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How To Get Health Insurance While Unemployed

How To Get Health Insurance While Unemployed text overlaying image Losing a job can be a stressful and challenging experience, and one of the many concerns that may arise is how to maintain access to essential healthcare services. Health insurance is a critical component of overall well-being, providing financial protection and access to medical care when needed. Fortunately, there are several avenues available for individuals who are unemployed to secure health insurance coverage. In this article, we will explore some options and provide guidance on how to navigate the process.

Explore COBRA Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that permits eligible workers to keep their employer-sponsored health insurance coverage for a set length of time when they lose their jobs. While COBRA coverage may be more expensive than what you paid when employed, it frequently provides access to the same benefits and network of healthcare providers. Within 60 days after losing your employment, contact your former employer’s human resources department and inquire about COBRA coverage. To be eligible for COBRA coverage, you must have been covered by your employer’s health plan while employed, and your employer must have at least 20 employees. COBRA coverage is also offered for eligible dependents (spouse and children) in the event of job loss, divorce, or other qualifying situations.

 

COBRA coverage normally lasts from 18 to 36 months, depending on the conditions. The term can vary depending on criteria such as the reason for job loss and any extensions granted due to disability. While COBRA allows you to keep the same health insurance coverage you had while employed, it can be more expensive. Under COBRA, you are responsible for paying the entire premium, including the portion that your employer previously paid. This can lead to much higher monthly rates. However, it may still be less expensive than other options, particularly if you want to keep your current healthcare providers or have certain medical needs.

 

After you lose your employment, your employer must present you with a COBRA election notice within 44 days. This letter includes information regarding your eligibility, coverage costs, and enrollment deadlines. You normally have 60 days from the date of the notice to determine whether to elect COBRA coverage. If you decide to join, you must pay the initial payment within 45 days.

Medicaid

Medicaid is a joint federal and state program designed to provide healthcare coverage to low-income individuals and families. Eligibility and benefits vary from state to state, but it often serves as a vital safety net for individuals who are unemployed and have limited financial resources. Here’s a more in-depth look at Medicaid and how to access it when you’re unemployed:

Income Eligibility

Medicaid eligibility is primarily based on income, household size, and other factors. In states that have expanded Medicaid under the Affordable Care Act (ACA), eligibility limits have been increased, allowing more low-income adults to qualify. However, even in non-expansion states, you may still be eligible if your income falls below the poverty level or if you meet specific criteria such as having dependent children or being pregnant.

Application Process

Applying for Medicaid typically involves contacting your state’s Medicaid office or using an online portal provided by your state’s government. The application process may require you to provide documentation of your income, assets, and other personal information. Many states also offer assistance through local social service agencies to help individuals with the application process.

Retroactive Coverage

In some cases, Medicaid coverage can be retroactive to cover medical expenses incurred up to three months before the month of your application, depending on state regulations. This can be particularly helpful if you had medical expenses before obtaining Medicaid coverage.

Benefits

Medicaid provides comprehensive healthcare coverage, including doctor’s visits, hospital stays, prescription medications, preventive care, and other essential medical services. Coverage may also include dental, vision, and mental health services, depending on your state’s Medicaid program.

Managed Care

In many states, Medicaid recipients receive their benefits through managed care organizations (MCOs). These organizations coordinate your healthcare services and provide access to a network of healthcare providers. You may be required to choose an MCO or be assigned one based on your location.

No Monthly Premiums or Low Cost

Unlike private health insurance plans, Medicaid typically does not require monthly premiums. In some cases, Medicaid recipients may be subject to nominal co-payments for certain services, but these costs are generally low, and there are often exemptions for those with limited income.

Renewal and Redetermination

Medicaid eligibility is not always permanent. You will need to periodically reapply or recertify your eligibility, typically on an annual basis. Changes in your income or household circumstances may impact your eligibility, so it’s essential to stay informed and report any changes promptly.

Additional Services

Some states offer optional Medicaid programs that provide additional services, such as home and community-based services for individuals with disabilities or long-term care needs. These programs can be particularly beneficial for those who require specialized care.

Health Insurance Marketplace

The Health Insurance Marketplace, often known as the Affordable Care Act (ACA) Exchange, is a website where individuals and families may compare and purchase health insurance plans. It is a great resource for those who are unemployed or experiencing financial difficulties, since it provides a variety of solutions designed to give reasonable and comprehensive coverage. The Health Insurance Marketplace includes an annual Open Enrollment Period, during which you can apply for or alter your coverage. Typically, this time lasts from November 1st to December 15th, though particular dates may vary from year to year. It is critical to record these dates on your calendar and take advantage of this opportunity to obtain health insurance.

