Sweetser Law Office knows how devastating a job loss and loss of employer-sponsored health insurance can be during normal times. Becoming unemployed and medically uninsured in the middle of the coronavirus pandemic (at precisely the time when it’s perhaps more important than ever to have some level of health coverage for you or your family) can be overwhelming. Sweetser Law Office is providing the information below to help you or a loved one make the transition quickly because it is important to act before enrollment periods end.
Many recently unemployed workers will be eligible for insurance through the Affordable Care Act (ACA) marketplaces or Medicaid.
Lays Offs Can Affect Your Employer-Provided Health Insurance
If you have been laid off or are experiencing reduced pay due to coronavirus, amidst the shock, you should begin preparing to replace your healthcare coverage if your employer is not covering you (or will stop coverage soon). You are not alone. Employer-sponsored health insurance is the most common type of health coverage for individuals under age 65, when most Americans become eligible for Medicare. And with millions of Americans out of work as businesses shut down during the coronavirus pandemic, analysts say the ranks of the uninsured also will rise.
If you are uninsured (or soon to be uninsured) you should apply for coverage right away.
There are special protections if you have recently lost employer coverage, but you should act quickly. You have 60 days of your employer coverage end date to enroll in Washington Health exchange and if your income qualifies Washington Apple Health coverage is available year-round. You can report your loss of employer coverage in Washington Healthplanfinder up to two months before it ends. This will help you avoid gaps in coverage.
Washington Health Benefit Exchange Enrollment is Open Until May 8
If you do not have medical insurance for any reason, Washington Health Benefit Exchange is OPEN FOR ENROLLMENT until May 8 due to COVID-19 (deadline extended). You need to enroll by May 8 for coverage that begins May 1. Premium subsidies and cost-sharing assistance may be available depending on income. Currently, the next open enrollment period will not be until November 1, 2020 – January 15, 2021.
Additionally, if you also lost coverage from your employer, this opens a Special Enrollment Period for you to shop for a plan. Plan selection must occur within 60 days from the qualifying life event.
Apple Health (Medicaid) for Qualifying Families of Reduced Income or Work Hours
Job loss could make you newly eligible for no cost or low-cost coverage through Washington Apple Health. Or, a reduction of work hours could make you newly eligible for no cost or low-cost coverage through Washington Apple Health.
You should report the change of income to see if you qualify for extra financial help. You can apply at any time for Apple Health if your income qualifies you at Washington Healthplanfinder, or click here to report income changes.
Washington Apple Health coverage starts the month you enroll and can typically be used within 24-hours to obtain care or prescriptions. Washington Apple Health can also help with recent unpaid medical bills up to 3 months old.
If you have Apple Health it will not be terminated during COVID-19. For anyone who was enrolled in Medicaid on or after March 18, 2020, eligibility must continue regardless of any changes in circumstances or redeterminations at scheduled renewals that otherwise would have resulted in termination. The only situations in which coverage can be terminated are if (1) an individual asks to be terminated from Medicaid voluntarily, or (2) they are no longer considered a resident of the state. This coverage would last until the month of the end of the public health emergency.
Children’s Health Insurance Program (CHIP)
CHIP, a state health coverage program with low out-of-pocket costs, is available for all children. Monthly premiums vary by household income, and families that earn up to 300% of federal poverty are eligible for a discount. People who are currently enrolled in Medicaid or CHIP cannot be removed from the program during a declared public health emergency. Families already paying a premium for CHIP who have lost income should call to find out if they are eligible for a decreased rate.
Medicare Will Cover Telehealth Appointments
Medicare expanded its telehealth benefits to Medicare beneficiaries, who are at a higher risk for coronavirus, can receive a wider range of health care services from their doctors without having to travel to a health care facility. This means Medicare will pay for more than 80 additional services when furnished via telehealth, such as:
- Common office visits.
- Emergency room visits.
- Mental health counseling.
- Preventive health screenings
Beneficiaries may use phones or smartphones and other devices that have audio and video, or just audio capabilities to get telehealth services. Telehealth services are billed at the same amount as in-person services. Medicare coinsurance and deductibles still apply, however, the federal government allows health care providers to reduce or waive cost-sharing for telehealth visits.
Commercial insurance coverage for COVID-19 testing
For commercial medical insurance coverage, the Washington Insurance Commissioner regulates many (but not all) health insurance carriers, including those offering plans in the Health Benefit Exchange, and has ordered these carriers not to charge copayments, co-insurance, or deductibles for COVID-19 related testing.
All major insurers in Washington have now agreed to cover the cost of COVID-related treatment without cost-sharing. There are differences in how these insurers will handle the coverage, and each has currently specified an end date for this coverage expansion.