The Importance Of Understanding Your Health Insurance Options
The COVID-19 pandemic means its more important than ever to have some level of health coverage. Thankfully, testing for the virus is now free for all Americans, with or without insurance. But, the cost and coverage of treatment for COVID-19 is a different story.
If you end up needing hospital care and are uninsured, you could be responsible for an enormous bill. To estimate COVID-19 treatment costs, a study by Kaiser Family Foundation looked at hospital stays for pneumonia. Researchers found that the average total cost for one stay was around $10,000 for patients who had no complications. That amount jumped to $20,000 for patients who experienced major complications.
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Medicaid Provides Health Coverage For Low
Medicaid developed during the 1960s as a low-cost health insurance program for Americans with a limited ability to pay for care. Organized as a joint federal-state program, Medicaid operates somewhat differently in each of the 53 regions where it is available .
Most people who sign up for Medicaid do so through their state or territorys government, usually online or in person at a human services office. Applications are subject to verification of income and assets, and in some states, medical need, age or pregnancy. Once an application is approved, which takes anywhere from a few days to several weeks, new enrollees are issued a benefits card they can present to healthcare providers and pharmacies at the point of payment.
Some Medicaid plans are directly administered by the state offering benefits, while others are managed by private sector insurance providers. There is very little difference to beneficiaries between these two options, apart from the generally larger provider network that a Medicaid-funded HMO or PPO offers. Medicaid participants may be expected to pay some of their medical costs out of pocket. This usually depends on their state, income or other factors.
Collecting Unemployment And Social Security Disability Benefits Simultaneously
Contrary to what you might think, it is possible to collect Social Security disability insurance and unemployment benefits at the same time. Of course, it is rather difficult to qualify for both of these benefits at the same time because the eligibility criteria are fundamentally at odds. To qualify for unemployment, you must be actively looking for a job. To qualify for a disability claim with SSDI, you must be permanently and totally disabled. Only a small handful of applicants can meet both of these criteria.
If you receive unemployment benefits, the Social Security Administration will take them into account when they examine your SSDI application. It is your responsibility to prove to the SSA that thereâs no conflict between the two benefits.
The same is true for Supplemental Security Income benefits, which are paid to disabled persons. While it is theoretically possible to receive this benefit alongside unemployment benefits, the criteria for the two programs are again largely at odds with each other. Unlike receiving Social Security retirement benefits and SSDI, receiving unemployment benefits may reduce your Supplemental Security Income benefit. Claimants should consult with a qualified disability attorney in either of these cases in order to ensure that they are following the rules and receiving every benefit that they qualify for.
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Eligibility Criteria For Unemployment Benefits
If youâve lost your job for a reason that wasnât your fault, the foundational criteria for receiving unemployment benefits are fairly straightforward, although specific eligibility criteria does vary from state to state. Without question, you have to be willing and able to work and be actively seeking a job. If you are working a part-time job while seeking full-time employment, you can still usually get at least a partial weekly benefit. The number of hours that you work and the wage that you earn will determine how much in unemployment benefits you qualify for.
Your work history also plays a major role in determining how much you will get each week and how many weeks youâll receive benefits. Applicants who have worked for many years at a high-paying job will likely qualify for more benefits than an applicant with a year of full-time work history.
Recent legislation has also extended unemployment benefits to independent contractors, self-employed workers, and gig workers. This legislation has increased the pool of eligible candidates by several million claimants. There are some cases, in fact, whereby an applicant who would not have qualified for unemployment benefits before could now be eligible for benefits under the rules of the new legislation.
Best For Telehealth: Cigna
Individual plans available in only 10 states.
Policies must begin on the first day of the month.
Access to telehealth services can be a lifesaver for anyone dealing with unemployment. Virtual care saves you the time and cost of getting to a doctors office, and you also can get remote treatment for some minor ailments without having to pay for an in-person visit. Cigna includes $0 telehealth visits with all of its individual plans through partnerships with MDLive and Amwell, two of the largest telemedicine providers in the United States.
Virtual health visits arent the only advantage to purchasing health insurance from Cigna. In-house customer service is available 24 hours a day to answer questions and provide assistance. The company also places a $25 monthly out-of-pocket cost limit on insulin regardless of your coverage level.
Unfortunately, individual and family policies are available from Cigna in only 10 states, although dental insurance can be purchased anywhere in the U.S. for as little as $19 per month. While health insurance premiums depend on many different factors, Cigna was priced a bit above average when we compared sample quotes with competitors.
