It’s been a bad year for health insurance. Studies show at least 7.7 million people lost their employer-sponsored health insurance as of June 2020 due to the coronavirus pandemic. When you include their family members and dependents, this leaves nearly 15 million people without health insurance in the middle of a deadly pandemic.
That’s why this may be one of the best times for your patients to sign up for coverage on the ACA marketplace, aka Obamacare. Open Enrollment began last weekend and runs until December 15th. There’s been a lot of talk of the U.S. Supreme Court striking down the ACA, but experts believe this is still the best option for those that have lost their employer-sponsored health insurance, even if the law could change down the line.
From Unemployed to the ACA
For many Americans who are out of work, finding insurance and applying for low-cost health plans may take a backseat to other concerns, such as shopping for food or finding childcare.
Stan Dorn, a health-policy expert at Families USA, a liberal policy group that wants to expand access to affordable healthcare, says signing up for insurance can easily get lost in the shuffle. “These folks typically are focusing on survival needs — getting food on the table, paying next month’s rent. Not many [unemployed Americans] have the bandwidth to learn about health-care programs and then fill out all the paperwork, so it’s a really tough situation right now for a lot of people.”
Experts also say signing up for Medicaid may not be on many people’s radar, especially if they’re used to getting health insurance through their employers.
Enrollees typically receive subsidies, technically tax credits, that reduce the cost of premiums. The Centers for Medicare and Medicaid Services says that around 8.3 million people were enrolled in health plans through one of the Obamacare-authorized health exchanges at the start of 2020. However, the coronavirus pandemic will likely lead to a surge in demand now that open enrollment has arrived.
How to Qualify
If someone has recently lost their job, they should head over to the Healthcare.gov website to learn more about their options. Some states have their own state-run ACA programs, such as New York and New Jersey, but states like Florida and Texas rely on the federal website.
When the Affordable Care Act was first passed in 2010, some states chose to expand their Medicaid programs to reduce the number of people without insurance, but other states did not. For those who live in the 39 states that chose to expand Medicaid, applicants need to show a household income of 138% of the federal poverty line in order to qualify. For an individual, that would mean up to $17,609; for a family of four, $36,156.
Administrators of the program will only look at the person’s income, not their assets or retirement contributions.
For those who make too much to qualify for Medicaid or those who do not live in the 39 states that have expanded the program, they still might be able to find a lower cost plan on the ACA marketplace.
As for people who have already sought out medical care, Medicaid will still cover any medical bills within the last three months if the person would have qualified for the program but didn’t sign up.
Even if some people are making too much money to qualify, their kids may be eligible for a low-cost insurance program through Medicaid or the Children’s Health Insurance Program.
When signing up for ACA health insurance online, the website will ask the person to estimate their income for the following year, which can be tricky for the newly unemployed.
“You’re going to have to make a projection of what your income is going to be next year, which is going to be harder for some people if they’re out of work and they don’t know when they’re going to go back or they’re working intermittently,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
KFF has also created a calculator tool to help people get a sense of how much assistance they are eligible for based on their income.
The projected income will then be compared to last year’s tax return. “If the income that you project for 2021 is substantially different from what you reported on your last tax return, it will go ahead and give you the subsidies temporarily at your lower new income, but it’s going to ask you for additional documentation,” Pollitz says. That means some people may have to send unemployment documentation or a letter explaining why their income has changed.
What If the ACA Goes Away?
With Justice Amy Coney Barret on the U.S. Supreme Court, there is a chance the ACA, or at least parts of the law, could get struck down over the next nine months. The case California v. Texas is expected to appear before the court next week, but the justices won’t issue their opinions until June 2021.
Experts say people should still enroll in the ACA even if there’s a chance it could go away.
“No matter what the Court does, people who sign up for insurance now will get insurance and likely will keep it for a while,” Dorn said.
“It is the law right now, and people should sign up. If something changes down the road, we’ll worry about it then.” Pollitz said.
Let your patients know that ACA Enrollment is here, so they can lock in low-cost insurance before it’s too late.