 

In addition to the Open Enrollment Period, Special Enrollment Periods (SEPs) are triggered by certain life events, such as job loss, marriage, childbirth, or other qualifying events. If you lose your employment and employer-sponsored coverage, you have 60 days to apply for coverage through a SEP. One of the most major benefits of the Health Insurance Marketplace is the availability of subsidies. The government provides subsidies to help lower-income individuals and families afford health insurance premiums. Subsidies are classified into two types: premium tax credits and cost-sharing reductions. These subsidies can drastically lower your monthly premiums and out-of-pocket expenses, making insurance more reasonable.

 

All Marketplace plans must provide basic health benefits like preventative care, prescription medications, maternity care, mental health services, and more. This ensures that you have adequate coverage for all necessary medical procedures. The Marketplace website offers tools and resources for comparing various health insurance plans based on characteristics such as premiums, deductibles, co-payments, and provider networks. You can refine your search to locate plans that match your healthcare choices.

State-Specific Programs

In addition to Medicaid and the Health Insurance Marketplace, many states provide their own health insurance programs for low-income or unemployed individuals and families. These programs differ greatly per state, both in terms of eligibility requirements and services offered. These programs have various names in different states, such as “Basic Health Program,” “State Children’s Health Insurance Program (SCHIP),” or “State-specific Health Coverage Program.” Each state has the freedom to create its own program to meet the specific healthcare needs of its citizens.

 

Eligibility for state-specific programs is typically based on income, and the requirements vary by state. Some programs cater to certain demographics, such as children, pregnant mothers, or people with impairments, while others accept a larger variety of applicants. Job loss and unemployment are common variables that improve your chances of qualifying. State-specific programs offer a variety of healthcare services, including doctor visits, hospitalization, preventive care, prescription drugs, and more. Some states may additionally provide extra benefits like dental and vision care, mental health services, and substance addiction treatment.

 

To apply for these programs, contact your state’s Department of Health or the organization in charge of managing healthcare programs. Online applications are frequently accessible, making it easy to apply from the convenience of your own home. You may be required to supply evidence proving your income, citizenship or residency status, and other relevant information. Some state-specific schemes may have minimal or no monthly premiums, while others may impose small fees or co-payments for specified services. The cost-sharing arrangement varies, but the overall purpose is to make healthcare cheap for individuals with limited resources.

Spouse or Family Coverage

One potential option for obtaining health insurance when you’re unemployed is to explore coverage through a spouse or family member’s employer-sponsored plan. This approach allows you to become a dependent on their policy, granting you access to healthcare benefits. The availability of spouse or family coverage largely depends on the policies of your spouse or family member’s employer. In most cases, employers offer the option for employees to include their spouses and dependent children on their health insurance plans. Some employers extend this benefit to domestic partners as well.

 

In addition to the regular open enrollment period, many employer-sponsored plans offer special enrollment periods (SEPs) triggered by qualifying life events. These events can include marriage, the birth or adoption of a child, or a spouse’s job loss. If you’ve recently lost your job, you may be eligible to enroll in your spouse’s plan during a SEP. Enrolling in a spouse or family member’s plan typically involves sharing the cost of premiums. The employer and the covered employee typically contribute a portion of the premium cost, while the dependent (you, in this case) is responsible for any additional premiums. It’s essential to understand the financial implications and budget accordingly.

 

The specific benefits and coverage options offered by the employer’s plan may vary. Review the plan’s coverage details carefully to ensure that it meets your healthcare needs. Consider factors such as the network of healthcare providers, prescription drug coverage, and any deductibles or copayments associated with the plan.

Short-Term Health Insurance

Short-term health insurance plans, sometimes known as temporary health insurance, are intended to provide coverage for a limited time, usually ranging from a few months to a year. They can be a solution for people who are unemployed or in between jobs but require some type of coverage. Short-term health insurance plans are temporary in nature, and their lifespan varies depending on the insurer and state restrictions. While they can give coverage for up to a year in specific situations, the majority of states limit it to three to six months. Be warned that these plans often do not provide as much coverage as long-term health insurance options.

 

Short-term plans are designed to provide basic, essential coverage and are typically less extensive than standard health insurance. They may exclude pre-existing conditions, maternity care, mental health services, preventive care, and prescription medications. Before enrolling, make sure to carefully review the plan’s advantages and limitations. Short-term plans do not meet the Affordable Care Act’s (ACA) minimum essential coverage criteria. This means that even if you just have a short-term plan, you may be subject to the ACA’s individual mandate penalty (if applicable in your state) for not obtaining complete health insurance.

