Millions of Americans have lost employment in the months since the pandemic began, and many others have had insecure, partial, or sporadic work that didn’t cover their health care costs. Since health insurance is tied to employment for most people, according to the U.S. Census Bureau, that has the potential to leave vast numbers with no insurance at all.
If that describes your situation, you can do something about it right now, thanks to two government programs.
You could shop for a low-cost or even free health care plan through the Affordable Care Act marketplace, signing up for what’s commonly referred to as Obamacare. And if you have lost your job, you could take advantage of a provision in the recent stimulus bill that lets you continue the health coverage you had under your employer — with the government paying your insurance premiums. That essentially makes what’s known as COBRA insurance free, for at least part of this year.
Open enrollment in the Affordable Care Marketplace is usually open once a year, in November and December. That’s the only time when anyone can select a health insurance plan under the Affordable Care Act, or ACA; special circumstances, like losing a job, can open an enrollment period for some individuals as well. Some states use their own state-based marketplaces to provide a similar option.
But this year, the ACA marketplace has been reopened — with a January executive order from President Joe Biden — for an extraordinary enrollment period until May 15, allowing more people to consider their options in the marketplace, even without a qualifying event like a recent loss of employment-based healthcare.
Anyone who is without healthcare coverage would benefit from a renewed look at the options on the Affordable Care Marketplace portal, Healthcare.gov, since many of them have changed this year due to new legislation and become more affordable. These changes, in many cases, will stay in effect till the end of 2022, making Obamacare a viable medium-term option for people who otherwise might not have access to health insurance.
Who Is Eligible for Enrollment in the Affordable Care Marketplace
A variety of individuals and families are newly eligible for enrollment in the ACA healthcare marketplace’s subsidized plans, and thanks to the stimulus package passed last month by Congress they will pay less than they would have before. The stimulus measures will save money on premiums for as many as 14.9 million currently uninsured individuals, according to government figures.
About 1.7 million currently uninsured individuals whose incomes are at 150 percent of the poverty line or less (about $19,000 for a single person and $39,000 for a family of four) will qualify for a free basic plan through the marketplace.
Don’t assume you make too much money to try out the KFF Health Premium Calculator or just apply for subsidized insurance options through Healthcare.gov. Neither site costs you anything up front, and new provisions in the stimulus bill could help you find affordable insurance
People who choose plans with greater coverage in the Silver or Gold tiers, or who make more than 150% of the poverty line, will have to pay — but less than before.
One element of the expansion that is particularly helpful is that there is a share-of-income premium cost cap for all income levels now: no plan will charge more than 8.5% of income, no matter how high that income is. This means that even people with incomes substantially above the poverty line could qualify for a less expensive plan.
If you are employed but either have very expensive health premiums or no health insurance offered through work, you may also qualify for enrolling in an ACA plan. The expansion is large enough that unemployed, underemployed, and low- to middle-income earners can all benefit from looking into their Obamacare options.
What You Can Expect to Pay
Many people who are making poverty or near-poverty level wages will find that they qualify for an ACA or Obamacare plan that is completely free through their state exchange or through Healthcare.gov.
For higher-level plans or for higher earners, the additional tax credits available — which reduce premium costs upfront — are likely to average to about $50 less per person, or $85 less per policy, per month.
COBRA Is No Longer Unaffordable
People who have lost their job and the health insurance that went with it can turn to COBRA, a federal program that allows staying on the same plan, but only by paying its full cost — including the part the employer previously paid. This is so expensive that many people opt not to use this option. With the stimulus package, also known as the American Rescue Plan, that’s no longer the case.
If you are eligible for COBRA currently, you may qualify to have your whole premium covered by another provision in the package, until September 31st. While it may still make sense to switch to an ACA plan — especially if you now qualify for free insurance premiums through the end of 2022 — some may prefer to stick with their employer plan for the duration of the COBRA premium benefit.
