- Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too
- Preventive Services Without Cost-Sharing
- Pre-Existing Condition Exclusions
- Dependent Coverage To Age 26
- Annual Out-Of-Pocket Limit
- Prohibition On Annual And Lifetime Limits
- External Review
- Health Insurance After the Death of a Spouse, Parent or Other Plan Member
- Your Loss Begins a Special Enrollment Period
- Loss of a Spouse or Dependent is a Qualifying Life Event (QLE)
- How Can a Sole Surviving Spouse or Child Stay Insure?
- 1. Enter a Special Enrollment Period Due to a Deceased Spouse:
- 2. Continue Your Deceased Spouse or Parent’s Employer Insurance Using COBRA Rules:
- How Can You Adjust Health Insurance if Your Dependent Passed Away?
- If A Dependent Not On Your Plan Passes Away
- Taking the Next Insurance Steps After Your Spouse, Parent or Dependent Passes Away
- Questions to Ask Your Health Insurance Provider During Your Bereavement Period
- When to Begin Health Insurance Changes After a Loss
- The U.S. Supreme Court’s Obamacare case is about health care — but also simple math
- The court’s ruling could determine health insurance access for millions during a pandemic
- How will Justice Barrett affect the case decision?
Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too
Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.
5 million people ly to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market.
Overlooked in the declarations of who stands to lose under plans to “repeal and replace” the ACA are those enrolled in employer-sponsored health plans – the primary source of coverage for people under 65.
Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan.
It’s easy to understand the focus on the individuals who gained access to coverage thanks to the health reform law.
ACA drafters targeted most of the law’s insurance reforms at the individual and small-group markets, where consumers and employers had the greatest difficulty finding affordable, adequate coverage prior to health reform.
The ACA’s market reforms made coverage available to those individuals with pre-existing conditions who couldn’t obtain coverage in the pre-ACA world, and more affordable for those low- and moderate-income families who couldn’t afford coverage on their own.
Less noticed, but no less important, the ACA also brought critical new protections to people in large employer plans.
Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals—particularly those with costly, chronic health conditions—with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses.
Preventive Services Without Cost-Sharing
The ACA requires all new health plans, including those sponsored by employers, to cover recommended preventive services without cost-sharing, bringing new benefits to 71 million Americans.
That means individuals can get the screenings, immunizations, and annual check-ups that can catch illness early or prevent it altogether without worrying about meeting a costly deductible or co-payment. With that peace of mind, it’s no wonder it’s one of the most popular provisions of the ACA.
Women employees can also access affordable contraception, making available a wider variety of contraceptive choices and increasing use of long-term contraceptive methods.
Pre-Existing Condition Exclusions
Under the ACA, employers cannot impose a waiting period for coverage of a pre-existing condition. Prior to the ACA, individuals who became eligible for an employer plan—for example, once hired for a new job—might have to wait up to 12 months for the plan to cover pre-existing health conditions.
You could “buy down” that waiting period with months of coverage under another plan, so long as it was the right kind of plan and you didn’t go without coverage for 63 days or more.
But if you lost your job, couldn’t afford COBRA, went a few months without coverage and then were lucky enough to get another job with benefits, you might find the care you needed wasn’t covered under your plan for an entire year.
Dependent Coverage To Age 26
The ACA requires all health plans, including those sponsored by large employers, to cover dependents up to age 26.
Prior to the ACA, one of the fastest growing groups of uninsured was young adults – not because they turned down coverage offered to them, but because they were less ly to have access to employer-based plans or other coverage.
The result has been a dramatic increase in the number of insured young adults, particularly among those with employer-sponsored coverage. This ACA requirement is one provision President-elect Trump and many anti-ACA legislators have pledged to retain.
Annual Out-Of-Pocket Limit
The ACA requires all new health plans, including those sponsored by employers, to cap the amount individuals can be expected to pay out-of-pocket each year. Prior to the ACA, even those with the security of coverage on the job couldn’t count on protection from crippling out-of-pocket costs.
Prohibition On Annual And Lifetime Limits
The ACA prohibits employer plans from having an annual or lifetime dollar limit on benefits. Prior to the ACA, employer plans often included a cap on benefits; when employees hit the cap, the coverage cut off.
For individuals who needed costly care, a baby born prematurely or those with hemophilia or multiple sclerosis, that often meant a desperate scramble to find new coverage options as one after another benefit limit was reached.