State Regulations For Short Term Plans

Each state has its own set of rules governing short-term plans. In reality, some jurisdictions prohibit residents from purchasing these plans, although the majority allow for a limited time to have one. The following states enable you to get short-term coverage for 364 days and can renew up to three times for a total of three years:

 

The next set of states allow for coverage from short term plans to last between 1 and 3 years:

 

  • Kansas – 365 days for your initial plan and 1 renewal, giving you a total of 24 months.
  • Maine – 364 days for the initial plan, with 1 renewal for a total of 24 months.
  • Ohio – 364 days, no renewals.
  • South Carolina – 11 months for the initial plan, plus allows 3 renewals for 33 months in total.
  • Wisconsin – 364 days, allows for renewal but only for a maximum of 18 months of coverage.

If you live in the following states, your initial term with one of these plans can be be up to 6 months:

The next states have an initial term of 3 months:

The last set of states have either banned or no longer offer short term plans due to a change in their laws:

 

For more in-depth information on your state’s laws surrounding short term insurance, check out our state-by-state guides to health insurance.

Non-Profit and Community Resources

In addition to government programs and traditional health insurance options, there are non-profit organizations and community resources that offer assistance to individuals who are unemployed or facing financial hardship. These resources can provide valuable support in accessing healthcare coverage and essential medical services.

Community Health Centers

Community health centers, also known as Federally Qualified Health Centers (FQHCs), serve as primary healthcare providers for underserved populations. They offer a wide range of healthcare services, including medical, dental, and behavioral health services, often on a sliding fee scale based on income. These centers are essential for individuals without insurance or with limited resources.

Free Clinics

Many communities have free or low-cost clinics staffed by volunteer healthcare professionals. These clinics provide basic medical care, preventive services, and sometimes prescription medications at little to no cost. They are a valuable resource for individuals who may not have insurance coverage.

Non-Profit Health Organizations

Various non-profit organizations, such as the American Cancer Society, American Heart Association, and American Diabetes Association, may offer financial assistance programs or resources to help individuals access necessary medical care. These programs may focus on specific health conditions and offer support for related expenses.

Prescription Assistance Programs

Some non-profit organizations and pharmaceutical companies offer prescription assistance programs for individuals who cannot afford their medications. These programs provide discounts or free medications to eligible individuals based on income and other criteria.

Navigators and Enrollment Assistance

Non-profit organizations and community groups often have trained navigators or certified application counselors who can assist individuals in navigating the health insurance enrollment process. They can help you understand your options, complete applications for government programs like Medicaid or the Health Insurance Marketplace, and provide guidance on available resources.

Local Social Services Agencies

Local government social services agencies can connect individuals with a range of resources, including healthcare coverage options, food assistance, housing support, and more. They can assess your eligibility for programs like Medicaid and provide guidance on accessing community resources.

Disease-Specific Support Organizations

If you have a specific medical condition or are dealing with a chronic illness, consider reaching out to disease-specific support organizations. These organizations often provide educational resources, financial assistance, and support networks to individuals and their families.

Charitable Foundations

Some charitable foundations and philanthropic organizations provide grants or financial assistance to individuals in need of medical care or health insurance coverage. These grants may be available on a case-by-case basis and can help cover medical expenses or insurance premiums.

Local Churches and Religious Organizations

Religious institutions and local churches may offer support programs, including healthcare assistance, to members of their community. Reach out to local congregations or organizations to inquire about available resources.

Conclusion

Losing a job can be a challenging time, but it’s essential not to overlook the importance of maintaining access to healthcare. By exploring the various options available, such as COBRA coverage, Medicaid, the Health Insurance Marketplace, and state-specific programs, you can find a solution that suits your needs and budget. Don’t hesitate to seek guidance from healthcare professionals or social service organizations to help you navigate the process and secure the health insurance coverage you need during this transitional period. There is a way to get affordable health insurance without all the hassle. A licensed EZ insurance agent can outline the benefits and drawbacks of each plan. And assist you in creating the plan that will work best for you. 

 

Working with an agent saves you time and stress, no more trying to decode legal jargon or reading fine print. Agents do all the heavy lifting while you rest easy knowing that your coverage will be the best fit for your financial and medical needs. Not to mention EZ agents can save you hundreds of dollars every year on health insurance premiums.

 

We do this by having the ability to search both on and off market for the most affordable plans. We’re also able to find and apply any discounts you may qualify for. And we don’t stop at just finding you a plan, we help maintain your plan after the fact too! We can help you file claims with your provider and even help renew your policy when the time comes. To get started, simply put your zip code into the box below or give one of our licensed agents a call at 877-670-3557.

