Health Care and Coverage in the Face of Massive Layoffs
The economy is shutting down and millions are getting layoff notices when they least expected or can afford it. So what do you do now?
There are two issues to understand: the Covid 19 disease and the complex choices for health coverage of laid-off workers.
The Disease
Covid 19 is highly contagious and very easily spread, even by those showing no symptoms. There are as yet no vaccines to prevent Covid 19 and no treatments for Covid 19. For 80% of those infected, it's a flu. For 20% it’s quite serious, and for 2-3% it’s lethal. So far, the elderly and those with compromised immune systems or respiratory illnesses are at the highest risk; however 40% of US hospitalizations are for younger adults. Children are at the lowest risk of getting quite ill from it because their immune systems are so much stronger, but they are carriers and contagious and potentially lethal for their elderly grandparents or any other individual with compromised immune systems.
At this point in LA, 3/4th of those known to be infected are between 18 and 64, but we don’t really know how many are infected since there are still very few tests available, so we are all flying blind.
https://www.latimes.com/california/story/2020-03-23/here-is-the-latest-l-a-county-communities-with-confirmed-coronavirus-cases Also at this point due to limited testing and wider travel patterns, it appears that more affluent communities like Brentwood have a higher rate of Covid 19 positives, and lower income communities like East Los Angeles have not yet reached that level. Unless we contain it, 60% of all Californians may catch the disease, and the spread will be unchecked overwhelming our health care system.
Since there are no known treatments, infected patients are recommended to stay home in self-isolation for two weeks until the disease has run its course. Feeling Sick, Experts Offer Some Straight Talk, Los Angeles Times, (3/24/20) and https://www.mayoclinic.org/diseases-conditions/coronavirus/diagnosis-treatment/drc-20479976 Treat the disease with lots of rest and sleep and hydration and allow your body’s own immune systems to fight and cure the disease. Those who become seriously ill need to notify and go into the emergency room for admission to the hospital where you are likely to be treated in isolation or quarantine to avoid infecting other patients, your spouse and family, the doctors and the hospital staff.
Getting health coverage after a job lay off
Medicare is for seniors and the disabled. There are no income tests and no asset tests; it’s just age and disability for the most part; however the undocumented are ineligible.
You can enroll in Medicare Part A and/or Medicare Part B in the following ways: Online at www.SocialSecurity.gov. By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
Medicaid (MediCal) is for the low and moderate income. There is an income test, but not an asset test. The income test is $17,236 for an individual, $23,336 for two persons, $29,435 for three persons and $35,535 for a family of four. The test is for your current income, not your income back before you were laid off. For most, there is no asset test, so you will not be disqualified for your savings or checking account, your condo or your car (if any). Citizens and permanent legal residents are eligible for full scope coverage. The undocumented are eligible for limited scope coverage – emergencies and maternity care. Undocumented children and young adults are now eligible for full scope coverage.
The income eligibility for children under age 18 is 266% of the federal poverty level ($68,495 for a family of four). The income eligibility for a pregnant woman can go up to 312% of FPL, but you may be required to pay part of the premium. https://www.coveredca.com/individuals-and-families/getting-covered/pregnant-women/ and http://mcap.dhcs.ca.gov/Costs/Income_Guidelines.aspx
You can apply at any time, including on line and by phone. https://www.dhcs.ca.gov/services/medi-cal/Pages/ApplyforMedi-Cal.aspx
Covered California offers premium assistance that helps pay monthly premiums and cost sharing assistance that helps lower copays and deductibles. Financial help is available to uninsured US citizens and lawful permanent residents. The new state of California subsidies are available to individuals with incomes up to 600% of FPL -- $74,940 for an individual or $154,500 for a family of four. The amount of assistance is graduated based on family income, age of family members, and the subscriber’s choice of plan.
Subscribers have a choice of plans and a choice of levels of coverage. There may be up to 5 plans competing in some regions and as few as two in lightly populated rural regions.
There are four different levels of coverage: bronze (60%), silver (70%), gold (80%) and platinum (90%) of expected medical expenses. Financial assistance with copays and deductibles (if you qualify) is linked to the silver plans. Basically you pay more if you choose the higher cost plans and the more extensive coverage.
You can apply on line or by phone. https://www.coveredca.com/apply/apply-online/ or https://www.coveredca.com/apply/ But you can only apply during the annual open enrollment or during a special enrollment period (within 60 days of losing your existing coverage).
COBRA coverage allows you to continue your existing coverage through your employer’s plan even if you have been laid off. You pay 103% of the cost of coverage. This allows you to stay within your existing provider network and your existing copays and deductibles. But it is not subsidized to reduce the costs of your premiums. So COBRA may better for some higher income individuals and families and worse for moderate and middle income families.
Apply using your employer and its health plan.
Individual coverage is available through your insurance broker or Covered California (for participating plans). There are no subsidies. There are no pre-existing condition exclusions. You will likely need to apply during the annual open enrollment or special enrollment periods (i.e. you just got laid off and are losing your employment-based coverage).
Stimulus coverage of Covid 19 testing is supposed to be free; insurers are supposed to pay for them, and for the uninsured, government is supposed to pay. We’ll have to see whether and how that works out. Some doctors according to the LA Times are charging their patients up to $500-$600 for a test despite the assurances of the President and the Governor. There is no comparable requirement for Covid 19 treatment in the hospital or out; however House Democrats are fighting for this as part of the Third Stimulus package currently in negotiations with the House and Senate.
Prepared by: Lucien Wulsin
Dated: 3/24/20