Options for lost health insurance with lost job
Most people who have lost their jobs — and with it their health insurance — in Wisconsin can get coverage at minimal or no cost.
It can be a bit of a hassle, and, given the complexity of the U.S. health care system, it can be a bit confusing. But help with getting coverage is available and easy to find.
“It is very hard to fall between the cracks, even if you have a total loss of income,” said Jon Rauser, president of the Rauser Agency and vice president of Robertson Ryan & Associates.
Depending on their household income — which includes unemployment insurance and a spouse’s income — most people have one of three main options:
❚ BadgerCare Plus, the state’s largest Medicaid program.
❚ Health plans sold through the marketplaces set up under the Affordable Care Act.
❚ Continuing coverage through their former employer under what is commonly known as COBRA. Each has its pluses and minuses. “It’s different for every person you talk to in some ways,” said Bobby Peterson, executive director of ABC for Health, a public interest law firm based in Madison.
Here are the three main options:
BADGERCARE PLUS
BadgerCare Plus covers adults with incomes below the poverty threshold — $12,760 for one person this year — and may be the first option to check for people who suddenly find themselves with no income.
“When their income drops like a stone, it can open up eligibility,” Peterson said.
Two complications:
One, eligibility is based on household income, so if you are married and your spouse works, you will not be eligible if your combined income is above $17,240 a year.
Two, unemployment insurance counts as income. This means that if you are single and getting $250 a week or more, you won’t be eligible for BadgerCare Plus.
(The cutoff for eligibility for pregnant women and children is much higher: roughly $39,000 a year.)
There also are some additional
steps if you are self-employed.
Another complication is if your income for March exceeds the cutoff for eligibility. In that case, you may not be eligible until April and coverage won’t begin until May 1.
“Here is where it gets really complicated in a hurry because dates are going to matter,” said Jeni Appleby, program manager of Milwaukee Enrollment Network. “And we can help.”
People can sign up for coverage online. And, again, an array of organizations, such as Covering Wisconsin, can help with the process.
“The process we have is a bit of an eligibility corn maze,” Peterson said. “I wish it was a lot simpler. Unfortunately, it’s not.”’
The county shouldn’t require a letter from an employer that says the applicant is no longer working, Peterson said.
“If they are asking for it, a good response is, ‘Can you help me get it?’” he said.
Counties then are required to help you obtain the information or accept the best available information – and that can be “I lost my job.”
Once enrolled, you have a choice of health plans offered by private health insurers who contract with the state to manage the care of people covered by the program.
AFFORDABLE CARE ACT
If you had health insurance through an employer and have lost your job, you are eligible to sign up for a health plan on the marketplaces set up through the Affordable Care Act.
People with incomes between $12,760 and $51,040 for one person this year are eligible for subsidies to help offset the cost.
The subsidies are pegged to income and the cost can be minimal for people with very low incomes — which includes just about everyone who is unemployed.
The catch is you must have had and lost coverage to be eligible for what is known as a special enrollment period.
Sen. Tammy Baldwin (D-Wisconsin) and 24 other senators have asked the Trump administration to open enrollment to people who now don’t qualify for a special enrollment period. The Trump administration, which is seeking to have the Affordable Care Act declared unconstitutional, reportedly is considering a special enrollment because of the coronavirus crisis.
(Eleven states, including Minnesota, which run their own marketplaces, have done this.)
But, for now, getting coverage through a health plan sold on the marketplaces is limited to people who have had health insurance.
Be aware of one nuance. People with incomes below a certain threshold — 250% of the federal poverty level, or $31,900 for one person this year — are eligible for additional subsidies, but only if they buy a health plan in the socalled silver tier.
This means that buying a lower-cost plan in the bronze tier could cost you more money. The health plan also will have much higher deductibles.
People can enroll on their own through healthcare.gov. But given that this stuff gets complicated, they would be wise to get help from an insurance broker or one of the organizations that help people understand their options for coverage.
“That’s the takeaway that we always try to emphasize — that health insurance is complicated for all of us,” said Appleby of Milwaukee Enrollment Network. “But there is a lot of free help, local experts, who can help people through the process.”
Because the subsidy is based on income, if you are lucky enough to be back at work in a few months and again getting health insurance through your employer, you may have to pay back part of the subsidy at tax time.
“But if you are on the plan for only a few months, the payment would be minimal,” said Rauser, the insurance broker.
One glitch is if your spouse gets health insurance through an employer who offers family coverage, you are not eligible for the federal subsidies.
“That would be a great thing for the feds to remove,” said Peterson of ABC for Health.
One more thing: If you already have health insurance through the Affordable Care Act and have lost your job, you should report your new estimated income. You may be eligible for a larger subsidy, which would lower your monthly premium.
COBRA
The Consolidated Omnibus Budget Reconciliation Act — the name makes clear why it’s commonly known as COBRA — enables people who have lost their jobs to buy coverage through their employer for 18 months.
The downside is you must pay the full cost of the coverage, and that can be expensive.
Nationally, the annual premium for health insurance through an employer averaged $7,188, or about $600 a month, for single coverage last year, and that doesn’t include deductibles and other out-of-pocket expenses.
In some cases, for people who are older and who are ineligible for subsidies through the Affordable Care Act, COBRA can be a better option than buying insurance on your own. This is because the cost of health insurance through a large employer doesn’t vary with age. It does for individuals who buy health insurance on their own.
But this holds only for large employers. For employers with fewer than 50 employers, the premiums may be based on someone’s age.
“It isn’t black and white,” Rauser said.
PLACES TO GET HELP
This isn’t a complete list but here are some places to get help. And, again, brokers who sell insurance sold directly to individuals and families also can help.
❚ The healthcare.gov website has a link titled “find local help” that has a list of organizations and brokers who can help you sign up for coverage through the Affordable Care Act.
❚ The Wisconsin Department of Health Services has a webpage with information on BadgerCare Plus.
❚ Covering Wisconsin has people on its staff who can help you enroll in the BadgerCare Plus and Affordable Care Act. People also can make an appointment with someone who can help them through the “connector tool” on its website.
❚ ABC for Health has an online BadgerCare Plus Resource Library with information on enrolling in the health program.