Since the beginning of the COVID-19 pandemic, some 40 million Americans have lost their jobs. With the loss of jobs, comes the loss of health insurance.
For cancer patients, maintaining your health insurance is essential.
The good news is, you probably have some options to keep your coverage or get new coverage.
Keeping Your Coverage Through COBRA
The Consolidated Omnibus Budget Reconciliation Act of 1985 gave us the law we now know as “COBRA.” COBRA guarantees that health insurance can continue for qualified individuals after a change in employment status. This means, in some cases, you can maintain your health insurance coverage after you have a change in your job.
If you have lost your job as a result of COVID-19, you may be eligible to maintain your health insurance coverage through COBRA. You must be notified by your employer within 44 days of your options to continue coverage.
The benefits of continuing COBRA include that you have your same plan and can stay with your same care providers. Challenges of COBRA are:
- It’s expensive. If you choose to use COBRA you need to make sure that you are able to pay for the entire cost of the plan yourself and family members you want to remain covered by the plan.
- With COBRA, your employer is no longer contributing to the costs of your health care premiums. Often these are shared for by the employee and employer.
- If your employer goes out of business, as so many have with the COVID-19 pandemic, COBRA is not an option.
COBRA rules, eligibility and how long you can be hard to navigate. Learn more about COBRA here.
Switching Your Coverage to a Marketplace Plan
A loss of coverage triggers a special enrollment period for insurance plans associated with the Affordable Care Act (ACA or “Obamacare) purchased through the healthcare marketplace (healthcare.gov or state based marketplaces). You have 60 days after losing your coverage to purchase a plan through the marketplace. In addition, depending on your income, you may be eligible for premium tax credits and cost-sharing through lower out of pocket contributions from the individual/family.
But, remember that plans available in your area may be limited and you may not be able to stay with your same cancer team depending on the network of participating providers with this plan.
You can explore plans available in your area by visiting healthcare.gov. Also ask your social worker, navigator or practice manager at your treatment center for a list of participating ACA providers. This will help avoid a disruption in your treatment or change in providers.
BUT—And it is a BIG BUT…
You can’t elect to go on COBRA, then decide it is too expensive and switch to a marketplace plan. There are special rules about COBRA and ACA sponsored plans through the Healthcare Marketplace. Remember that the marketplace is typically for people without insurance. If you have COBRA coverage, you have insurance. Outside of annual open enrollment for ACA plans, you cannot drop COBRA coverage just because a less expensive plan may be available through the Marketplace.
You CAN purchase an ACA plan during open enrollment (which is in Nov-Dec of 2020) to begin in January 2021 and drop your COBRA at that time. But ,if you chose COBRA now, be prepared for that to be your coverage for the remainder of 2020.
Are There Other Options?
Yes. If your spouse is working and has insurance coverage through their employer, you could be added to their coverage. Again, there will be cost involved and every employer has differing rules for “life changing events” that qualify for a change in coverage mid-year. But it never hurts to inquire with Human Resources about this option.
Depending on where you live and your income changes related to the COVID-19 pandemic, you could be eligible for Medicaid. Medicaid is a state run insurance plan for individuals with lower incomes and/or disabilities. Every state has its own qualifying criteria, and states that expanded Medicaid as a result of the Affordable Care Act cast a wider eligibility net. Again, it’s important to ask your social worker or navigator for help in determining if Medicaid may be an option for you.
Don’t forget there are many sources of additional financial assistance available as a result of the pandemic. Read more about these funds here.
What’s Next?
In the most recent House of Representatives bill passed for pandemic related assistance, a provision was included to help cover COBRA costs for individuals who have lost their jobs. This type of assistance was enacted before after the economic crisis of 2008. Unfortunately, this bill has not been taken up by the Senate yet.
You can contact your Representatives and Senators and let them know how you have been impacted by the pandemic and about your struggles to maintain insurance coverage and continue you cancer treatment. Make you voices heard!