Personal Finance

Out of work? Here's what you need to know about getting health insurance

Key Points
  • The pandemic has led to millions of Americans losing their jobs and their health insurance.
  • Here's what to do about getting health coverage while unemployed.
Jad Kamal, 36, of New York, lost his job in March.
Source: Jad Kamal

In mid-March, Jad Kamal was laid off from his job as a sommelier at Lupa, an Italian restaurant in Manhattan. That meant another loss: his health insurance. 

What followed were headaches. "Sorting out Medicaid and unemployment was work," Kamal, 36, said. "I didn't mind putting in the effort, but the prohibitive layers of bureaucracy make you feel like they don't actually want to help you." 

This one-two punch of losing your paycheck and then your health insurance will be a familiar pain to many people during the coronavirus pandemic. In 2018, more than 160 million Americans received health insurance through their employer. Over the last few months, with unemployment claims exceeding 40 million, that popular pathway to coverage has quickly narrowed. 

"It's stressful for most people right now, but particularly if you've been laid off and have lost coverage," said Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation, a nonprofit that helps patients access and pay for health care. 

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"As overwhelming as it may be, it's important to look for coverage quickly," Donovan added. "The last thing you want to do is remain uninsured."

Your first step should be to speak with someone in your company's human resources department to understand when your coverage technically ends.

"There's no blanket rule here: For some, coverage may end immediately, for others, it may go until the end of the month," Donovan said. "Either way, you should immediately start planning to transition to a new plan." 

If you've been furloughed, an increasingly common circumstance amid the public health crisis, there's a chance your coverage will not end. If your employer is allowing you to stay on the group plan while you're not working, you should still ask how it is handling the employee contribution, said Colleen Carey, a health-care expert and assistant professor at Cornell University. 

Some companies have said furloughed employees don't have to pay their premiums while they're out of work, which makes sense since they're not receiving a paycheck from which the company can deduct the monthly payment. However, expect to have to pay those premiums when and if you're brought back to your job, Carey said. 

Navigating the health insurance landscape on your own can be stressful and confusing. There are resources you can turn to for help. If you have a diagnosed condition, including cancer, lupus or diabetes, you may be able to get support deciding on and enrolling in a plan with the National Patient Advocate Foundation, Donovan said.

You can also consult with a local health-care "navigator." 

Generally, newly laid off and uninsured people will have three ways to get coverage: COBRA, the Affordable Care Act subsidized marketplace or a public plan like Medicaid or Medicare. In some cases, if your spouse still works at a job that offers family coverage, you can request to join their group health plan, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Keep in mind you'll typically have to do this within 30 days.

It's stressful for most people right now, but particularly if you've been laid off and have lost coverage.
Caitlin Donovan
spokesperson for the National Patient Advocate Foundation

COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows people who work at companies with 20 or more employees to pay to continue their workplace insurance plan for certain periods of time. The option is pricey – $600 a month, on average – because you're now shouldering the cost of the entire plan.

"Most people find this option to be too expensive without their employer subsidies," Donovan said. However, she pointed out that if you have a Health Savings Account, you can dig into it for your COBRA premiums. Under this option, you also don't have to fret about meeting a new plan's deductible or losing your current doctors. 

You have 60 days from the loss of your job to sign up for COBRA, Carey said. And because the coverage will be retroactive to when you were laid off, if you're in-between jobs, you could wait and see if you need care, and only enroll in COBRA if you find you do, Carey said. 

If you take this route, however, proceed with caution.

"The person should make sure they know the price of COBRA, and have that money set aside," Carey said, adding that they should also understand the exact enrollment steps should they need to quickly take them. 

For many people, the ACA marketplace will provide more affordable options. 

"Depending on where you live, you can access either the federal marketplace or your state marketplace," Donovan said. "Losing your job will qualify you for a special enrollment period for either option." The enrollment window here lasts 60 days

Still, some plans on the marketplace will be costly, especially if you're newly unemployed. Because the subsidies are based on annual income, someone who makes a good living and is only out of work for a short time may find it difficult to qualify for them, Carey warned. Also: State unemployment benefits and the additional $600 weekly check will be counted when applying for subsidies on the marketplace, Pollitz said. 

Medicaid has zero premiums in most states, so if cost is a problem Medicaid should be the preferred option.
Colleen Carey
health-care expert

To figure out if you can afford a given plan on the marketplace, Donovan recommends asking yourself these questions: What is the maximum you can spend per month on a premium? Do you have any predictable health-care expenses, like regular medications you take or appointments you need to keep? Then evaluate how much a given plan will cost you, not just with the premium, but with the co-pays, deductibles and co-insurance expenses, too.

Confused? Here are some definitions:

  • Deductible: how much you'll have to shell out before a plan's coverage kicks in.
  • Co-pays: the fixed amount you'll pay for health-care services after you've paid your deductible.
  • Co-insurance: the percentage you'll still be on the hook for with covered services after your deductible is paid. 

The National Patient Advocate Foundation has a calculator to help you determine what your costs on the ACA marketplace will be. 

If you have certain doctors you don't want to give up seeing, find out if they'll accept a new plan before you sign up for it. Another option is to ask your current doctor if she would consider joining the provider network of your new health plan, Pollitz said. Still, she added, "whenever you change health coverage, there's a chance you might need to change doctors." 

Many jobless Americans will turn to Medicaid.

"Medicaid has zero premiums in most states, so if cost is a problem Medicaid should be the preferred option," Carey said. 

She pointed out another benefit: "Medicaid eligibility is based on monthly income so even a short-run decline in income should make someone eligible for Medicaid for those months." Collecting unemployment may impact your eligibility. It depends on your state, but the additional $600 federal benefit shouldn't count towards your income when calculating if you qualify.

If you were on your employer's plan and are over the age of 65, now might be the time to sign up for Medicare. There are time limits for this, as well.

Keep in mind that other options, including short-term health insurance plans and Christian ministry plans, are not regulated by the ACA. That means they do not have to cover essential services and can cap their benefits, potentially leaving you with an enormous bill if you're hospitalized.

In most cases, you shouldn't wait until you're employed again to get health insurance coverage. 

"You can always cancel your plan if you get a new job," Donovan said. "But most people don't know when that will be."