The ACA guarantees individuals the right to an independent review of a health plan’s decision to deny benefits or payment for services, regardless of whether the employer plan is insured or self-funded.
Prior to the ACA, only workers in insured plans had the right to an independent review of a denied claim.
But more than 60 percent of workers are in self-funded plans, and the only option for those workers to hold their plan accountable was to sue, an expensive and lengthy process.
If you’re one of the 150 million people who get their coverage through an employer plan, you may want to pay attention to the prognostications of what’s to become of the ACA. Your access to high-quality, affordable health care will depend on the outcome.
Health Insurance After the Death of a Spouse, Parent or Other Plan Member
When a loved one passes away, the last thing you tend to think about is your health insurance plan. Nevertheless, this major life change will affect your health insurance coverage and make you eligible for a Special Enrollment Period.
Ultimately, there isn’t a lot of information out there about what to do when your insurance-dependent spouse or insurance-carrying family member has passed on.
And understanding what to do about health insurance during a time of loss is difficult and frustrating.
So, we’re here to outline all you need to know to keep your health insurance coverage active, without paying for coverage you no longer use.
Your Loss Begins a Special Enrollment Period
A Special Enrollment Period (SEP) is a 60-day window which allows people to change or sign up for new health insurance coverage outside of the limited yearly Open Enrollment Period.
To qualify for a Special Enrollment Period, you need to have experienced a Qualifying Life Event.
Loss of a Spouse or Dependent is a Qualifying Life Event (QLE)
Before we sort out the details of a death Qualifying Life Event, it’s important to understand what a Qualifying Life Event is.
There are many types of QLEs, all of which can begin a Special Enrollment Period. In the insurance world, a QLE is triggered by major changes that could affect your health plan — everything from getting married to having a child, being laid off, and more. Suffering the passing of a spouse also counts as a QLE.
How Can a Sole Surviving Spouse or Child Stay Insure?
While health insurance may be the last thing you’re thinking about during these hectic times, it’s actually quite important to check that your coverage is continuing as normal. Having secure, affordable health insurance after the loss of your spouse or dependent is one more way to give yourself much-needed support.
Think of healthcare as a preventative measure from any stresses that may arise, and consider the increased financial and emotional help that a health plan can provide during these times.
1. Enter a Special Enrollment Period Due to a Deceased Spouse:
The loss of a spouse is a Qualifying Life Event that triggers a Special Enrollment Period where you can join an ACA health insurance plan or change your existing coverage.
You qualify for this SEP if…
- Your spouse or parent has passed away in the last 60 days,
- Your spouse or parent was your health insurance dependent, and
- The health insurance coverage is in your name.
You also qualify for this SEP if…
- Your spouse or parent has passed away in the last 60 days,
- You were dependent on your spouse or parent’s health insurance coverage, and
- The health insurance was in your spouse or parent’s name but you were named on the plan.
If your current monthly income is substantially lessened following the death of a loved one, you may qualify for increased payment help or Medicaid.
But, it is important to note that Special Enrollment Periods are only available in a short window. If you experience a QLE your spouse passing, you only have a 60 day window from their death to enroll or change your ACA health insurance coverage. If you miss this Special Enrollment Period, you then have to wait for the annual Open Enrollment Period to start a new plan.
2. Continue Your Deceased Spouse or Parent’s Employer Insurance Using COBRA Rules:
If your spouse or parent had health insurance via a large group or an employer, and you were a dependent on that plan, then you can qualify for something called COBRA. With COBRA, you pay the full monthly costs of your employer health insurance plan. It can be expensive, but it’s one way to put off other changes in your life during this time.
This safety net policy was created to cover employees and their families who had involuntarily or voluntarily lost their job, had their hours reduced or were transitioning between jobs. COBRA also covers life-altering events death of a spouse or divorce.
If your primary policyholder passed away in the last 60 days, and you want to continue to stay on their employer-based health insurance plan, COBRA rules allow you to do so. COBRA is not a permanent or long-term solution, though, as it only lasts for up to 18 months after you enroll.
You can qualify for COBRA if…
- Your spouse passed away in the last 60 days
- You were a named dependent on your spouse or parent’s health insurance plan
- You want to stay on your spouse or parent’s employer-based health insurance plan.
It’s also important to note here that you do not need to stay on your spouse’s employer-based insurance plan, COBRA simply allows you to do so if you want to.
