AMA urges individuals who lost their employer coverage to seek out coverage through ACA marketplaces or Medicaid; Warns consumers against sham insurance policies

With the significant number of people who have recently lost health insurance coverage due to job cuts, the American Medical Association (AMA) is working to increase awareness of options so that the recently unemployed can regain individual or family health insurance coverage. While many individual and family budgets will be stretched due to economic conditions, people with low-income have a number of options for subsidized coverage from the states and the federal government.

“Millions of people have suddenly and unexpectedly lost their health insurance, compounding the stress caused by job loss amidst this unprecedented economic and public health crisis,” said AMA President Patrice A. Harris. M.D., M.A. “Unlike past economic recessions, unemployed individuals have more options for enrolling in affordable health insurance. Provisions in the Affordable Care Act (ACA), along with actions taken recently by Congress and some states, mean more opportunities for getting coverage. The COVID-19 pandemic has highlighted the importance of having meaningful health insurance coverage.”

Having insurance is the most important factor in guaranteeing people have access to health care. For individuals who recently lost their job-based health insurance, and for people who were uninsured before COVID-19 struck, there are viable options available to get low- or no-cost health insurance through state health insurance exchanges and Medicaid.

Affordable Care Act Marketplaces. Family and individual health plans can be bought in the health insurance marketplaces created by the ACA. Losing a job is a qualifying life event that allows unemployed individuals up to 60 days to enroll in a marketplace health plan before the close of a special enrollment period. Due to the COVID-19 pandemic, certain states have reopened enrollment periods when all consumers – not only those who have experienced a job loss - can enroll in marketplace health plans and potentially qualify for financial assistance to purchase these plans based on their income.

Subsidies available to eligible individuals through the health insurance marketplaces can help with premiums and out-of-pocket costs, making coverage more affordable. The Kaiser Family Foundation can help calculate an estimate of premiums and subsidies based on an individual’s income, age and family size. It will also estimate an individual’s eligibility for Medicaid.

Medicaid. While each state’s program has unique attributes for coverage, Medicaid can offer no- or low-cost coverage for those with the lowest of incomes, with limited cost-sharing requirements. Unlike the ACA marketplaces, there is no defined open enrollment period for Medicaid and eligible people can sign up at any time. State eligibility requirements and income qualifications vary by state. Every state covers low-income children, pregnant women, and people with disabilities, while 36 states and the District of Columbia have expanded Medicaid coverage so that adults with income up to 138% of the federal poverty level can qualify.

“The AMA strongly believes that every American should have access to meaningful, affordable coverage,” said Dr. Harris. “In the grips of the COVID-19 pandemic, the ACA marketplaces and Medicaid expansion will help ensure that fewer people fall through the cracks.”

The AMA cautions patients to avoid short-term limited duration plans whenever possible, especially during this pandemic. Short-term plans are designed to fill temporary gaps in health insurance, when comprehensive coverage may not be an option. But it is important to understand that these plans offer very limited benefits and do not usually cover COVID-19 testing and treatment, preexisting medical conditions, mental health services, prescription drugs, and preventative and wellness care.

It is better for individuals to consider the most affordable health insurance option that meets the criteria of the ACA (e.g. covering pre-existing conditions and essential health benefits) to avoid worrying about a temporary plan with major gaps in coverage. Before enrolling in any health plan, carefully consider the federal subsidies available against the fine print and consider the coverage trade-offs between high deductibles and low premiums.

Now is the time for lawmakers and policymakers at every level of government to take additional steps to cover the uninsured, strengthen the safety net to ensure there is meaningful, affordable health insurance coverage for all people. For additional AMA perspective, please see the Dr. Harris’ viewpoints article.