Last Chance For AEP

Last Chance For AEP text overlaying image of an hourglass Every year, from October 15 to December 7, the Medicare Annual Enrollment Period takes place. This is a good time to look over your present Medicare coverage. Does it cover the medicines you need? Are you able to pay for the plan? Are you able to see your favorite doctor through the plan? The Medicare AEP is not the same as the other times you can sign up for a Medicare plan. You can add, change, or get rid of Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans during the Medicare AEP. After that, you can also make the following changes:

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Medicare Options

There is a time every year when people who already have Medicare can switch from Original Medicare (Parts A and B) to Medicare Advantage (Part C). Or the other way around. However, if you want to change, you might have to do some other things too. Changes to and from different types of plans will require you to make different choices.

Switching to Medicare Advantage

In this scenario, you are currently enrolled in Traditional Medicare and are considering switching to a Medicare Advantage plan. In addition to that, you can also have a separate Part D plan for your prescription medication. The majority of Medicare Advantage plans offer comprehensive coverage that encompasses all of your needs. They will pay for your Medicare Part A and Part B benefits. As well as your Medicare Part D prescription medicines and most other health services or items that are not covered by Original Medicare. A few of these additional things are dental, eye, and hearing care, in addition to memberships at fitness centers. To prevent you from spending an excessive amount each year, Medicare Advantage plans come with a cap on the amount of money you are responsible for paying out of pocket.

 

You have the ability to switch from Original Medicare to a Medicare Advantage plan if you do so during the Annual Enrollment Period. If you already have Medicare Part D coverage, but decide to enroll in a Medicare Advantage plan, you may find that you no longer require a separate Part D plan. If you decide to enroll in a Medicare Advantage plan instead of Original Medicare, the plan will coordinate the transfer of your benefits with Medicare. There is no requirement for you to initiate contact with Medicare on your own. Your new plan will begin covering you as of the first of the year. 

Switching to Original Medicare

Only Part A (covering for hospital stays) and Part B (coverage for medical services) are included in Traditional Medicare. It doesn’t cover prescription drugs, dental care, vision care, or fitness programs like some Medicare Advantage plans offer. Because there is no yearly out-of-pocket maximum with Original Medicare, there is also no built-in financial security for beneficiaries.

 

You will need to get additional coverage if you still intend to have these things. For instance, if you want coverage for prescription drugs. You will have to search for a stand-alone Part D plan and sign up for it. Previously, this was not the case. In the event that you determine you require additional coverage, you will be required to select a Medicare Supplement Plan and register for it directly with the issuer of that plan. In order to make the transition back to Original Medicare, you will need to contact either the provider of your Medicare Advantage plan or Medicare itself.

What If I Miss The AEP?

A number of different things might happen, and it all depends on the coverage that is being given right now. What transpires next will be determined by the type of coverage you currently have in place. The majority of people who are enrolled in Medicare have either Original Medicare with a Part D prescription medication coverage or Medicare Advantage together with a Medicare Supplement insurance policy.

Missing The AEP With a Medicare Advantage Plan

During the AEP, beneficiaries who are enrolled in Medicare Advantage plans have the opportunity to make modifications to their coverage. If you do not enroll in the new plan during the Annual Enrollment Period, your existing plan will be transferred to the new plan automatically. One possible exception to this rule is if your existing Medicare Advantage plan moves out of the area it serves or is terminated. In the event that this takes place, you will be eligible for a Special Enrollment Period. The SEP will extend for two months after the Part C program has concluded.

 

You have the ability to make modifications to the Medicare Advantage Open Enrollment Period if you are enrolled in a Medicare Advantage plan and you are currently enrolled in the plan. Every year, the MAOEP begins on the first of the year and continues until the end of March. You have the opportunity to make changes to your Medicare Advantage plan during this period of enrollment. If you do not enroll during the AEP or MAOEP, you will not be able to change your plan until you have a Special Enrollment Period that meets the requirements.

 

Imagine you are only eligible for Original Medicare, and you fail to enroll during the Annual Enrollment Period. If this is the case, the only way for you to add a Medicare Advantage plan or a Medicare Part D plan is if you have a Special Enrollment period during which you are eligible to do so.

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Missing The AEP With a Part D Plan

If you miss the AEP, your existing plan will carry over into the following year. Just like it would with a Medicare Advantage plan, unless the program is discontinued. If you miss the enrollment period for a program and then decide you want to switch to a different one, you won’t be able to make the switch unless there is a special enrollment period. An SEP is triggered by particular occurrences in a person’s life as well as unusual conditions. 

