Many consumers are concerned about losing health insurance for themselves and their family in the event of layoffs or job losses resulting from the Coronavirus (COVID-19). Depending on the size of the employer and whether the employer remains in business with an active group policy, there are several options available. Unfortunately, an unprecedented number of people have been laid off or have lost their job completely during the coronavirus outbreak. Now these individuals and families are faced with having to make quick decisions to remain insured during this emergency either through keeping their job-based health insurance coverage through COBRA or looking for alternative coverage.
This process can be confusing, stressful, and expensive. Now is not the time to be uninsured. Consumers should seek the advice of a local insurance professional who can help them evaluate the best options for their family.
Some will save money by moving to a subsidized health plan through the Affordable Care Act Marketplace or a Medicare or Medicaid health plan, but these decisions must be made within 60 days of health insurance coverage loss. Individuals should first look to get enrolled in the health plan of a spouse or parent. The ACA allows people who’ve lost coverage to enroll in their spouse’s plan or, if they’re younger than 26, their parents’ plan.
For assistance in navigating options, contact a local insurance professional or check the SC Departmet of Insurance (SC DOI) website for partners, such as Palmetto Project, and other available resources.
COBRA (20 or more employees)
If an individual had insurance coverage through their employer and the employer has 20 or more employees and is still in business with an active group policy, they are entitled to continuation coverage by the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).
Under COBRA an individual may continue health care coverage for up to 18 months. This is an expensive option as they are required to pay the full premium, even if their employer paid part of their premium while employed. Consumers should reach out to their employer’s Human Resources Department for enrollment information.
State Continuation (less than 20 employees)
If an employer had less than 20 employees and is still in business with an active group policy, our state has a mandatory continuation of coverage privilege. The law provides that an employee or member who has been insured under the group policy for at least six months and who loses coverage for any reason (other than non-payment of premium) may continue coverage for the portion of the policy month remaining plus six months. View the SC state continuation brochure for more information.
The Federal Marketplace (https://www.healthcare.gov/coronavirus/)
Marketplace plans are subsidized for people who earn less than four times the poverty level, which is around $50,000 a year for a single person and around $105,000 for a family of four. A consumer will have 60 days of eligibility for enrollment in the Federal Marketplace. Consumers should reach out to the Marketplace at 1-800-318-2596 or visit healthcare.gov for details on available coverage and pricing or one of the local professionals provided above.
This type of coverage is also known as temporary health insurance or short-term medical. It typically lasts several months, but cannot last for longer than 11 months in South Carolina (although it may be able to be renewed). It is primarily designed to fill gaps in major medical health insurance coverage, such as when between jobs or switching coverage. Coverage may be more affordable than major medical insurance, but it does not provide the same protections as major medical coverage and can be subject to pre-existing condition exclusions, among other limitations. This is a viable and affordable option for someone without chronic medical conditions.
In South Carolina, this is not an option for most people unless the patient is pregnant or meets the low income threshold. In many other states, if an individual lost their job and does not have any income currently, even if they were a middle or high income earner, they can be eligible for the Medicaid program, only if they live in a state that expanded Medicaid eligibility for low-income adults. Medicaid is based on a person’s current income, and unemployment checks aren’t counted — even the $600 bump in unemployment that was part of Congress’ recent stimulus bill. There are 14 states that haven’t expanded Medicaid to cover more low income people — Wyoming, South Dakota, Wisconsin, Kansas, Missouri, Oklahoma, Texas, Tennessee, North Carolina, South Carolina, Mississippi, Georgia, Alabama and Florida.
For pregnant patients who lost their job or coverage, they should review the information at SC Health Connections to see if they qualify. (https://www.scdhhs.gov/eligibility-groups/pregnant-women-and-infants) They can also get free quotes online for maternity coverage only at Maternity-Inurance.org. ( https://www.maternity-insurance.org/Exit/PreQuote?leadType=HEALTH&trafficType=ZipSubmit)
If an individual is uninsured, they can still get tested for COVID-19 at no cost to them; however, there’s nothing that would cover treatment costs for people without insurance. For those who remain insured, any testing related to COVID-19 is covered. The Family First Act passed by Congress in March, requires health insurance issuers to provide coverage (at no cost sharing or pre-authorization/ medical management requirements) for the testing and administration of FDA-approved COVID-19 tests. The same requirements would apply to related services, including an in-person or telehealth provider visit, urgent care center visit, and emergency room visits that result in an order for COVID-19 testing. Prior authorizations, copays, and coinsurance is waived and should not be billed to a patient. NOTE: The waiving of cost sharing and related requirements only applies to the services relating to COVID-19 evaluation and testing, NOT treatment.
Insurers are publishing information on their websites as well as within national organizations, communicating to the public their response to the virus and associated coverage guidelines. For more information, visit America’s Health Insurance Plans (AHIP) (https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/).