Health Ins. Options During Coronavirus Pandemic

The COVID-19 pandemic has disrupted and changed the health insurance landscape for many people.  Here’s a review of the various options available to people, depending on their specific situation and eligibility:

1. Remain on current, employer group health plan (as an employee or dependent)*
2. Elect COBRA coverage, if eligible
3. Elect State Continuation coverage, if eligible (generally available in certain circumstances, to employees of groups that are not subject to COBRA)
4. Enroll in a subsidized, ACA approved plan
5. Enroll in a non-subsidized, ACA approved plan
6. Enroll in a non-subsidized, non-ACA approved plan (e.g., short term major medical)
7. Medicaid, if eligible (Note: many states have expanded eligibility to include previously ineligible enrollees, including childless adults.)
8. Medicare, if eligible
9. Military coverage – Tricare and VA
* IMPORTANT: Several companies offering group health insurance including United Healthcare, Blue Cross Blue Shield Plans, and Aetna announced the availability of a limited duration, special enrollment period, in light of the Coronavirus pandemic. This would only apply to employees (and their eligible dependents) that previously waived health insurance when initially eligible and is only offered for a brief period of time in April of 2020. Check with your HR representative on the availability of the limited, special enrollment period.)

If someone loses their employer based coverage, they become eligible to enroll in an ACA approved insurance company plan, on a guaranteed issue basis, with no pre-existing condition exclusions; provided they enroll within 60 days of losing their employer group coverage.  This is referred to as a “special enrollment period”. They can either enroll for coverage on the exchange (i.e., www.healthcare.gov), which offers subsidies to eligible applicants; or they can purchase a “private” health insurance plan, off the exchange.  Both sources of coverage are ACA approved plans. There are more options available off exchange than on the exchange, so I generally recommend that if one is subsidy eligible, go to the exchange; if not, go direct to one of the insurers, an agent/broker, or an online broker like www.ehealthinsurance.com.

There are a variety of government health insurance options that are available based on a number of factors.  These include Medicare, Medicaid, Tricare, and the Veterans Administration (VA).

Lastly, there is a specific, niche type of health insurance product referred to as “temporary”, or “short term major medical” coverage.  It allows one to purchase health ins. at a fraction of the cost of COBRA, or Individual Health Insurance for that matter, to bridge  from one health insurance  plan to another.  Although considerably less costly, these types of plans have preexisting condition limitations, limited coverage durations (up to one year), and fewer covered benefits relative to ACA individual plans. Here’s our online source to shop for and purchase such coverage – www.smstevensandassociates.com/insurancestore

*As for employees being furloughed, laid off, or experiencing a reduction of hours, during the Coronavirus pandemic, many group health insurance plans have “relaxed” their eligibility guidelines, allowing otherwise ineligible employees to remain on their employer’s group health plan, for a defined period of time. Note: each insurer has a different timeline associated with these relaxed, eligibility guidelines,  so employees are urged to check with their employer (Human Resources) to understand/review their options (i.e., COBRA, state continuation, remain on the plan as a covered employee, Individual health ins., short term coverage, etc.).

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