Have you or your patients struggled with finding or maintaining health insurance? Job losses resulting in uncovered individuals and families, along with increasing healthcare costs, have prompted recent changes in the federal government that allow for additional avenues to obtain or retain health insurance.
The Health and Human Services Organization made it possible for the 36 states offering marketplace plans to provide a Special Enrollment Period from February 15 – May 15, 2021 on healthcare.gov. In addition, several states that operate their own marketplace platforms will also offer new enrollments outside the standard enrollment period. This special enrollment period allows members to sign up without a qualifying event.
Further, the American Rescue Plan Act of 2021 (ARP) was developed to help individuals eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage. COBRA allows an individual who is no longer eligible for group health insurance due to job loss or reduction of work hours to continue coverage under the group plan for a fee. The ARP also provides support to some beneficiaries seeking premium assistance. For Assistance Eligible Individuals, the premium is paid directly to the employer. The premium assistance program will be offered from April 1, 2021 to September 30, 2021. Some individuals who previously declined or canceled COBRA coverage may be eligible to apply for this program. Refer to the Department of Labor (DOL) overview for full details.
Aside from commercial insurance coverage, many individuals and families may be eligible for Medicaid coverage due to either disability or income status. Most states are also expanding the availability of Medicaid programs. In most cases, Medicaid covers services at or near 100% with little or no out-of-pocket cost for the beneficiary with deductibles, copays, coinsurance, or even costs of the premium.
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Department of Labor
Health and Human Services:
National Conference of State Legislatures: