As the novel coronavirus continues its spread across the United States, Americans are understandably worried about the high costs of treatment. Most vulnerable are those without health insurance, and some states are stepping up to offer assistance.
The open enrollment period for health insurance on state and federally run exchanges, which are for people obtaining coverage on their own rather than through employers, ended months ago. But people looking for insurance, either because they lost coverage or because they suddenly decided to get it, have opportunities to buy ― although the exact circumstances will vary depending on the state.
The exchanges in Colorado, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington state have reopened under “special enrollment periods” in response to the growing number of Americans who have or may have contracted COVID-19. Enrollment is underway in each of those states except Colorado, where it begins Friday.
In addition, California already was accepting new sign-ups to help people avoid paying tax penalties for not adhering to the state’s new individual mandate to get coverage, and the District of Columbia’s exchange already had been reactivated to enable uninsured people to get insurance at the same time of year they file their income taxes.
The special enrollment periods allow residents of those states who are uninsured an opportunity to protect themselves from high medical costs, but time is limited, and every jurisdiction except the District of Columbia has April deadlines to sign up.
Enrollment Not Happening In Most States
The federal government hasn’t announced a special enrollment period for the people in the 38 states that use HealthCare.gov for enrollment, and neither have the state-run exchanges Your Health Idaho, Minnesota’s MNSure and Vermont Health Connect. But it might still be possible to get covered in those states.
The Affordable Care Act, which created the exchanges, allows states that run their own insurance marketplaces and for the federal government in other cases to enact special enrollment periods like this under certain circumstances.
“Special enrollment periods are part of the ACA and are required for all marketplaces, state-based as well as the federal marketplaces,” said Jennifer Tolbert, director of state health reform at the Henry J. Kaiser Family Foundation in Washington. “There is discretion, however, and in the case of a number of state-based marketplaces ― these are states that run their own marketplaces, have their own websites ― they have made this decision to create a special enrollment period in response to the coronavirus.”
In the states that have taken this action, exchange coverage is available to any uninsured people who would otherwise qualify to use the marketplace: U.S. citizens or lawful residents who are not incarcerated. People who bought alternative forms of health coverage, such as short-term plans, may also be eligible to shop on the exchanges.
People with incomes between the federal poverty level and 400% of that amount ― a range from $12,760 to $51,040 for a single person ― may be eligible for tax credits that reduce monthly premiums.
Those who earn between the poverty level and 250% of that, or up to $31,900 for a single person, may qualify for extra assistance that reduces out-of-pocket costs, such as deductibles and copayments. Anyone who is offered employer health benefits that meet the ACA’s standards for affordability is not permitted to receive tax credit subsidies on exchange policies.
As of Thursday, the deadlines to sign up in those nine states and the District of Columbia that are running special enrollment periods are:
In other states, people may also still have a chance to get coverage if they need it. The same special enrollment periods under the ACA that enable states to reopen their exchanges also permit customers everywhere to enroll in health coverage under certain circumstances, even though HealthCare.gov and the state-run exchanges in Idaho, Minnesota and Vermont remain closed.
One of the main reasons a person would become eligible to shop for insurance outside of the annual open enrollment period is when she loses her job.
With a growing number of workers unemployed or otherwise unable to work because of the coronavirus outbreak, this could apply to a substantial number of people. Other life changes ― such as getting married, having a baby, getting divorced, moving, or involuntarily losing health insurance for any reason ― also would allow people to use an exchange right now.
Medicaid Is Always Available
In addition to access to private insurance from the health insurance exchange, people with low incomes may qualify for Medicaid coverage, and enrollment in the joint federal-state program is open year-round. The income limits are different among the states and vary for different populations, such as children, pregnant women, people with disabilities, parents and adults without children.
Typically, Medicaid only is available to adults earning up to 133% of the federal poverty level, which is $16,971 for a single person, although coverage may be available for some groups, such as children, in families with higher incomes. Children from households with incomes too high to qualify for Medicaid may be eligible for the Children’s Health Insurance Program.
Adults who don’t have a disability and don’t have minor children living at home cannot qualify for Medicaid, no matter how low their incomes are, in the 14 states that refused to participate in the Affordable Care Act’s expansion of the program.
The federal government has taken two actions to bolster Medicaid during the coronavirus emergency. The Centers for Medicare and Medicaid Services has invited states to seek permission to waive certain Medicaid rules to facilitate enrolling eligible people who need coverage, such as relaxing income documentation requirements and fast-tracking applications. In addition, the coronavirus relief legislation Congress passed this week boosts federal funding for state Medicaid programs.
The Centers for Medicare and Medicaid Services is “looking closely at all its policies and across all its programs” to assist with the federal coronavirus response, the agency said in an email to HuffPost.
“CMS is not currently offering a special enrollment period specifically designated for COVID-19. However, consumers who are not currently enrolled in coverage can see if they qualify for other special enrollment periods by visiting HealthCare.gov. We will continue to work closely with states and health plans around the country to assess what additional actions are necessary to ensure the American people have coverage for and access to the services they need during this time,” the agency said.
MNSure has “no immediate plans” to open up enrollment in response to the coronavirus, a spokesperson told HuffPost via email.
Coronavirus is “not currently considered grounds for a Special Enrollment Period in Idaho,” a Your Health Idaho spokesperson wrote in an email. A spokesperson for the Vermont Department of Financial Regulation, which oversees the state’s health insurance exchange, did not respond to a telephone message seeking comment.