Oftentimes, families find it too expensive to keep these plans and will instead turn to the Affordable Care Act’s marketplace using an SEP.
But no matter what you choose, it is important to know all of your options before you make a decision.
To continue existing coverage using COBRA, promptly call your current health insurance provider to work through the change in ownership.
How Can You Adjust Health Insurance if Your Dependent Passed Away?
If a dependent in your family dies – and they’re not your spouse – this may also qualify you for a Special Enrollment Period. Even if your dependent did not add to your annual income, a child, their presence on your health insurance plan may have been contributing to the cost of your overall coverage.
The death of a dependent generally qualifies you for an SEP, although this is not guaranteed. No matter what though, you would only have 60 days to enroll or change your health insurance coverage after their passing. So, it is important to get an assessment of your coverage as soon as possible and see if you qualify for an SEP in this case.
You may qualify for this specific SEP if…
- Your dependent has passed away in the last 60 days
- Your dependent was named and insured on your plan.
- The health insurance coverage is in your name listed on application.
If A Dependent Not On Your Plan Passes Away
If a dependent of any age in your household passes away – whether or not they were covered by your health insurance plan – it could give you an opening to change your health insurance coverage or join a new plan.
Since loss of a loved one is a major change in anyone’s life, it can still affect your income and decisionmaking. Considerations include whether or not they were listed on your health insurance application (whether or not they were covered); if they are on your taxes (since income affects coverage). It’s best to call an expert for more information in these circumstances.
Taking the Next Insurance Steps After Your Spouse, Parent or Dependent Passes Away
If you are the person in your household who provides health insurance coverage for your family, you might not realize that the death of your spouse or dependent could even trigger a QLE.
Even though you might have the plan through your job or a pension, you may still be able to get an ACA plan with income-based subsidies now that they have passed.
Questions to Ask Your Health Insurance Provider During Your Bereavement Period
Tell your insurance expert that your dependent or spouse has passed away and get the conversation started with questions this:
- My spouse or dependent passed away within the last 60 days. Does your marketplace consider this a QLE and qualify me for a SEP?
- My spouse passed away in the last 60 days and I was a dependent on their plan. What are my options now?
- What paperwork do I need to provide you with?
- Do I qualify now for an income-based subsidy?
- Is there a different plan I need to sign up for now?
- How is my current plan going to change?
- If so, when would these changes take effect?
If your current, private healthcare provider can’t provide any subsidies you can explore other options. If you want to see if you can get a subsidy or less expensive plan, your SEP will guarantee enrollment in other Affordable Care Act plans for 60 days after your dependent’s passing.
If your spouse has passed away and you were a dependent on their plan, or your spouse or dependent has passed away and you want to reconsider your health insurance options, you only have 60 days to enroll or change your Affordable Care Act health insurance coverage. That’s why it’s important to get in contact with your current health insurance provider or an online marketplace to see what your options are before your Special Enrollment Period expires.
When to Begin Health Insurance Changes After a Loss
Because Qualifying Life Events are time sensitive, it is important to explore health insurance sooner rather than later.
We know that during this time, health insurance is probably the last thing on your mind, and certainly not the first thing you want to deal with.
But your health is as important as ever, so take the tips here and use them to ensure your coverage is still there for you going forward.
The U.S. Supreme Court’s Obamacare case is about health care — but also simple math
Nine U.S. Supreme Court justices have the fate of health insurance coverage for approximately 20 million Americans in their hands.
Tuesday morning marked oral arguments in a Supreme Court case challenging the Affordable Care Act.
The Trump administration and 18 Republican-leaning states argue the whole law must go. After federal lawmakers in 2017 zeroed out the individual mandate’s penalty for lacking health insurance, the entire Affordable Care Act (ACA) must fall with it, they contend.
There’s no reason the whole law has to collapse and deprive an estimated 20 million people of health insurance, say more than 20 Democrat-leaning states and the Democrat-controlled House of Representatives.
Now it’s a question of which side can convince at least five members of the high court that they have the better arguments, an issue that has new resonance as the coronavirus pandemic continues to surge. More than 10.1 million Americans had contracted COVID-19 as of Tuesday, according to a running tally from Johns Hopkins University.
The Supreme Court case, Texas v. California, is about health care. But it’s also about math.
There’s the addition of Justice Amy Coney Barrett, a conservative-leaning judge who replaces Justice Ruth Bader Ginsburg, a member of the court’s liberal wing who died in September at age 87.