Options After Missing The AEP

Even if you miss the Annual Enrollment Period for Medicare, you still have choices available to you to obtain health insurance.

Special Enrollment Period

You may be able to make changes to your Medicare coverage outside of the Medicare Annual Enrollment Period if you meet the requirements to qualify for a Special Enrollment Period (SEP). There are numerous instances in which you may be eligible for a SEP. Some of these circumstances could result in you losing your health insurance coverage, either temporarily or permanently. The following are some instances of circumstances that may qualify you for a Special Enrollment Period, which allows you to join up for a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, or alter your current plan, without having to wait for regular enrollment periods.

 

  • You moved out of your plan’s service area.
  • You moved into, out of, or still live in a skilled nursing facility. Or another institution such as a long-term care hospital.
  • You left your employer-based or union-based health insurance.
  • You used to be eligible for Medicaid, but now you’re not.
  • You just got out of jail.
  • You’re moving back to the United States after living outside the country.
  • Your plan is losing or ending its contract with Medicare.

Keep in mind that these are only some examples. If you suffer significant changes to your plan, your coverage, or even your health, it may be worthwhile to check with Medicare to see if you may qualify for a Special Enrollment Period to change your coverage. This can be done if you contact Medicare after you have experienced any of the aforementioned changes. There is a possibility that various SEPs will have varying durations. Your specific circumstances will determine how much time you have to make the adjustment. But in most cases, you will have at least two months to do so.

COBRA Coverage

After certain qualifying events, such as the loss of a job or a reduction in the number of hours worked, individuals who are eligible are able to continue their employer-sponsored health insurance coverage for a limited amount of time through COBRA coverage, which is an abbreviation for the Consolidated Omnibus Budget Reconciliation Act. It can provide temporary coverage and assist you in bridging the gap until you find alternative options for health insurance.

 

If you are qualified, you have the opportunity to continue receiving health insurance coverage from your employer even after you have left your position there. This enables you to keep your present health benefits after becoming eligible for Medicare, which is a significant advantage. It is crucial to check with your employer to understand the precise rules and requirements for remaining on your company’s plan while still being eligible for Medicare. This information can be obtained by checking with your employer.

Wait For The Next AEP

In the event that you don’t qualify for any SEPs or any other special enrollment choices, you will have to wait until the subsequent open enrollment period in order to make any modifications to your Medicare coverage. Both the AEP and the IEP are considered to be the most important enrollment periods. You have the ability to make modifications to your current Medicare plan. Or enroll in a new plan for the following calendar year during these enrollment periods. It is essential to be aware of these enrollment times. And to make appropriate preparations in order to guarantee that you will have the necessary coverage.

Help From EZ

If you miss the Medicare Annual Enrollment Period, you can find yourself in a stressful situation. Agents located in your area are available through EZ.Insure to provide assistance and answer any questions you might have. Our sales representatives have received extensive training to assist you in selecting the solution that is most suited to meet your requirements. Estimates for Medicare Supplement Plans will be sent to you by our agent. Who will also assist you in signing up for coverage at no additional cost. These estimates will come from the leading insurance companies in your area. Simply enter your zip code in the box below to get free immediate quotes. If you would like to speak to a local licensed representative, you can call us at 877-670-3602.

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COBRA: What You Need To Know

COBRA: What You Need To Know text overlaying image of cobra written on a wooden table Due to recent events, unemployment in the U.S. has reached an all-time high. And because our healthcare system often ties coverage to work, there are a lot of people who could lose their access to healthcare. If you, like many employers, are worried about your workers in these uncertain times. Remember that if you have to let them go or cut their hours, they can keep their coverage for a certain amount of time. COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) lets your workers keep the insurance coverage you provided them. Even though your employee pays the payments, there are still things you need to know and do about COBRA.

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What is COBRA?

COBRA was created in 1986 as part of the larger Employee Retirement Income Security Act of 1974 (ERISA). It gives certain workers the right to pay premiums and keep their group health insurance coverage in certain situations. Before Congress passed the ERISA law, people who had health insurance through their employer lost it as soon as they left their job for any reason. After COBRA was passed, workers who left a company that offered health insurance could choose to keep their coverage temporarily. COBRA coverage is often much more expensive than what active employees pay for their group health plan because the company typically pays for some or all of the coverage. 

 

Under COBRA you, as the employer, are no longer responsible for any health insurance costs. All medical bills can be charged directly to the ex-employee who is receiving the services. COBRA is usually offered to qualifying employees for anywhere between 18-36 months. However, COBRA eligibility and how long the coverage continues depends on certain circumstances.