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Can The Unemployed Get Medicaid
People who have lost their jobs, for whatever reason, may be eligible for health coverage through Medicaid. Medicaid provides basic health insurance for tens of millions of Americans with a limited ability to pay. Unemployed workers who have lost their income may be able to sign up for the healthcare services Medicaid provides, even if they were not eligible for coverage while employed.
Losing a job can be difficult, regardless of the reason. Apart from the loss of your former stable income, you might find yourself without the health insurance you counted on to protect yourself and your family. Many people who find themselves out of work wonder how they can keep their families covered until a new job comes along. Fortunately, Medicaid offers basic health services to people with medical needs and financial limits that make it difficult to pay. Not everyone is eligible for coverage, however, and your former income could complicate your income verification during the application process.
How To Claim The Extra Subsidies
HealthCare.gov has not yet implemented automatic subsidy updates, although thats coming in September . But for now, youll need to log back into your account and update your application to activate the subsidies. You can do this through HealthCare.gov, or through an enhanced direct enrollment entity if you use one.
Some of the state-run exchanges already implemented systems to automatically apply the additional subsidies to accounts where applicants indicated that theyre receiving unemployment compensation this year. But if youre in a state that runs its own exchange, its in your best interest to log back into your account to confirm that youre receiving all of the benefits for which youre eligible.
If you enroll or update your account between August 1 and August 15, your new subsidies will take effect on September 1. The COVID-related special enrollment period ends on August 15 in most states, so this is an important deadline to keep in mind.
If youve already got coverage through the exchange but you dont update your application to start receiving the additional unemployment-based subsidies, youll be able to claim the premium subsidy on your 2021 tax return. However, there is no way to claim cost-sharing reductions after the fact. So its important to make sure youre enrolled in a Silver plan as soon as possible, if you want to take advantage of that benefit.
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Do I Need To File A Tax Return If I Dont Have Income But I Do Have Healthcare
If you receive premium tax credits, then you must file tax returns, even if your income level wouldnt normally require a tax return. In other words, if you dont pay full price for your healthcare coverage, then you will need to file tax returns regardless of your income. You will know whether you use premium tax credits to pay for healthcare, because you will receive an IRS Form 1094-A.
Get On Your Spouses Domestic Partners Or Parents Health Insurance
If your spouse or domestic partnerâs job offers health insurance coverage to employeesâ spouses and dependents, getting added to their plan can be a simple solution.
A spouseâs or partnerâs health insurance is a known quantity: Your spouse is already familiar with the benefits, costs and deductibles, and knows the level of coverage, which can help in assessing its value. On the other hand, if their coverage doesnât fit your needs, you may want to explore other options.
Normally, you can enroll in health insurance only once a year, during âopen enrollment,â which takes place in the fall. However, leaving your job is considered a qualifying event, and gives you 30 days to sign up for your spouseâs or partnerâs plan no matter the time of year. Youâll need to complete an application and may need to provide proof that you are losing your health insurance.
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What Youll Pay When You Need Medical Care
If you enroll in a Silver plan, youll get the full benefits of the unemployment-based subsidies, meaning that youll have fairly low out-of-pocket costs if you need medical care later this year. Any Silver plan you choose will have a maximum out-of-pocket of no more than $2,850 in 2021, and its common to see these plans with deductibles that range from $0 to $500. Copays for office visits and many prescriptions also tend to be fairly low.
If you choose a non-Silver plan, the normal cost-sharing will apply. No matter what plan you select, your out-of-pocket maximum for in-network care wont exceed $8,550 this year, but the specifics of the coverage will vary considerably from one plan to another.
Are Employers Required To Provide Health Insurance To Their Employees
Maybe, depending on the Employer. . The Affordable Care Act requires that all businesses with 50 or more full-time employees provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee. This health insurance, usually offered through a group plan, provides benefits to the people who belong to the group The benefits often include payment toward hospitalizations, physician care, and prescription medicines. Other than under Obamacare, employers are not required to provide health and welfare benefits to employees.
Exception: In selected cities, where local governments have enacted living wage ordinances, if an employee is working for a government employer or an employer that has a contract relationship with the city or county, the employee may be entitled to employer-paid health benefits or an increase in hourly wage so that the employee can independently obtain health insurance. San Franciscos Health Care Security Ordinance requires employers who have at least 20 employees to pay a certain amount of money on the health care of their employees, either through paying the employees health care premiums, contributing to the employees health benefit flexible spending account or reimbursing fees incurred by employee who received direct health services. To be covered by the HCSO, an employee must have worked for his/her employer for 90 calendar days and must work at least 10 hours per week in San Francisco.
