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Lost Your Job? These Are Your Health Insurance Options

Losing a job is one of the worst feelings on the planet, especially if it’s a job you actually enjoyed.

In addition to the feelings of anger, depression, fear, and grief, you’re now saddled with the responsibility of finding new health insurance if your company was the one providing your coverage.

Luckily, you have a number of options available to you after losing job-based coverage that you should begin to explore as quickly as possible, starting with ...

Primary Options For Coverage After a Job Loss

Coverage from Your Spouse or Domestic Partner’s Employer

If your spouse or domestic partner’s insurance plan is open to family members, you may be able to join now that you no longer have insurance through your employer.

Under the Health Insurance Portability and Accountability Act (HIPAA), you have 30 days from the time that your former employer stops paying for your insurance to enroll in your spouse or domestic partner’s plan. This rule stands even if your loss of coverage doesn’t occur during an open enrollment period.

Coverage from the Marketplace

 

Under the Affordable Care Act (ACA), you can enroll in a health plan in the Marketplace during a Special Enrollment Period if you lose your job-based coverage outside of the normal open enrollment period. You may even be eligible for subsidies for reduced premiums and you might qualify for lower out-of-pocket costs.

 

Coverage from the Individual Market

 

If you don’t qualify for a subsidy for reduced premiums from the Marketplace, you can simply sign up for a new plan off of the marketplace through the individual market. Not sure whether or not you’ll qualify for a subsidy? This interactive tool on the Marketplace’s website can help you determine that.

Continuing Current Coverage Through COBRA

 

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives you the right to remain on the health plan that you had with your former employer. (COBRA does not apply if your employer had fewer than 20 employees, if your employer went out of business or if you were fired for “gross misconduct.”)

If you are eligible for COBRA benefits, you will receive notice from your former employer or the health plan and can enroll within 60 days after receiving the notice.

  • COBRA generally guarantees coverage for 18 months but may be longer depending on your circumstances.
  • Each family member can make a different COBRA election, even if your entire family was once covered under your employer’s health plan. Or, your child(ren) may elect COBRA on your plan and you may find coverage elsewhere.
  • You are responsible for paying the full COBRA premiums, which includes the amount you used to pay while employed, the amount paid by your former employer and an administrative fee. This can make COBRA coverage very expensive.

We recommend exploring the first 3 options above before looking into COBRA coverage as COBRA is likely to be your most expensive option for continuing coverage.

Secondary Options for Coverage After a Job Loss

State-Sponsored Programs

There may be state laws that complement federal COBRA regulations or other consumer protection statutes. They include:

  • Mini-COBRA plans. If you worked for an employer with 20 or fewer employees, your state may have mini-COBRA laws that allow you to obtain the same benefits by paying the full premium (or more in some states).
  • Conversion policies. If you cannot continue coverage with your former policy, your state may require insurers to convert your policy into an individual plan.

Protections Under HIPAA

Under this federal law, at least one insurer must sell you a health plan if you can meet the following conditions:

  • You previously had 18 months of coverage without a break for more than 63 days.
  • The last day of your coverage was through your employment.
  • You do not have a COBRA or mini-COBRA option available.

Trade Adjustment Assistance (TAA) Reauthorization Act and Health Coverage Tax Credit

If you lost your job due to a trade policy (moving your job overseas), you may qualify for 72.5 percent of the cost of your health insurance for up to three years under TAA. 

Medicaid, The Children’s Health Insurance Program (CHIP) or VA Coverage

Medicaid is available for low-income individuals and children, parents with dependent children, permanently disabled individuals or those over 65. Eligibility varies from state to state.

  • Though you may not qualify for full Medicaid benefits, you may be eligible for screenings for breast and cervical cancer or assistance with tuberculosis or sickle cell anemia treatments.
  • Consult your local health department for more information about public coverage options in your area.
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Going in for Surgery? Avoid Surprise Medical Bills

It’s always a good idea to confirm that your hospital is in your health plan’s network before you go in for a procedure – but this proactive step still may not be enough to avoid surprise medical bills.

Millions of Americans get surprised bills from doctors who don’t participate in their health plan but who practice in hospitals that do. This often happens when an anesthesiologist or assistant surgeon you didn’t even know was going to be in the room during your surgery (and who doesn’t participate in your health plan), scrubs up and steps in during your procedure. When it’s all over, the out-of-network doctor bills you for the difference between what your insurer paid and what the doctor charges. The practice is called “balance billing.”

The Affordable Care Act requires insurers to cover out-of-network emergency services at in-network rates. But the law doesn’t stop doctors from balance billing, and it doesn’t release patients from their responsibility to pay surprise medical bills.

Although you don’t have complete control over whether or not you’ll get a balanced bill, there are steps you can take to reduce the likelihood and to fix the problem once it happens.

Plan ahead. Before a planned surgery ask about the team of healthcare providers who will treat you while you’re hospitalized.

It’s very difficult to control who sees you at the hospital or to know which doctors participate with your health plan. But it can’t hurt to ask that they keep non-participating providers out of your room.

Check for mistakes. It may be that an in-network provider got recorded incorrectly as out-of-network in your insurer’s system when your claim was processed.

When you get a bill, don’t pay it right away. Instead, call your health plan to discuss the bill you received and ask if you can get the charges removed if they’re incorrect.

If you get health insurance at work, your employer may be able to help dispute the bill.

Talk to your doctor. Physicians are sensitive to the financial burden patients are under these days, including those caused by surprise medical bills. It’s worth calling to ask if the doctor is willing to reduce the price of the bill.

Your health plan should also be able to step in and help. In some cases, your insurer will negotiate for you with physicians to either lower or waive out-of-network charges.

Check your state. Federal law does not protect patients from balance billing. However, about a quarter of the states do have laws in place that protect consumers from balance billing by health care providers that don’t participate in their health plan. Check with your state’s department of insurance to learn about the protections where you live.

File an appeal. The law entitles you to both an internal appeal with your insurer and an external review by an independent third party. Your health plan must provide guidelines about how to go about the appeal process.

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