qualifying event, you may also be able to get health insurance coverage through a spouse or other family member’s employer-sponsored insurance plan. Individuals younger than 26 may be able to join a parent’s employer-sponsored plan. Keep in mind that you have 30 days from the time your previous employer stops paying for your insurance to enroll in your family member’s plan.
- Other options include short-term, limited duration health insurance plans, discount health plans and health care sharing ministries. Commissioner White cautions that, while these plans may be less expensive than coverage through marketplace plans or COBRA, they may not offer the same consumer protections and coverage. They are not subject to ACA rules and often cover less than ACA-compliant marketplace plans. In addition, they may deny eligibility for coverage or exclude services because of pre-existing conditions and may apply dollar limits on the amount they will pay.
- Depending on your circumstances or income level, you may qualify for other assistance, such as Medicaid or Family Access to Medical Insurance Security. In Virginia, the Medicaid program is administered by the Department of Medical Assistance Services. When applying for health insurance coverage through the ACA marketplace (www.healthcare.gov), it will provide you with information on this program if you qualify. For more information concerning Virginia Medicaid programs, visit coverva.org or call 1-855-242-8282.
Before signing up for any health insurance plan, the Bureau of Insurance encourages Virginians to carefully consider what health care services you and your family need. According to Commissioner White, “not all health plans are the same, and some are not insurance.” He encourages Virginians to protect themselves when shopping for health insurance by fully understanding the coverage, costs and protections before they sign up for any health plan.
When comparing options, Commissioner White encourages Virginians to consider healthcare provider networks, premiums, deductibles, annual coverage limits, co-pays, coinsurance, out-of-pocket limits and any exclusions (for example, exclusions based on pre-existing conditions). If you have questions, the Bureau of Insurance can help.
You also can compare plans using the tool at www.scc.virginia.gov/boi/pubs/hlthplan_compare.pdf.