Then there’s the addition of President-Elect Joe Biden, a proponent of the health-care law who is poised to take office in January as the court mulls its decision, which is expected for release in spring 2021.
See also: Supreme Court increasingly ly to uphold Obamacare even after Barrett’s confirmation, analysts say
Biden, who was vice president when President Barack Obama enacted the law in 2010, can’t stop the court from deciding the case once he takes office, legal observers say. But with court permission, his administration can pivot and argue the law should be upheld.
Biden was scheduled to speak later Tuesday on the lawsuit, according to his transition team.
The court’s ruling could determine health insurance access for millions during a pandemic
The Supreme Court’s ruling on the Affordable Care Act would have fairly immediate ramifications for many Americans who have lost their employer-sponsored insurance amid layoffs triggered by the coronavirus pandemic.
“ More than 6 million workers lost access to worker-provided health insurance since the pandemic’s onset, according to one estimate. ”
A recent report from the Economic Policy Institute, a nonprofit, non-partisan think tank, estimated that around 6.2 million workers lost access to health insurance they got through their employers as a result of being let go since the onset of the coronavirus pandemic. That figure takes into account workers who were originally laid off but have since found new employment.
In many cases, these workers’ health-care plans also covered their spouses, partners and dependents. Altogether, the rise in unemployment has cost some 12 million people their health-insurance coverage.
Because of the expansion of health-insurance options created by the Affordable Care Act, though, most of these workers are eligible for government-subsidized health insurance.
Open enrollment for health care through the Affordable Care Act’s marketplace runs through Dec. 15.
“ ‘Some people will fall outside the reach of the ACA, particularly in January 2021 when [unemployment insurance] benefits cease for many and some adults fall into the Medicaid coverage gap due to state decisions not to expand coverage under the ACA.’ ”
— Kaiser Family Foundation researchers
A separate study from the Kaiser Family Foundation found that nearly half of people who became uninsured after job loss were eligible for Medicaid. And roughly a quarter of those people who lost their employer-sponsored plans could qualify for subsidized insurance purchased through the insurance marketplaces set up by Obamacare.
“Some people will fall outside the reach of the ACA, particularly in January 2021 when [unemployment insurance] benefits cease for many and some adults fall into the Medicaid coverage gap due to state decisions not to expand coverage under the ACA,” the researchers wrote.
All told, millions of Americans had health insurance coverage that was made possible by Obamacare before the coronavirus pandemic began. Around 11.4 million people across the country enrolled in health-insurance plans through the insurance exchanges, according to data from the Centers for Medicare and Medicaid Services.
And as of January 2020, 70.7 million individuals were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), up from 14.2 million in 2013.
Another factor in Obamacare’s expanded coverage that’s also of significant concern for many Americans in the COVID era: The requirement for insurers to provide coverage to people with pre-existing conditions.
That’s because COVID-19 could be considered a pre-existing condition, especially for individuals with lingering symptoms.
Prior to the passage of Obamacare, health insurers could deny coverage, limit payouts or charge higher premiums to people with pre-existing medical conditions. If the Supreme Court were to eliminate the Affordable Care Act, those protections would ly go away.
That substraction could bring some more costly additions, some researchers say. The pandemic may have already added on approximately 3.4 million adults under age 65 who caught COVID-19 to the ranks of Americans with a pre-existing condition, according to the Commonwealth Fund, a private foundation offering grants and analysis on health care matters.
Before the pandemic’s onset, America had up to 133 million people with one or more pre-existing condition, Commonwealth Fund researchers said.
(On the campaign trail, Trump and Vice President Mike Pence said pre-existing conditions would be protected, but critics have said the GOP plans and protections were short on details.)
How will Justice Barrett affect the case decision?
Democrats have warned that Barrett’s nomination to the court could mean the end of the Affordable Care Act. Barrett has written in the past criticizing Chief Justice John Robert’s decision in the 2012 case, even going so far as to say that the legislation should be called “SCOTUScare.”
But Republican lawmakers said Barrett’s position on the case is unknown. And Barrett said during her confirmation hearings that she made no promises to anyone in exchange for her nomination.
“I have not made any commitments or deals or anything that,” she said at the hearings. “I am not here on a mission to destroy the Affordable Care Act. I’m just here to apply the law and adhere to the rule of law.”
This story was updated on November 10, 2020.