Who Is Required To Offer COBRA?

First, you should find out which companies are required by federal law to offer COBRA coverage. If you run a private business with 20 or more employees and offer a group health plan, COBRA rules apply to you. Your employee handbook should have information about it.  But even if you don’t think any of the above applies to you or your business, there are still a few other things to think about. COBRA adds up the hours of two or more part-time workers to make one full-time worker. So, if you have two workers who each work 20 hours. The law says that they are the same as one full-time worker. 

 

Another thing to think about is that even if the federal government doesn’t require you to offer COBRA coverage, your state might. Some states have passed “mini-COBRA” rules that cover people who work for businesses with group health plans, but have fewer than 20 employees.

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Mini-COBRA 

Like federal COBRA, mini-COBRA laws require group health plans to give continuing health coverage to eligible employees who would otherwise lose coverage because of a qualifying event. One big difference is that mini-COBRA rules cover a wider range of people. Mini-COBRA rules usually cover employers with less than 20 workers, while federal COBRA only covers employers with 20 or more workers. In a few states, the number of workers is between 2 and 19. Some states require almost all workers, no matter how big or small, to follow the rules of mini-COBRA.

 

The length of coverage changes by state. It can be as short as 2 to 6 months or as long as 39 weeks or even forever if the employee meets certain conditions, such as becoming totally disabled while working. In some places, employees are eligible for mini-COBRA even if they were fired for being a bad employee. There is some kind of mini-COBRA law in the following 40 states:

 

  • Arkansas
  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Florida
  • Georgia
  • Illinois
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Mississippi
  • Missouri
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • West Virginia
  • Wisconsin
  • Wyoming

If your business is subject to mini-COBRA, you have to let eligible workers know that state law gives them the right to keep their coverage. The date for giving notice varies by state, so check your state’s laws to make sure you get the word out on time. Even though the rules for other mini-COBRA notices vary by state, they may be similar to those for federal COBRA.

When Does COBRA Apply to Group Health Plans?

The law says that a group plan is “any arrangement that an employer sets up or keeps up to provide medical care for employees or their families.” This can be done through insurance, a health maintenance organization, the employer’s assets, or some other way. Group health plans that don’t meet this definition are not covered by COBRA, but they may be subject to certain state continuation rules. COBRA does not apply to other group benefits, like life insurance or disability payments. If your business has 20 or more workers and offers group health insurance of any kind, it’s best to talk to an expert about COBRA eligibility to avoid fines or penalties.

Eligible Employees

Employees may be qualified for COBRA continuation coverage if they are enrolled in an eligible group health plan and meet certain qualifying event requirements. This could mean:

 

  • Full-time employees
  • Part-time employees
  • Spouses of eligible employees
  • Dependents of eligible employees
  • Retirees

There are limits to how long a company has to offer COBRA coverage. Even if the business has at least 20 employees, some employees won’t be able to get COBRA coverage because they didn’t choose a qualifying plan, the reason they were fired, or there were other special situations. This could mean:

 

  • Employees who are ineligible for coverage in the group plan
  • Workers who declined to participate in the group health coverage
  • Employees who are enrolled for benefits under Medicare
  • Employees terminated for gross misconduct

In addition to being an employee and being enrolled in a qualified group health plan, an employee must also have a qualifying event for COBRA coverage to continue. Usually, this will include something that causes the employee to lose group health benefits. For example, if an employee is fired for something other than gross misbehavior, their hours are cut, or they are laid off temporarily or permanently, they lose their benefits. Qualifying events can also include an employee’s spouse or dependents if they cause a change in status for the whole family and affect the family’s ability to keep health care. COBRA can be used to continue coverage for a spouse or child if:

 

  • The covered employee passes away
  • If a spouse gets divorced or legally separated
  • The spouse or child lost coverage because the employee qualifies for Medicare
  • The dependent child is no longer dependent on the employee (aging out of their parent’s coverage)

Employer Responsibilities

Plan administrators are required by law to tell people who are qualified when their status changes. In some cases, the employer is in charge of running the plan and must take care of all of these tasks. If you have workers who might be eligible for COBRA, you must do the following:

 

  • Tell the group health plan administrator within 30 days of a qualified event if a person is eligible for COBRA.
  • Give notice to employees who are qualified for COBRA within 44 days about their COBRA rights.
  • If COBRA coverage is rejected for any reason, let the people who need it know within 14 days.
  • If the employee chooses to keep coverage under COBRA, give them the same coverage as the plan they were on before the qualified event.

