The COVID-19 pandemic is causing 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.
The good news is that loss of coverage triggers a special enrollment period during which you can buy ACA-compliant individual health insurance (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 11 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. As of early April, special enrollment periods for uninsured residents are ongoing in 11 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 a few months ago).
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.
These special enrollment periods are currently scheduled to end between mid-April and June, although several states have already extended their COVID-19 enrollment windows. 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.
Most of them are allowing retroactive effective dates, with coverage effective April 1 – even when applications are submitted after that date. Some of the states with extended enrollment windows will assign May or June effective dates to some enrollees, depending on when they apply. (In most cases, you cannot choose your effective date; the exchange will assign it to you based on when you apply). 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 indicated that it did not plan to open a special enrollment period through HealthCare.gov – despite the fact that several states that use the federally run exchange had asked HHS to do so. Of the states that run their own exchange platforms, Idaho is the only one that has not opened up a special enrollment period for uninsured residents.
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. 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.
Source: Health Insurance