May 13, 2020 - NPR
Selena Simmons-Duffin
If there's a time that people particularly need access to good health care and health insurance, it's during a global pandemic.
But in the U.S. 33.5 million people so far have had to file for unemployment benefits ・and most people in the nation get their health insurance through their jobs. An analysis from the Kaiser Family Foundation published Wednesday estimates that 27 million people have recently lost their health coverage.
The bit of good news is that the report also found that the vast majority of those who lost their insurance can remain covered by switching to a spouse's plan, or are eligible to get subsidized health insurance elsewhere ・either via Medicaid or via a plan on the Obamacare insurance exchanges.
"To me that the takeaway from this report is that the Affordable Care Act is serving as the safety net it was intended to be," says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. "Of course, the ultimate irony is it's performing this function at a time when the Trump administration is arguing before the Supreme Court that it should be struck down."
The question now is how many people who have lost their coverage will actually enroll in a new plan. Health insurance is complicated, and signing up can be hard. "There are a lot of stressors on people right now," says Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation and an author of the report. "You may be unemployed, you might be sick, you might be quarantining ・and there's just a limit to how many life things you can deal with at once."
Still, the clock is ticking. If you've lost coverage because of a job loss, that's what's called a "qualifying life event." You can go to Healthcare.Gov or your state's insurance exchange right now to enroll in a new plan.
But that needs to happen within 60 days of losing coverage ・and especially for people who lost their employer-based insurance in early March, there's no time to lose. Here is a guide to a few of the options available to you if you're one of the millions who've recently lost your job and your health insurance:
I got laid off and had insurance through my job
You might be able to keep the same health plan under federal rules known as COBRA ・if you worked for an employer with 20 employees or more. Levitt says one advantage of COBRA is "it provides the most continuity of coverage, because you stay in exactly the same plan you were in when you were employed ・same network of doctors and hospitals, same deductible ・everything is identical." But this continuation of your current health coverage can be quite expensive because, at least under normal circumstances, you would have to pay the full monthly premium, without your employer chipping in to make it more affordable. Your insurer is required to notify you if you have the COBRA option, and you have 60 days to elect to take it. (For those who lost coverage in March, the clock is ticking to elect this option).
The next place to look is the insurance exchanges set up under the Affordable Care Act. Losing health insurance that you got through your job is considered a "qualifying event" to enroll in a plan on all the health insurance exchanges. That means you can go to Healthcare.gov or your state-run exchange and shop for a new plan. The Kaiser Family Foundation has a handy subsidy calculator so you can see what you might pay in premiums for these plans ・remember that your unemployment benefits count as income on the exchanges. Again, you only have 60 days to choose this option after losing coverage (unless you live in a state that's created a special enrollment period), so be sure and enroll in that time window.
If your income has been wiped out with the lost job, you should also check to see whether you qualify for Medicaid, the national health insurance program for low-income people that's jointly funded by federal and state governments. Medicaid enrollment takes place year-round and is based on monthly income, not annual income, and it's essentially free for people who are eligible. You're more likely to qualify if you live in one of the 37 states and D.C. that expanded Medicaid under the Affordable Care Act.
I was already uninsured
Your options to get covered if you're one of roughly 28 million Americans who were uninsured even before the COVID-19 crisis depend on where you live. Medicaid may work for you, but the rules for eligibility (including the income cut-off) vary by state. States that have not expanded Medicaid ・which is how Obamacare broadened coverage to 12 million previously uninsured people ・have more restrictive rules about who qualifies. According to the Kaiser foundation, nearly 6 million adults already qualified for Medicaid before COVID-19 but were not enrolled.
If you don't qualify for Medicaid, next look to the state insurance exchanges that were set up under the ACA. The Trump administration has decided not to open a special enrollment period for Healthcare.gov, the federal insurance exchange. But some states run their own insurance marketplaces and have created a special enrollment period during the coronavirus crisis. In these states ・including hard-hit places like California and New York ・that means you don't need to have a "qualifying event" like job-based coverage loss or the birth of a child to newly enroll right now in an Obamacare plan.
It's worth checking to see whether you can enroll and get an affordable plan ・according to KFF, more than 4 million people who were uninsured before the coronavirus crisis would have qualified for a subsidized ACA health plan that would cost them nothing in monthly insurance premiums.
One thing to note is that Congress has put funding in some of its emergency funding bills that may help hospitals and health systems pay for COVID-19 care for the uninsured. "While people who are uninsured might still receive bills from providers, [these federal funds] will help reduce the burden on patients because the hospitals will be compensated at least partially for their costs," says Corlette of Georgetown University.
White House officials have pointed to this funding as a reason why a federal special enrollment period may not be necessary. Uninsured patients' bills related to COVID-19 might be forgiven by doctors and hospitals, the White House suggests. Many details about how that federal funding will be dispersed are still up in the air, and it's limited to care and testing related to the coronavirus.
"While COVID-19 is a very present risk right now in a lot of people's minds, people have health care needs that go beyond the coronavirus." notes Levitt. If you end up with cancer, for instance, or a burst appendix and you're uninsured, that could be financially ruinous, which is why health policy experts always recommend getting covered if you can.
My kids have lost their coverage, too
There will be many people ・more than 5 million ・who won't have access to insurance they can afford, even with the options mentioned above. If you can't get a health plan for the adults in your family, your children might still be able to get coverage ・the rules are different for them, as well as for pregnant women. InsureKidsNow.gov is a good place to start to determine if your children may be eligible.
What about short-term or "skinny" plans?
Short-term health insurance plans were originally designed to be used for just several months ・to tide people over between the end of schooling and the start of a new job, for instance. Since then, the Trump administration has promoted these plans, and their more affordable monthly premiums, as good long-term alternatives.
But the plans often have more limitations in what they cover than ACA plans do. They're allowed to restrict enrollment to those without preexisting conditions, for example, and don't have to cover all "essential benefits" included in all Obamacare plans. "They might exclude prescription drugs; they might cap how much they'll pay in a hospital," says Levitt. "So if you look at one of these short-term plans, you really want to read the fine print carefully."
Once I'm insured, what's covered in the time of coronavirus?
Congress has required that the cost of coronavirus testing be covered by insurers (though testing is still not always available). What's less clear is how much your treatment will cost you if you get seriously ill and need to be hospitalized for COVID-19.
Hospital and emergency care are considered essential benefits and must be covered, but patients may still have to meet the annual deductible of their policy and pay things like copays and coinsurance on top of that. Some large commercial insurers have pledged to waive these patient costs for COVID-19 treatment, and several nonprofit community health plans have as well. The limited availability of diagnostic testing may make it tricky to prove you qualify for these benefits, Levitt points out.
Unfortunately, surprise bills are still a concern ・those are bills that come directly from out-of-network hospitals or doctors who provide your care. Nearly 1 in 5 inpatient admissions for pneumonia results in a surprise bill, according to a KFF analysis. It's possible members of Congress will try to address this in future coronavirus legislation, but until they do, this will remain a way that people could be exposed to high medical bills.
If you do get a surprise bill from COVID-19 treatment, the same advice applies as always (this will be familiar to those who follow NPR's Bill of the Month series): Call your hospital or doctor and/or insurance company, and try to negotiate a lower bill. If they won't budge, check with the doctor or hospital to see if they can help you with a payment plan, or forgive the debt, as a part of a charity care program.
The original version of this updated story published on April 3, 2020.