Once an employee has a qualifying event, COBRA requires group health plans to give the employee and any qualifying partner or dependents a time to decide if they want to keep their coverage under COBRA. Once the qualifying event happens, the person must have 60 days to choose to keep benefits or not. Even though everyone in a household who went through the same qualifying event has the same election period, each person’s election method is different. The employee, their partner, and any qualifying dependents can choose to get coverage or not, depending on what is best for them.

How EZ Can Help

Taking care of your workers is part of being the boss, and that means making sure they can get health care. A big part of your job is to know what their rights are and let them know about them, even after they’ve left your company. If you don’t stay on top of things like COBRA, you could face fines. We at EZ.Insure know that running a business is hard and that insurance is just one more thing to think about. We’d like to take some of that weight off your shoulders by giving you free, instant access to an informed agent. Enter your zip code in the bar below to start, or call 877-670-3531 to talk to an agent if you have questions or are looking for a new plan.

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Unemployed? Get the Cheapest Functional Health Insurance With The Help of EZ

If you’ve lost your job or have chosen to leave your job, you’ve probably also lost your health insurance. And while it might seem like health insurance will be out of your reach now that you’re no longer working, there are very affordable plans for unemployed people. In fact, these plans can cost as low as $47 per month or less! The best way to find these types of plans is by working with an EZ agent, who can compare plans with great rates and coverage in your area within minutes, for free!

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If you lose your job, you qualify for what’s known as a Special Enrollment Period, because losing your job is considered a qualifying life event. This means you won’t have to wait for the annual Open Enrollment Period to purchase a plan. Not only that, but you will have many options available to you, whether you would like a short-term plan with a higher deductible, which is generally for healthier people, or are looking for a more comprehensive plan for you and your family. 

Your Options

If you’ve lost your job, you have a variety of options for insurance coverage, including:

  • ACA Plans– You can head to your state’s Marketplace and look for private health insurance. You will have multiple coverage tiers to choose from, each with a different cost-sharing structure. Because of the wide range of plans available, you should be able to find an affordable plan that meets your coverage needs. In addition, you cannot be denied coverage if you have a pre-existing condition.
  • Joining a family member’s plan– Another option for you would be to hop onto your spouse’s plan if they are working and have insurance. If you lose your insurance, you are automatically qualified for a 30-day Special Enrollment Period to get on your spouse’s employer-based plan.
  • Medicaid- States look at your current income when deciding if you qualify for assistance from this program. Eligibility varies by state, but the monthly income limits are generally $1,470 for an individual and $3,000 for a family of four.
  • COBRA– With this program, you can extend your employer’s coverage for up to 18 months. However, it is important to note that COBRA can be quite expensive because you are required to pay your entire premium.short term and long term written on a board
  • Short-term health insurance– These plans will provide you with quick coverage, since you can sign up at any time, but the benefits are not as comprehensive as those of traditional health insurance. You will have a lower monthly premium and a higher deductible with these kinds of plans, and there is usually a medical questionnaire to qualify for them.

More Affordable Coverage? 

While the price of employer-based health insurance varies, it’s generally fairly affordable for people with families, because your employer usually chips in and pays some money towards your premiums. But the good news is that you might be able to get even more affordable coverage while you are unemployed through the ACA Marketplace. 

You can get coverage regardless of your income, and the amount you’ll pay is based on your expected annual income. That means, if your expected income is $0 right now, you could get a plan for as low as $47 a month. In addition, you might also qualify for premium tax credits, which are subsidies that reduce the monthly cost of your health insurance and also give you cost-sharing reductions.

If you have recently lost your job, EZ will help you find an affordable plan to cover your healthcare needs. We will provide you with a personal agent who will compare all available plans in your area, and find one that fits your needs. To get started, enter your zip code in the bar above, or to speak with an agent, call 888-350-1890. Our promise is that we will help you find a great, affordable plan, so you can remain healthy and safe during these hard times. EZ’s services are free of charge because our focus is on making sure that you feel supported throughout your search for insurance, not on making money off of you.

Can Your Health Insurance Company Drop You?

Insurance companies are businesses, and, like most businesses, they have terms and conditions of service. It is possible for your health insurance to legally drop you, but only under certain circumstances. If this happens to you, don’t worry! EZ.Insure will help you find a new plan, for free. We know that you have a lot on your plate and might be feeling overwhelmed, so we will take that weight off your shoulders and help you to get back on your feet.

Reasons You Can Be Dropped

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Insurance fraud is one of the reasons that your health insurance company can drop you.

