Insurance

Health Insurance Options After Job Loss

What are my options for health insurance if I lose coverage from my employer?

There are several options for comprehensive major medical insurance through COBRA, the Federal Marketplace, and the Hawaii Med-QUEST Program. Individual fixed indemnity coverage is also an option, but is not comprehensive major medical insurance.

What is COBRA?

If you had/have insurance coverage through an employer with 20 or more employees and your employer is still in business with an active group policy, you are entitled to continue your coverage through the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). Under COBRA you have the option to continue your employer group health care coverage for up to 18 months. Under certain circumstances, you may also be entitled to an additional period of coverage if you are disabled, qualify for Medicare, or experience a second qualifying event. This information should have been mailed to you within 14 days of employment separation. You should contact your employer’s human resources department or representative for enrollment information.

• Carefully research your options before making a decision. With a COBRA plan, you will pay the full premium cost, plus an administrative fee.
• You may want to choose this option if you incurred significant medical expenses, and met the deductible or out-of-pocket expenses under your plan.

Information regarding COBRA and frequently asked questions are available at:
https://www.dol.gov/general/topic/health-plans/cobra and
https://www.healthcare.gov/unemployed/cobra-coverage/

What is the federal Marketplace?

You can purchase individual or family health insurance on the federal Marketplace. The federal Marketplace is a platform which offers comprehensive major medical insurance plans to individuals and families. Typically, the enrollment period takes place in November and December of the year prior to the year in which the coverage will take effect. However, you can apply for a special enrollment period (SEP) in the case of a qualifying event, such as losing coverage due to job loss or loss of another health plan. During the SEP you have 60 days to enroll after loss of coverage OR you can enroll now if you expect to lose coverage in the next 60 days.

• You may be eligible for a subsidy to assist with premium payments. Additional assistance for prescriptions or doctor visits may also be available if you are income eligible. To determine whether you qualify for a subsidy, it is recommended you visit https://www.healthcare.gov.
• When you look at the cost of a plan, be sure to factor in the deductible and out-of-pocket expenses. You also need to confirm if your medical providers participate in the plan you select.
• If you purchase through the federal Marketplace, you will be asked to complete an application. You may also be asked for additional information regarding the loss of your previous health insurance. Once you fill out the application, you will find out if you qualify for a subsidy to assist with the premium and out-of-pocket health care costs.
• Coverage through the federal Marketplace during a SEP should generally start the first day of the following month after you pay your premium.
• You can apply for a 2021 health plan during the next open enrollment period which runs from Friday, November 1, through Sunday, December 15, 2020.

To sign up for a plan, you will need to go to https://www.healthcare.gov/
Or call 1-800-318-2596.
FAQs and additional information regarding the federal Marketplace and the coronavirus are available at: https://www.healthcare.gov/coronavirus/

What is an individual catastrophic plan?

If you are under 30 years old (or any age with a hardship waiver from the federal Marketplace), you may be eligible to purchase a catastrophic plan. This type of coverage has a very high annual deductible, which means you will be paying the costs of the healthcare services until you have met the high deductible.

Information regarding Individual Catastrophic Plan is available at:
https://www.healthcare.gov/choose-a-plan/catastrophic-health-plans/

What is Med-QUEST?

Certain individuals and families in Hawaii with qualifying household size and monthly income should apply to the State of Hawaii’s Medicaid program at the Med-QUEST Division. To see if you are eligible, and to apply, go to: https://medical.mybenefits.hawaii.gov/. Residents must create an online account and submit their application. Residents may apply to the Med-QUEST Division anytime, there are no closed enrollment periods, and applications are accepted online 24 hours a day, 7 days a week.

For eligibility requirements, go to: https://humanservices.hawaii.gov/mqd/quest-overview/
For information on applications, providers, and benefits, go to: https://medquest.hawaii.gov/

What is individual fixed indemnity coverage?

This type of coverage pays a stated amount regardless of the actual expenses incurred. It is typically guaranteed-renewable to age 65, as long as the required premium is paid. The benefits may not cover the entire cost of care, and medical providers are not required to accept the benefit as payment-in-full. This is not comprehensive major medical insurance. Be aware that these plans may exclude pre-existing conditions, which means there is no coverage for treatment of medical conditions that are known to you, or that reasonably should have been known. These plans are not a substitute for the minimum essential coverage required by the Affordable Care Act (ACA).

 

Information is current as of April 30, 2020