Have you ever wondered what you would do if you lost health insurance? You're not alone. While the health care debate continues in Washington, D.C., many consumers and patients worry about how they'll pay for health care.
Many normal life transitions -- job change, marriage, divorce, growing older, new baby, etc. -- can lead to lost health insurance. In addition, many regions of the country have seen rising premiums and insurance carriers pulling out of the market. While the Affordable Care Act (ACA) remains in place for now, its future is far from assured.
In this era of uncertainty, it helps to know your options.
Employer-Based Insurance
Most Americans get their insurance through their employer or a family member's employer, and changing jobs, retiring, or working reduced hours can affect access to insurance. If you're switching jobs, inquire about insurance options offered by your new employer before you start work. This will help to ensure that you transition from one plan to another smoothly and without gaps in coverage. Those who are retiring or working too few hours to qualify for insurance will have to look at the other options below.
COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law that requires most employer-based insurance plans to offer options for continuing coverage under certain circumstances -- such as retirement, layoff, or reduced hours. But many people don't realize that COBRA coverage applies to covered family members, too.
For example, say your 25-year-old son has remained on your employer-based insurance, as allowed under the ACA. As he nears his 26th birthday, he can opt to extend his coverage on your group insurance through COBRA, paying the full cost himself. COBRA may also be an option in the event of divorce, legal separation, or death of a covered employee.
However, COBRA coverage is temporary -- perhaps tying you over until you get a new job or qualify for other insurance. You'll still need a more permanent solution.
Health Care Insurance Marketplace and State Exchanges
If you don't have access to employer-based insurance, start your search for coverage on the Healthcare Insurance Marketplace. Although the standard enrollment period is from November to January, you may be able to sign up at other times of the year if you've lost health insurance. Even if you qualify for coverage under COBRA, you should check here to compare prices and options. You must buy your insurance through the Marketplace to receive any tax credits or subsidies you may qualify for under the ACA.
The exchange offers plans at four levels, with varying benefits and costs. Bronze plans have lower premiums but require you to pay more for health care services that you use. Platinum plans cost more per month, but you'll pay less each time you go to the doctor. The right plan for you will depend on your health, your budget, and how you use health care services.
Medicare
If you're 65 or older, or have a disability, you can apply for Medicare, the federal health insurance program. You're eligible to sign up for Medicare three months before you turn 65. There are four parts to Medicare. Part A covers hospital are, skilled nursing care, hospice, and some home health care. Part B covers certain doctors' services, outpatient care, preventive care, and medical supplies. Part D covers prescription drugs, and Part C is an optional managed care plan that combines the benefits of Parts A and B.
Medicaid and CHIP
Depending on your income and your work status, you or your children may qualify for Medicaid or CHIP, funded jointly by the federal government and the states. Medicaid offers insurance for some low-income adults, families and children, pregnant women, the elderly, and people with disabilities, while CHIP offers health care coverage for children. Some states expanded Medicaid eligibility as part of the ACA, so more people qualify now than have in the past.
You can apply for these programs at the same time as you research your insurance options on the Healthcare Insurance Marketplace, or you can contact your state Medicaid agency. Even if you don't qualify for Medicaid, your children may qualify for CHIP.
Insurance Brokers, Agents, and Brokerage Services
Working with a broker, agent, or service can take some of the headaches out of buying health insurance, but make sure you work with someone who is licensed and reputable. Brokers usually offer plans from a variety of companies, and agents only represent one company and you'll have to talk to several to get information on different plans. A variety of brokerage services have websites where you can compare different options. Policies sold through brokers or agents may not qualify for a tax credit or subsidy.
No matter how you get coverage after you've lost health insurance, compare provider lists to ensure that you can continue to see the physicians and other health care professionals you have already built a relationship with.
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