Cowboy Diva asked a good question this morning:
Losing your job is considered a qualifying life event on the ACA exchanges, right? Even if you get offered a replacement (ala COBRA) package by your employer, you don’t need an open season to apply for a healthcare plan on an exchange.
Because that’s the case, for a lot of people suddenly on unemployment, the current administration’s shenanigans about opening ACA don’t make a difference.
Almost but not quite.
Losing your job but not losing insurance as you were already uninsured does not open up a Healthcare.gov Special Enrollment Period (SEP).
Losing health insurance through work is a qualifying life event that opens up a regular SEP on Healthcare.gov.
Losing insurance through work is a life transition. A SEP is always opened up even if you are eligible for COBRA. We’ve talked about the trade-offs between Exchange and COBRA before:
Fundamentally, the question is what are the trade-offs between COBRA and the ACA?
This is a damn good question…
what is the best choice?
It depends!
The major variables are time of the year, amount of cost sharing left on the COBRA plan, hassle/transition costs, age and eligibility for ACA subsidies.
A 21 year old who has no claims in their work insurance who is COBRA eligible in February and is eligible for big ACA subsidies is likely better off in the ACA individual market as they are likely to see a low to no premium Bronze plan that they are unlikely to use as they are statistically likely to be as healthy as a horse anyways.
A 64 year old who has already maxed out their deductible when they became COBRA eligible in February, makes too much for ACA subsidies and has a knee replacement surgery scheduled in March will likely be better off in COBRA.
If you lost your insurance through work, you can look at the ACA exchanges. There might be a good deal available. At the same time, COBRA may still be attractive if you make too much for ACA subsidies to matter and you anticipate significant medical costs for the rest of the year and have already spent your deductible.
Now if you live in a state (excluding Idaho) that runs its own Exchange/marketplace, you can get a COVID-19 general SEP that applies even if you were uninsured for the first few months of the year. However that is restricted to states that are acively engaged with their own markets.
West of the Cascades
You’ve surely saved lives with your posts over the years. Thank you.
The unwillingness of this evil administration to open a new SEP for the exchanges is unconscionable thing # 12,378,334,356 the Republicans have done since 1980.
Sister Golden Bear
I looked at Covered California, but the good news is my former company got a really deal on health insurance — probably because they do work for one of the insurers who provided our health care. So my COBRA will be about half the cost of the equivalent Covered CA plan. Which is a big deal considering I may be out of work for quite a while (as well as not having to pay a heft deductible all over again).
The bad news is that until I actually get the COBRA paperwork and make the payment, I’m effectively without health insurance. Yes, I know that legally it’s supposed to be retroactive, and normally that wouldn’t be a huge issue, but…. Color me a cynical Gen Xer, if I were to come down with coronavirus I’m sure the insurer would find a way to wriggle out of it. Because moar hookers and blow.
In the interim, I’m terrified about getting sick.
SteverinoCT
Another consideration is if you think you will be re-hired after the crisis and the business reopens. In that case would you be better off taking the COBRA? Would you slide back into your employer-based coverage?
My wife’s situation is this: her company has sent her home but is paying her; first for two weeks, and now for two weeks more: they seem to be playing it by ear. My concern is that they eventually let everyone go with the plan to bring everyone back after. It’s not a “small business”, a big retail company. She has no medical needs (doesn’t even get checkups at age 62!) but *I* am on her plan and I am fat, lazy, and diabetic: the 20% that uses 80% of the benefits. I have met my deductible, and am within $1500 of max out-of-pocket.
We wouldn’t go on the CT state exchange: we’d switch to my company’s insurance plan: I am now WFH, and the only reason we’re on her plan and not mine is that she got a job first. But I’d have to start from scratch on deductible and out-of-pocket, correct?
Mnemosyne
@Sister Golden Bear:
As someone who once sent in her initial COBRA payment postmarked on the 89th day … you will be covered retroactively. Obviously, stay as safe and well as you can and don’t take up a dangerous new hobby like skateboarding, but you should be okay. Though I would probably be calling HR to ask when they’re sending the paperwork, like, every other day.
Mnemosyne
The Giant Evil Corporation announced yesterday that they may be furloughing “non-essential” employees, but the good-ish news is that they specifically said that THEY will pay our full health insurance premium if that happens (ie both the employer and the employee portions). So that was good to hear. Now to find out if my department is considered “essential” or not …
Bondo
What about “changes in your income that affect the coverage you qualify for?” Shouldn’t that apply to a lot of people even if they weren’t insured before? Or I suppose if they are qualifying for Medicaid they don’t need a QLE?
evap
Thanks for this. My daughter (26) just got laid off and lost her health insurance. We have agreed to pay for COBRA for a few months at least, but maybe she’d be better off looking into ACA insurance. She’s in Colorado.
Elizabelle
One has to be a dipshit’s dipshit to not open enrollment for Obamacare during a pandemic.
We are going to end up with ObamaCare and TrumpDeath.
DAVID ANDERSON
@evap: go straight to Exchange. Colorado is doing rapid enrollment. Your daughter is young enough that gross premiums in exchange are likely to be way cheaper than COBRA.
Cowboy Diva
Thanks again for the clarifying post!