“The problem with leaving a COBRA plan is that you may have already met your out of pocket maximum, so switching to a marketplace plan would cause you to start over with deductibles,” says Amy O’Meara Chambers, Chief Operating Officer at HealthBridge, who has worked for over 25 years in the healthcare industry. “If you are under some kind of medical management with your health plan with your employer, moving to a marketplace plan isn’t always convenient and can be worrisome.”
While many people also consider going without health insurance between jobs, the high cost of uninsured medical expenses makes that extremely risky. Under the American Rescue Plan, you don’t have to take that potentially dangerous route.
“Take a good look at all of the options. You may have been in a position before where the marketplaces weren’t attractive because you were making too much money, but now you may be eligible to get a comprehensive plan for a price you can afford,” says Jane Oates, President of WorkingNation, a nonprofit campaign looking at unemployment and work in the United States. “If you have the comfort of knowing you can get prescriptions and care, you’ll be in a better place to look for the kind of work you had before the pandemic.”
How to Apply for Obamacare
You can get an idea of what you qualify for by using this Health Insurance Marketplace Calculator from the Kaiser Family Foundation, which is updated to take into account the provisions of the American Rescue Plan.
You can then apply at Healthcare.gov; if your state uses its own separate exchange, the site will route you to that option, away from the Obamacare hub. Once you understand what kinds of tax credits you’re eligible for, you’ll be able to look at the different levels of health insurance available to you, at which prices.
How the Stimulus Bill Affects Health Insurance
Be aware that, while you may qualify for lower-cost insurance right now, the price updates take time to make after the stimulus plan was passed. If you did indeed qualify, you’ll receive reimbursement, and if you wait days or weeks to check your options, you may see fully updated prices in the marketplace.
Fundamentally, the stimulus bill shifts the equation even further in favor of getting health coverage for millions of Americans. Someone who wouldn’t be able to afford even a subsidized $100-a-month premium, for instance, may now qualify for a plan with a $0 monthly premium. A difference of $85 less per month on a premium, however, could also tip the scales for middle-income families that had previously been attempting to live uninsured.
The stimulus package changes the health insurance calculus for people who are already insured, too.
“People who are insured are going to seek out more needed care, rather than avoiding care because of costs,” says Tara Straw, Senior Research Analyst at the Center for Budget and Policy Priorities. “People often make job decisions based on benefits, and for instance, if people can get affordable health care, that frees them up to start or strengthen their small business. They have an alternate source of health care versus staying in a job that provides it.”
Alternatives to Obamacare and COBRA
If you are sticking with COBRA coverage from a prior job, be aware that your full premium payments under the American Rescue Plan end September 30th. If you do not anticipate getting a job with health care benefits by that date, you may want to sign up for Obamacare, and you should be aware that the special enrollment period for it ends May 15th. If you prefer to get onto an ACA plan, make sure you apply by that time, or prepare for what you’ll do between the time that COBRA coverage stops and the next open enrollment period in November begins.
Medicaid and CHIP — the latter provides low-cost options for children whose family earns too much to qualify for Medicaid — are a viable alternative to either one of the options above.
Neither has an enrollment period; you can apply and be approved at any time. If your state is among those that approved the expansion of Medicaid availability, you may qualify for a Medicaid plan even if you’ve never signed up for it before.
Medicaid coverages vary by state. In the coming months, some states that didn’t previously adopt the optional Medicaid expansion element of the ACA may consider expanding their Medicaid coverage because of funds allocated in the American Rescue Plan.
Whether you are recently unemployed, have been unemployed for a large part of the pandemic, or have work that does not provide health insurance, the American Rescue Plan provides you with options you did not have before to get health insurance. That applies to self-employed Americans, too.
Whether you’re thinking of signing up for an Affordable Care Marketplace plan or of having a previous plan extended under COBRA, now is the time to act. You have until May 15th to apply for Obamacare, and you may find that it is more affordable than you thought, thanks to new subsidies.
HealthBridge Mention in the Article
Amy O'Meara Chambers, JD
Chief Operating Officer