I lost my job, can I sign up for an ACA plan?
It’s important to know that job loss alone does not qualify clients for a Special Enrollment Period (SEP) for Federal Marketplace health insurance plans.
The qualification requirements for an SEP due to job loss
It does not matter whether you lost or left you job. To qualify for a SEP enrollment, you only need to meet these requirements:
(i) You lost their employer-sponsored health coverage, and
(ii) That health coverage needs to include minimum essential coverage (MEC)
You’ll want to check that your previous coverage was through your employer. If it was, the plan was considered minimum essential coverage, and you do qualify for an SEP.
Does I have other options?
After losing their employer-sponsored coverage, you have three main options for comprehensive health insurance:
(i) Marketplace insurance. Depending on your projected income for the year, you may be eligible for advanced premium tax credits (APTC) that make the monthly premium costs lower along with cost sharing reductions (CSR) that lower the deductible.
(ii) COBRA. You have the option to stick with the insurance from the employer, but you must pay the full cost of the premium and 2% of administration fees.
(iii) Medicaid. You may qualify for free or low-cost coverage if your projected income for the year falls below the federal poverty level (e.g. $26,200 for a family of 4). Medicaid eligibility varies by state, and in some states, you may not be able to qualify (e.g. adults without dependents in WY).
What do we recommend?
As an agent, we share information to help you choose which option fits best for their needs. Make sure you are aware of the following:
– On average, clients who enroll in an ACA plan will save over 80% on their COBRA premium. The average COBRA enrollee pays over $7,000 a year for individual coverage and over $20,000 for family coverage. In contrast, the average annual premium for the 3 million Americans who have enrolled in comprehensive ACA coverage thru us is right around $600 a year ($50 a month).
– You will get qualified health plans (QHP) through the Marketplace. Clients may be under the impression that ACA plans are lower quality than the employer-sponsored coverage. Know that ACA plans are comprehensive. If you have specific providers you want to keep in network or prescriptions you need covered, we can run a quote for you to see your options and will encourage you to call your provider’s office to see if they take any of them.
– Marketplace plans can last the rest of the year, or they can be a bridge until you get back on their feet. Clients may be resistant to ACA plans because they’re optimistic that they’ll get back on employer-sponsored health insurance in a couple of months. Know that you can end their ACA coverage if this occurs.
– Clients can apply for ACA coverage before they lose their job. If you qualify for a SEP they you can apply for ACA coverage up to 60 days in advance of losing your coverage.
– Application deadlines: You will have 60 days after losing job-based coverage to choose between COBRA and an ACA plan. You can sign up for Medicaid any time of the year.
This is another scenario we encounter. Clients are a married couple who were both on Spouse A’s employer-sponsored coverage. Spouse B is offered coverage through their employer, but it is outside of Spouse B’s Open Enrollment Period.
As an agent, we can give quotes for Marketplace health insurance. If Spouse B’s employer-sponsored coverage is more affordable than those options, we can enroll you in a Marketplace health plan for the time being. When Spouse B’s enrollment period comes around, the couple can go to Spouse B’s coverage and end their Marketplace plan.