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How Big Will Your Subsidy Be
You can use our subsidy calculator to see the subsidy amount that will be available to you. For people receiving unemployment compensation, the exchange will disregard any income above 139% of the poverty level for 2021.
The 2020 poverty level numbers are used to determine subsidy eligibility for 2021, so you can find the poverty level for your household size, multiply it by 1.39, and enter that number into the subsidy calculator. And if you need help finding a plan, our direct enrollment entity can provide assistance.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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How We Chose The Best Health Insurance For The Unemployed
Our analysis looked at 30 health insurers nationwide to identify the best companies based on the benefits they offer to those facing unemployment. We chose insurers with widespread geographic representation who provide flexible policies geared toward individuals with short-term insurance needs. Since financial strain is a main concern during periods of unemployment, we weighed policy pricing heavily by comparing quotes from five sample markets. Finally, we evaluated accessibility to care, including the number of in-network providers and the availability of telehealth services.
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How To Find The Right Health Insurance Plan
If you have encountered a change in your employment, eHealth can help you find the best health insurance plan available in your state. We offer licensed agents in every state, ready to help you find a health insurance plan that meets your needs and budget. When you enroll in a plan through eHealth, you can sign up on our website, through our live chat or on the phone. Once you are enrolled, we offer 24/7 support to help you manage your plan. Check out individual and family health insurance plans in your area to learn more about your options.
What Types Of Health Insurance Options Are There When Youre Not Eligible For Medicare
You may have a few choices when it comes to health insurance. For example:
- Major medical a major medical plan usually covers many types of medical services, such as doctor visits and hospitalization. Coverage details vary among plans. You generally pay some kind of cost sharing, such as a deductible, copayment, or coinsurance. You might also pay a monthly premium.
- Short-term just as it sounds, this is limited, temporary medical coverage and generally covers you for three months. Its often less expensive than a major medical plan. Its not for everyone, but may help cover you when you are waiting for other coverage.
- Critical illness this type of insurance may pay you cash in a lump sum to help you with medical costs from a serious illness. Its designed for medical conditions such as cancer, heart attacks, and strokes. However, it doesnt pay your doctors or other health-care providers directly you still may need other insurance such as major medical.
When you are eligible for Medicare coverage
Whether you have a qualifying condition that makes you eligible for Medicare at age 60, or you qualify at age 65, you may have a number of options related to your Medicare coverage.
In most cases, youll either be automatically enrolled in Original Medicare, Part A and Part B or youll need to sign up when youre eligible. Some people delay Part B enrollment.
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Medicaid Expansion For The Unemployed
Under the Affordable Care Act, states have the option to expand Medicaid to families with incomes up to 138 percent of the federal poverty level. To rapidly absorb the unemployed into affordable coverage, states should have the option to further expand Medicaid to two categories of enrollees: 1) individuals who are receiving unemployment insurance benefits or who were receiving unemployment insurance benefits that expired during the public health emergency and 2) families with incomes up to 200 percent of the federal poverty level. As under the current Medicaid program, eligible individuals who are enrolled in ACA coverage or employer coverage would be able to switch to Medicaid.
For the first eligibility category, states would automatically enroll in Medicaid all individuals who receive unemployment insurance benefits or food stampsunder the Supplemental Nutrition Assistance Program regardless of their income. This auto-enrollment would be similar to the current Express Lane Eligibility option, in which several states enroll children in Medicaid or the Childrens Health Insurance Program based on their SNAP eligibility.
States would guarantee continuous eligibility for these enrollees until the end of the public health emergency, at which point their eligibility would be redetermined. If they are no longer receiving unemployment insurance benefits, they would qualify for Medicaid under the second eligibility category.
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Individual Private Health Insurance
Individual private health insurance is a plan you purchase from a non-government exchange. Shopping on a private exchange, like eHealth, allows you to have more variety in your coverage options. You will also have the option of shopping for ACA-compliant plans, and youll even be able to apply for subsidies through eHealth by proxy.
Keep in mind that since the ARPA expanded qualifications for subsidies, you might now be eligible for assistance even if you did not qualify before. According to the new rules, enrollees now do not pay more than 8.5% of their income towards their insurance coverage, which has been reduced from nearly 10% under the prior limits. In addition, those earning more than 400% of the federal poverty level may now qualify for subsidies. In 2021, that includes individuals making about $51,000 or less annually and families of four making more than $104,800 annually.
If you find that subsidies arent an option for you, youll also be able to shop for alternative individual and family plans that may offer less benefits but be within in your price range. Short-term health insurance and catastrophic plans are two options that fall into this category.
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