Coronavirus (COVID-19) and health insurance: What you need to know

Filed Under: Costs, Health plans, Patients

So you’re worried about your health insurance given the coronavirus epidemic.

You’re not alone. Whether you have or had job-sponsored insurance, or were on the state exchanges, or were uninsured before COVID-19 hit, it’s a topic of concern. Here are some situations, with answers.

You lost your job and need insurance to replace employer-sponsored insurance. You might qualify for COBRA, the program allowing you to extend employer-sponsored health insurance on your own dime. It governs employers with 20 or more employees; you normally have 60 days from separation to choose to take it. Here’s further information from the Department of Labor. Ask Human Resources or your boss if you qualify. If you think you qualify and they don’t make it available to you, you can ask others who have been laid off at the same time or use the Department of Labor resources mentioned here.

COBRA can tend to be expensive. For some people, it’s a better choice to go on Affordable Care Act insurance, either on the state exchange (if your state has one) or the federal exchange, healthcare.gov. In both of those cases, if your income has been slashed, you might well qualify for a tax subsidy — a reduction in the monthly premium you’ll pay, figured on your income.

Those Affordable Care Act plans, either on your state exchange or via healthcare.gov, can be surprisingly inexpensive for low-income people. You’ll need to run the numbers to know. Here’s a subsidy calculator from Kaiser Health News, though you should know that the final answer will come from the state or federal exchange where you buy your insurance, and that they will check with your tax documents when you file next year to see that your estimate meets reality. You may also qualify for a cost-sharing reduction.

For details on how to pick the right insurance plan, here’s our general (non-COVID-19) handbook on buying insurance.

If you need help, see if you can find a navigator. On the New York State of Health site, they’re pretty easy to find. There are also community groups that can help. In New York, the Community Service Society of New York has people trained to help, and they also lead the statewide navigator network. If your state has an exchange, you should look there first.

If your state lacks its own exchange, the healthcare.gov site has a place to find help — but it seems to have not only navigators but also brokers, with no clear differentiation. We suggest looking at this page to see who in your state has received a federal grant to train navigators to assist insurance buyers; those navigators will not be selling you something but advising you; a broker will be selling you something. In some places, emergency counseling resources are available — at a library or community center, perhaps.

Your COBRA plan might have a bigger network; your A.C.A. plan might cost less. You’ll need to do the math.

You want to quit your job. Same as above, but in all likelihood you will not qualify for COBRA insurance extension if you quit. But job loss is a “qualifying event,” the formal name for a reason to go onto the healthcare.gov or state insurance exchanges.

Other qualifying events are having/adopting a child, getting married or divorced, turning 26, moving, moving back to the U.S. from overseas, getting out of prison, etc. This qualifies you for a Special Enrollment Period during which you can get insurance. Restrictions may apply, and paperwork will be needed. Go to healthcare.gov to see the rules.

You didn’t have insurance before but you want it now. Eleven states and the District of Columbia have opened up enrollment for their citizens on their state-run exchanges. This is a departure from the normal state of things, which requires you to have a “qualifying event” to buy insurance outside of regular open enrollment.

Here is a list of the states with new open enrollment, and their deadlines and page links, courtesy of Charles Gaba at acasignups.net.

SUMMARY OF #COVID-19 SPECIAL ENROLLMENT PERIODS:

California: thru 6/30 at CoveredCA.com
Colorado: thru 4/30 at C4HCO.com
Connecticut: thru 4/17 at AccessHealthCT.com
District of Columbia: thru 6/15 at DCHealthLink.com
Maryland: thru 6/15 at MarylandHealthConnection.gov
Massachusetts: thru 5/25 at MAHealthConnector.org
Minnesota: thru 4/21 at MNsure.org
Nevada: thru 4/15 at NVHealthLink.com
New York: thru 5/15 at NYStateofHealth.NY.gov (Update: Extended to June 15)
Rhode Island: thru 4/15 at HealthSourceRI.com
Vermont: thru 4/20 at VTHealthConnect.com
Washington State: thru 5/08 at WAHealthPlanFinder.org

If you’re not in one of those states, read on.

You didn’t have insurance before and you want it now, and you don’t live in one of those 11 state plus DC. You could use healthcare.gov, but you hear it is not open. What are you supposed to do? People who did not have a qualifying event and were not insured before will have access to the state-run insurance exchanges in those 11 states plus the District of Columbia. If you lost a job, that is a qualifying event (others are having/adopting a child, getting married or divorced, turning 26, moving, moving back to the U.S. from overseas, getting out of prison, etc.,) meaning that  you qualify for a Special Enrollment Period during which you can get insurance. Restrictions may apply, and paperwork will be needed. Go to healthcare.gov to see the rules.

If you were uninsured before and want to be insured now (and didn’t have a qualifying event), you’ll probably need to be in one of those 11 states or D.C.

You lost your job and your employer-sponsored insurance, You live in one of the states governed by healthcare.gov. The administration says it’s not opening healthcare.gov. What are you supposed to do? Again: If you lost your job, you can go on healthcare.gov, because you had a qualifying event. If you did not lose a job, but suddenly decided you want to be insured, it’s trickier.

You have kids to insure, in any of the above situations. We have heard a lot about people who are choosing to put their kids on  Children’s Health Insurance Program, or CHIP, insurance. This is limited by income level. States have their own rules, and you can apply any time of year.

Many families automatically put their kids on their family policies. But I know several families who have chosen the CHIP route and saved thousands and thousands of dollars.

Recent news coverage shows that 70 percent of kids on Medicaid and CHIP have parents who work at large private companies. Check the income guidelines in your state.

You are re-thinking insurance for the family at this critical moment. We have heard a lot about people who are thinking creatively about health insurance. This guy put all three members of his family on three different insurance plans because of their differing health needs, and saved around $13,000 in premiums.

You are on furlough, and you don’t know if you have insurance or not. Ask Human Resources. If you are on furlough, and have not formally been laid off, and you have job-sponsored insurance, that insurance should still be in force. But you must confirm that with your employer.

You want to increase your insurance coverage now because of coronavirus. There are supplemental insurance policies, but many of them will not cover something like coronavirus.

I’m going to apply for Medicaid. For some people, depending on income, your healthcare.gov or state exchange application will kick you over to Medicaid automatically. We hear that the Medicaid rolls are swelling. Here’s how to apply in your state. In some states, Medicaid requirements are extremely stringent. Here’s a map with details.

I’m just planning to get a short-term plan to take me through the next few months, which is what I think is the worst risk. We have heard nothing particularly good about short-term plans. We generally recommend that people avoid them if at all possible. That said, if you can take the risk of a plan that excludes people with pre-existing conditions, won’t cover coronavirus testing and has benefits that are much more limited than A.C.A. plans, you can take a look at this resource from the well-regarded healthinsurance.org. Do your homework.

I’m going to go put my name into a form on the Internet for one of the many insurance-selling sites there, and let someone reach out and contact me with help. I have a friend who did this, and she regretted it instantly. She received dozens of emails and even phone calls from people trying to sell her stuff. We’ll say it again: Brokers are working in their interest, selling you things that work for them. You want something that works for you. They may be the same thing, but they may not.

So I’m insured — what’s covered in the era of coronavirus? You’ll need to check your policy. Testing is supposed to be free under the new federal laws. Treatment is a different thing: Various insurance companies have said they would cover coronavirus treatment, but it seems clear that comes with a footnote “we’ll cover that under your existing policy.”

So for example, if you have a $12,000 in-network deductible, that $12,000 deductible is likely to come out of your pocket. Some are saying they will “waive all member cost-sharing” but we regard that with caution.

It’s early to say for sure at this time, but we don’t expect that insurers will universally cover that $12,000 for you. Again, check your policy and check with your company.

“Many health plans have already been pro-active in helping health care providers through the COVID-19 crisis,” Brian Klepper writes on The Health Care Blog. “For example, United Health Care and Anthem have waived patient co-pays for care associated with COVID-19, a move that will provide considerable relief to employees and their families already under considerable financial stress.

“Both Aetna and Anthem have announced that they now pay for telemedicine services at the same rate as in-person services. This is a huge step forward that encourages telemedicine as a first line of defense, limiting potential COVID-19 exposure in physician offices. Many innovative telemedicine companies have now found ways to facilitate services directly with a patient’s own primary care physician (PCP). Further, there are services that allow PCPs caring for patients with comorbidities access to specialists and pharmacists.”

Have other questions? Here’s our handbook for buying health insurance. Here’s a handbook from the well-respected healthinsurance.org. If you have questions or things you think we should know, write us at info@clearhealthcosts.com