Health Care and Coverage for the Newly Unemployed
Much of the economy has shut down, and millions are getting layoff notices and applying for Unemployment Insurance. There are now over 17 million Americans who have applied for UI and many more are waiting in line to apply. So what do you do now?
The complex choices for health coverage of laid-off workers are not that easy to understand, but you do have choices, some are more affordable than others.
Getting health coverage after a job lay off
If you are over 65 or disabled, apply for Medicare. 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.
If your income is now low or moderate, apply for Medicaid (MediCal) 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
That $600 weekly bump in your UI check under the CARES Act does not count in determining your eligibility for MediCal.
If your income is too high for MediCal; apply for Covered California. It 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 enhanced silver plans. Basically you pay more if you choose the higher cost plans and the more extensive coverage. If you and your family need a lot of medical care, make sure you apply for the plans like enhanced silver, gold and platinum that offer more coverage.
You can apply on line or by phone. https://www.coveredca.com/apply/apply-online/ or https://www.coveredca.com/apply/ You can only apply during the annual open enrollment or during a special enrollment period (within 60 days of losing your existing coverage).
Covered California has instituted a new special enrollment period for individuals in light of the Covid 19 pandemic, so you will need to apply very soon. https://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/
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.
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).
If you are uninsured and not eligible for any of the above, make sure you check out eligibility for county health services; if you are sick go the community clinics closest to you; if you are really sick, go to the nearest hospital emergency room. Even if you end up in a private hospital, that hospital may be able to get paid for your care if you have Covid 19 under a brand new financing program being set up under the CARES Act. If you need to be tested for Covid 19, it is supposed to be free and tests are becoming increasingly available.
Prepared by: Lucien Wulsin
Dated: 4/9/20