By Elisabeth Buchwald
Affordable health-care coverage is in high demand for the upcoming year.
Some 7.7 million Americans who were laid off during the pandemic lost their employer-sponsored health coverage as of June.
Those plans covered some 6.9 million of their dependents, impacting up to 14.6 million individuals, according to an October report published by the Commonwealth Fund, a private foundation that supports health-care issues.
Even during a public-health crisis, reclaiming health-care coverage may not be top of mind for jobless Americans.
“These folks typically are focusing on survival needs — getting food on the table, paying next month’s rent,” said Stan Dorn, a health-policy expert at Families USA, a liberal advocacy group. “Not many [unemployed Americans] have the bandwidth to learn about health-care programs and then fill out all the paperwork, so it’s a really tough situation right now for a lot of people.”
But many of these Americans could qualify for free or highly subsidized health-care coverage for the upcoming year. Some Americans will qualify for subsidized care through the Affordable Care Act marketplace.
Open enrollment for 2021 began on Sunday and lasts through Dec. 15, at which point some of these options could no longer be available. That’s why health-care professionals say it’s crucial to begin the process as soon as possible.
Unemployed Americans might not expect to qualify for Medicaid, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, a nonprofit, private foundation based in Menlo Park, Calif. But there’s a good chance jobless Americans in 39 states and the District of Columbia that have expanded Medicaid coverage, qualify for it.
“If you were making $100,000 a year from your job and you got laid off, and now you’re just getting unemployment, chances are you qualify for Medicaid.”
Medicaid is a great option for low-income Americans because “it offers comprehensive coverage” for hospitalization, prescriptions, doctor visits and mental-health services and often doesn’t have a premium or deductible.
One qualifies for Medicaid in the 39 states that have expanded the program if their current annualized household income is 138% of the federal poverty level. For individuals that equates to $17,609 a year or $1,467 a month.
“It looks at your current income, not what you made earlier in the year,” Pollitz said. Your assets, savings or retirement contributions are not taken into account when determining your Medicaid eligibility.
You can find out if you qualify for Medicaid here . Unlike the ACA marketplace, there is no open enrollment period for Medicaid, meaning you can sign up at any point during the year.
What’s more, if you would have qualified three months ago, but you didn’t sign up, Medicaid will still cover any medical bills that you’ve already incurred, Pollitz told MarketWatch.
If you’re ineligible for Medicaid because your annualized current household income doesn’t meet the requirements or you live in one of 12 states that haven’t expanded Medicaid coverage, you should consider the ACA marketplaces.
However, it is possible that your children could still qualify for Medicaid or Children’s Health Insurance Program, a subsidized form of health insurance for children in families that earn too much money to qualify for Medicaid . You can find out if your children are eligible for either through the healthcare.gov site.
You may have heard that the Supreme Court is set to begin hearing arguments next week for a case that could drastically change the criteria for qualifying for ACA coverage or eliminate the program altogether .
But it could be some time before Americans know the fate of the ACA since the justices, which include the newly sworn in Amy Coney Barrett, aren’t expected to release their opinion until June 2021 .
“No matter what the Court does, people who sign up for insurance now will get insurance and likely will keep it for a while,” Dorn told MarketWatch.
Some states like New York and New Jersey have their own state-run ACA marketplaces. Others like Florida and Texas don’t, and use the healthcare.gov marketplace instead.
You can find out which category your state falls under by entering your ZIP code here which will lead you to the appropriate website.
You will then be prompted to enter your expected income for 2021.
“You’re going to have to make a projection of what your income is going to be next year, which is going to be harder for some people if they’re out of work and they don’t know when they’re going to go back or they’re working intermittently,” Pollitz said.
If you estimate that your annual income for 2021 will be at least $12,760 for a single person or $17,240 for a couple, you can qualify for financial assistance through the marketplace.
You can get a good sense of the financial assistance you could qualify for using this calculator .
“If you’re just above the Medicaid eligibility threshold, you can get very good insurance in the exchange typically for $40 to $50 a month,” Dorn said. “A lot of people can get free insurance on the exchange, but it often has very high deductibles.”
Free of charge navigators can help you fill out your application and answer any questions you may have (you can find local resources here ). But as the Dec 15. deadline for open enrollment approaches, you’re much less likely to get a slot with a navigator, Pollitz said.
After you give your projected income for 2021, the marketplace will compare that against the most recent income data (for most people, that will be your 2019 tax return).
“If the income that you project for 2021 is substantially different from what you reported on your last tax return, it will go ahead and give you the subsidies temporarily at your lower new income, but it’s going to ask you for additional documentation,” Pollitz told MarketWatch.
You may be asked to provide unemployment documentation or a letter explaining why your income is lower, she added. “Be ready for that and pay attention. If the marketplace says, ‘I want more documentation’, give it to them because otherwise in 90 days they’re going to shut off your subsidies.”
COBRA, short for the Consolidated Omnibus Budget Reconciliation Act, generally lets workers at companies of 20 or more employees extend their health coverage for up to 18 months after losing their jobs.
Americans who were laid off during the pandemic may have opted for COBRA health insurance believing they were going to get another job in four months, but many are still unemployed “and still paying really expensive premiums,” said Suzanne Wikle, a senior policy analyst at the Center for Law and Social Policy, a nonprofit, non-partisan organization focused on policy initiatives for low-income people.
Annual premiums for job-based health coverage in 2019 were $7,188 on average for single coverage and $20,576 for family coverage, according to Kaiser Family Foundation survey data ; employers contributed about 83% and 71% of those premiums, respectively.
Recently unemployed Americans who did not opt for COBRA insurance could qualify for a special enrollment period that allows them to sign up for insurance through the marketplace outside of the open enrollment period. Their window of time to apply only lasts for 60 days ; otherwise, they have to wait until open enrollment starts up again.
Americans who opted for COBRA insurance “don’t get a special enrollment period until their COBRA coverage runs out,” Wikle said.
But these Americans can switch out of COBRA during the open enrollment period. “The annual open enrollment period that started Sunday is the time for anybody who wants to get off COBRA but still have coverage to do their shopping.”
“I suspect a number of people are using their savings to pay for COBRA premiums, and there are more affordable options out there,” she said.