Finding Affordable Health Care Now - Yahoo Finance

As the effects of the coronavirus pandemic took hold this spring, more than 38 million Americans lost their jobs, and an estimated 27 million workers and their families found themselves without health insurance, too. Nearly half of Americans got their coverage through an employer-sponsored plan in 2018, according to the Kaiser Family Foundation.

Consider COBRA

If you work for a company that has at least 20 employees and you lose health insurance because it reduces your hours or terminates your job for a reason other than gross misconduct, it must offer continuation health care coverage for you, your spouse and your dependent children under COBRA. The law generally lets you extend coverage that you already had through your employer's group plan for up to 18 months. Some states require small employers to provide continuation coverage (known as "mini-COBRA"), too, but term lengths and events that qualify you for it vary.

Get on a family member's plan

If you lose employer-sponsored coverage because of a job loss and your spouse works for a company that offers health insurance, you typically have 30 days to request special enrollment in your spouse's plan. But as with COBRA, temporary rule changes require employers to disregard the period between March 1 and 60 days after the end of the national emergency regarding the pandemic (or another date federal agencies may announce in the future). Using the example cited above in the COBRA section, you would have 30 days after July 29 --w hich is August 28 -- to enroll in your spouse's plan.

Explore the government marketplace

If you've lost job-based health insurance, you have a 60-day special enrollment period to purchase a policy in the individual market under the Affordable Care Act. You may also qualify for special enrollment if you lose coverage because you are no longer eligible for Medicaid or you're unable to use a family member's policy (because you turned 26, for example, or got divorced), among other events.

Notably, some states opened their health care exchanges to anyone for a limited time in response to the pandemic; most of those special open-enrollment periods have closed, but California's lasts until June 30. At healthcare.gov/get-coverage, choose your state from the drop-down menu. If your state runs its own marketplace, you'll be directed to it. Otherwise, you'll search for a policy via HealthCare.gov.

If you get an ACA policy and your income is between 100% and 400% of the federal poverty level, you are eligible for a tax credit that lowers the plan premium. If your income is close to the poverty level, you may pay as little as $20 a month in premiums, says Pollitz. For 2020 plans, the upper income limit to qualify for a subsidy is $49,960 for an individual, $67,640 for a family of two or $103,000 for a family of four.

The tax credit is based on your estimated annual income for the year that you're seeking coverage -- not last year's income --which may be helpful if you're newly unemployed and your income has fallen. But you'll have to do some guesswork about how much income you may receive for the rest of the year. You could, for example, start with any income you earned through your job and add unemployment benefits that you expect to receive the rest of the year, Pollitz says. (The extra $600 a week the federal government is adding to unemployment checks through July counts.) Income from traditional IRA and 401(k) withdrawals and interest and capital gains on investments also count.

If your circumstances change -- say, your income increases because you get a new job or you add or lose a household member -- go back to the marketplace and update your application. When you file your federal tax return for the year that you had the insurance policy, you'll have to repay any extra amount you received in advance tax credits if you underestimated your income. If you overestimated income, you'll get money back.

Going off the exchange

If you're eligible for a tax credit, you must buy a plan through the exchange to claim it. Otherwise, you may want to take a look at your options outside the exchange, too. You can shop directly with insurance companies or work with a health insurance broker or agent--search for one in your area at localhelp.healthcare.gov or nahu.org. You can also use a service such as ehealthinsurance.com, through which you can compare policies online or talk with an agent through a phone call or web chat.

Plans that you buy off the exchange may or may not be ACA-compliant. Some insurers offer plans that follow ACA rules but with different features than those they offer on the exchange -- for example, with different provider networks or cost-sharing breakdowns.

Short-term plans, which may last as long as 12 months and be renewed for up to three years, do not meet ACA requirements. They often exclude or charge more for care related to preexisting conditions. In addition, they usually don't cover maternal and mental-health care, among other services. In exchange for less-comprehensive coverage, short-term policies have low premiums. Using one of the lowest-priced plans, a family of three would pay an average premium of $116 per month, compared with $862 a month for a bronze plan from the exchange with no tax credit, according to eHealth. A 40-year-old woman would pay $60 a month, compared with $347 for an unsubsidized bronze plan.

If you're healthy, a short-term policy may make sense for a few months in case of emergency. "I'm seeing more people go with short-term plans," who often sign up in hopes that they will soon get a job and have access to employer-sponsored coverage, says Hyers, the Ohio insurance broker. For example, you could get a policy that lasts through the end of the year and cancel it if you find a job that offers insurance in the meantime. If you don't get employer-sponsored coverage by the time open enrollment starts--the period to sign up for a plan for 2021 through HealthCare.gov is November 1 through December 15, 2020--you could then explore the ACA-compliant options.

See whether you qualify for Medicaid

The Medicaid public health insurance program provides free or low-cost comprehensive coverage for those with low incomes, so it may not come to mind as a possibility if you were a moderate or high earner before you lost your job. But Medicaid considers current monthly income rather than annual income, "so if you're suddenly without income, you may very well qualify," says Cheryl Fish-Parcham, director of access initiatives for Families USA, a nonpartisan consumer health care advocacy organization.

In 36 states and Washington, D.C., you can qualify for Medicaid based solely on your income (in other states, factors such as household size, family status and disability are also considered). In those states, you're eligible if your income is less than 138% of the poverty level -- in 2020, that breaks down to $1,467 a month for an individual, $1,983 for a family of two or $3,013 for a family of four. Those limits include standard unemployment compensation but not the extra $600 a week the government is adding to unemployment checks through July.

Telemedicine takes off

As social distancing has become a fact of life in the era of COVID-19, the use of telehealth services -- which allow you to communicate with health professionals virtually or through a phone call--is skyrocketing. Some 96% of health insurers are seeing increased demand for telemedicine services, according to an eHealth survey. One health plan in the Detroit area saw its telehealth claims jump from an average of about 1,000 per month to 18,000 in March and more than 20,000 before the end of April, says Connie Hwang, chief medical officer and director of clinical innovation for the Alliance of Community Health Plans.

Recent changes in response to the coronavirus crisis have expanded the availability and insurance coverage of telehealth services. To encourage patients to stay home, some insurers are waiving co-payments or requirements to meet a deductible for telehealth visits. For a plan year that starts on or before December 31, 2021, a high-deductible health plan paired with a health savings account may cover telehealth services before the policyholder reaches his or her deductible.

During the COVID-19 national emergency, clinicians nationwide may use a broader variety of video-chat tools -- such as Apple's FaceTime, Facebook Messenger, Skype or Zoom -- to conduct virtual appointments without facing a penalty for violating privacy and security rules.

Medicare, meanwhile, will cover telehealth services for patients anywhere in the country, not just those in rural areas. And Medicare patients can receive coverage for a broader range of services through telehealth, use telehealth services as a new patient (previously, you had to have an established relationship with your doctor) and get coverage for audio-only consultations over the phone if they don't have access to video services. Some independent telehealth services are offering free or discounted consultations. CareClix, for one, recently provided free screenings for those who think they have been exposed to COVID-19 and are experiencing a fever and other symptoms.

Traditionally, telemedicine has been used for somewhat urgent but nonemergency needs -- say, to diagnose and prescribe treatment for a sore throat. But in recent years, telehealth has expanded to include such services as physical therapy and mental-health care. You may also be able to consult remotely with your physicians for management of chronic conditions, such as high blood pressure. To some degree, telehealth can help patients who may have COVID-19, too. Doctors may, for example, use a virtual service to evaluate a patient's symptoms and refer him or her to a testing facility, says Mary Kay O'Neill, partner with employee-benefits consultant Mercer.