Insurance companies cannot drop you for any reason; there needs to be just cause. Here are some circumstances when you can be legally dropped:

  1. Insurance Fraud– If you misuse your insurance policy in any way, then you have broken your contract with the company. Fraud can include faking your identity, or filing false claims. 
  2. Failure To Pay– Obviously,  if you fail to pay your premiums, then you will be in breach of your contract with the insurance company. If you have employer-based insurance that is  not automatically deducted from your paycheck, then make sure to pay your premiums on time. If you are lucky, you will have a grace period for unpaid premiums, although most insurance companies do not offer this. 
  3. Losing/Quitting Your Job – If you receive your health insurance through an employer, and lose your job, then your health insurance company has a right to drop you. You also forfeit your coverage if you voluntarily leave your job. 

While some people may think that you can get denied for filing too many claims, that is a myth. As long as your claims are legitimate, then you don’t have to worry. Health insurance companies in the U.S. are regulated by many laws on both the state and federal levels, so you can be sure that you won’t lose coverage just for making claims on your policy.  

picture with a road and 2 arrows poiting to an orange box with possibility written above it
EZ will find you an insurance plan after your company drops you. You have other possibilities.

There Is Hope

If you do end up losing your health insurance, don’t worry, you have options, and time. When a health insurance company drops you, they must give you 30 day’s notice before terminating  your plan. You also qualify for a special enrollment period when you lose health insurance, so take this time to compare other plans and sign up for a new one. If your plan was employer-based, then check to see if your employer offers COBRA plans to temporarily replace your old plan. 

Finding a plan can be overwhelming, especially after losing coverage, but we’re here to help. If you are lost, then EZ will provide you with a personal agent who will compare all the available options in your area, for free. Our highly trained agents will listen to your healthcare needs and budget, and advise you on which plan checks all of your boxes. To get free instant quotes on all plans, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890. No hassle, no obligation.

Divorce & Health Insurance

Going through a divorce can be one of the most stressful and emotional experiences in someone’s life. Not only are you losing your partner and the dreams you shared, but also your sense of normalcy and routine. The future might suddenly seem very uncertain, and that includes uncertainty about the status of your health insurance. If you were on your spouse’s insurance plan, your children will still be covered, but you will not be once your divorce is finalized. Don’t worry, though, there are options available to you. Just make sure to look for a new plan within 60 days of losing your coverage.

COBRA

A temporary, but expensive, option for coverage after your divorce is applying for COBRA through your spouse’s employer. The COBRA law allows you to stay on your ex’s plan for up to 36 months after your divorce. The downside is that employers do not contribute to the cost of COBRA premiums, so you will have to pay the full amount. This might be quite expensive for you, but it could be a useful stopgap until you find a private insurance or Marketplace plan.

Employer Coverage

If you are working and your company offers health insurance, contact your HR department to find out if you can get on your employer’s insurance plan. Because you lost coverage due to your divorce, you can enroll into a new plan without having to wait until the open enrollment period. Companies with 50 or more full-time employees may be required to provide health coverage to all full-time employees, so if you work for a large company, consider looking into their plan.

Individual Insurance

illustration of caucasian woman with blue shirt and head gear sitting in front of a white computer.
Working with an agent gives you the ability to ask about any discounts or lower rate options available in your area that you might not be able to access on your own.

You can purchase your own individual health insurance plan for you or your family. You can purchase these plans over the phone or online with an EZ.Insure agent. Getting your own insurance plan will cost less than going with your ex’s COBRA plan, and it might offer more coverage. An EZ agent can sit down and go through all of the options with you, and compare them to the price and coverage you would receive through COBRA. Working with an agent also gives you the ability to ask about any discounts or lower rate options available in your area that you might not be able to access on your own. There are a variety of plans available, so there is no doubt EZ will be able to find you a plan that meets your needs and budget. 

Marketplace Insurance Plan

Normally, if you want to enroll in an ACA Marketplace plan, you have to wait until the Open Enrollment Period from November 1 – December 15. But getting divorced qualifies you for a Special Enrollment Period, which means you have 60 days after losing coverage to sign up for a new plan. If you fail to sign up for a new plan within 60 days, you will have to wait until the regular Open Enrollment Period to sign up. You can shop your state’s exchange for an ACA-approved “metal tier” plan, and possibly find a discounted rate based on your income and location. If you are considered low-income, then you might qualify for some subsidies to help you save money. 

Divorce is a devastating thing to go through, and losing your health insurance will only make things more stressful. EZ.Insure can make the process of getting covered less daunting, so that you have one less thing to worry about. Our agents are highly trained and can search for and compare insurance quotes within minutes at no cost to you. Our services are always free and there is never any obligation. Allow us to help you manage your health insurance needs during this difficult time – we promise to find you the best plan for your needs. To get free quotes online, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

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