HEALTH INSURANCE OPTIONS
I've been laid off and lost my health insurance, what do I do?
Pennsylvanians have health insurance options. Check out your options to see what's best for you and your family.
- Medical Assistance. Depending on your income, you and your family may qualify for free or low-cost health insurance through Medicaid or the Children's Health Insurance Program (CHIP). Enrollment in these programs is open year-round. Medical Assistance provides comprehensive coverage and is there for people who fall on hard times and need help. Visit www.compass.state.pa.us to see if you qualify.
- Marketplace Coverage. If you've recently lost your job-based health coverage, in the past 60 days, you qualify for a special enrollment period (SEP) and can shop for and enroll in a plan at www.healthcare.gov. You may qualify for financial help to pay for your plan, but only if you don't qualify for Medicaid Assistance. Last year about 80% of Pennsylvanians who purchased Marketplace Coverage qualified for financial help. Here is a list of exchange assisters in your area who can help you apply for coverage. You can also search by using the find a health center page. If you have additional questions or need further assistance, please contact the PACHC's Navigator Hub at 1-866-944-CARE (2273).
- COBRA Continuation Coverage. COBRA allows you to continue the coverage provided by your former employer. If you are entitled to elect COBRA coverage, you must be given an election period at anytime for up to 60 days after the national emergency declaration is lifted for COVID-19. If you choose to continue your COBRA health insurance plan at your own expense, you will also pay the portion of the premium your former employer paid on your behalf. Just because you may be entitled to elect COBRA coverage, this does not mean you must elect it. It is recommended that explore your coverage options before deciding, as sometimes marketplace coverage may be the more affordable option. Learn about your COBRA rights and options from the U.S. Department of Labor by clicking here. You can also view frequently asked questions about COBRA by clicking here. If you work for a small business (2-19 employees), you may be offered Mini-COBRA. You can view frequently asked questions about Mini-COBRA by clicking here.
The rest of this document includes Frequently Asked Questions about Medical Assistance and Marketplace financial assistance and how to determine your income when you apply.
*If you lost your employer coverage, be sure to determine when your employer ended the coverage. If you have medical bills after your coverage ended, the bills may not be paid.
CARES Act Payments
Because of the CARES Act I received a payment of $1,200 per adult and $500 per dependent child. Does this impact how much I will pay for my health insurance?
No. This payment is not included in income for either Medical Assistance or Marketplace financial assistance.
Does the additional $600 per week in unemployment benefits I receive due to the Federal Pandemic Unemployment Compensation (FPUC) in the CARES Act impact how much I pay for health insurance?
The additional FPUC unemployment compensation is not included as income for Medicaid or CHIP. The additional compensation is included as income for the purposes of determining your eligibility for financial assistance to enroll in coverage through the Marketplace.
If you lose your job and health insurance, you and your family may qualify for Medicaid or CHIP. You can enroll in these programs at any time – you don't need to wait for an open enrollment period. You are eligible for these programs based on your expected monthly income. For example, a typical family of four must have income of less than $2,904 per month to qualify for Medicaid. A single adult, age 64 or under, must have income of less than $1,414 per month to qualify for Medicaid. These programs provide coverage and care at little or no cost to you. Once you are enrolled in Medicaid, you are allowed to keep it at least through the end of the COVID emergency.
You can find out more information on CHIP and the income limits for this program at www.chipcoverspakids.com or click here.
How do I apply for Medical Assistance?
The best way to apply for Medical Assistance is the Commonwealth's COMPASS tool, available at www.compass.state.pa.us. You may also be directed to Pennsylvania's Medical Assistance program through Healthcare.gov.
Does income I earned before I was laid off count for Medical Assistance programs?
No. You qualify for Medical Assistance based on your expected monthly income. Income you earned earlier in the year does not affect whether you qualify.
How do I know how much of my unemployment benefits counts as income for Medical Assistance?
Your regular unemployment benefits are included in income for Medical Assistance, but the additional FPUC benefits are not. The Pennsylvania Department of Labor & Industry sends unemployment benefits and FPUC benefits in separate payments in alternating weeks. When you apply for Medical Assistance, include the amount of the regular benefit but not the FPUC benefit.
How do I apply for marketplace coverage?
The Marketplace allows you to purchase health insurance for you and your family. If you've recently lost your job-based health coverage, in the past 60 days, you qualify for a special enrollment period (SEP) and can shop for and enroll in a plan at www.healthcare.gov. Here is a list of exchange assisters in your area who can help you apply for coverage. You can also search by using the find a health center page. If you have additional questions or need further assistance, please contact the PACHC's Navigator Hub at 1-866-944-CARE (2273).Depending on your projected income for the year, you may qualify financial assistance to help pay for your health insurance, but only if you do not qualify for Medical Assistance. There are two types of Marketplace financial assistance: Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR).
What is Advanced Premium Tax Credits (APTC)?
APTC is a tax credit you can take in advance to lower your monthly health insurance payment (or "premium"). When you apply for coverage in the Health Insurance Marketplace, you estimate your expected income for the year, and the Marketplace uses your estimate to help project your income. If you qualify for a premium tax credit based on your projected income, you can use any amount of the credit in advance to lower your premium.
- If at the end of the year you've taken more premium tax credit in advance than you're due based on your final income, you'll have to pay back some or all of the excess when you file your federal tax return.
- If you've taken less than you qualify for, you'll get the difference back.
What is a Cost Sharing Reduction (CSR)?
A CSR is a discount that lowers the amount you have to pay out-of-pocket health care costs like deductibles, copayments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called "extra savings." If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
- When you fill out a Marketplace application, you'll find out if you qualify for APTC and extra savings. You can use APTC for a plan in any metal category. But if you qualify for extra savings too, you'll get those savings only if you pick a Silver plan.
- If you qualify for cost-sharing reductions, you will also have a lower out-of-pocket maximum — the total amount you'd have to pay for covered medical services per year. When you reach your out-of-pocket maximum, your insurance plan covers 100% of all covered services.
I lost my health insurance when I was laid off and am interested in signing up for a Marketplace plan. How will this impact me?
Losing job-based insurance qualifies you for a Special Enrollment Period. Usually when you sign up for a Marketplace plan during a special enrollment period you assume that your current income will continue for the rest of the year. But the Federal Pandemic Unemployment Compensation (FPUC) income is set to expire at the end of July. You need to be careful not to overstate your likely income when signing up for health insurance on the Marketplace.
How should I calculate my income to apply for Advanced Premium Tax Credits (APTC)?
One way to calculate your income is as follows:
Take what you made before you were laid off (for example, January through March)
+ Your income after being laid off through July (unemployment compensation + additional $600 per week FPUC)
+ Your unemployment income after July (without the additional $600 per week from the FPUC) or your future projected earnings if no longer unemployed.
= Total Potential income for 2020
How do I know how much money I receive with unemployment compensation and Federal Pandemic Unemployment Compensation (FPUC) combined?
Unemployment benefits are based on your reported earnings during the base year (the first four of the last five completed quarters). You must also have over 18 credit weeks (weeks during which you earned $116 or more) in your base year to be eligible. As long as you are eligible for at least $1 of regular unemployment compensation, you are eligible for the additional $600 FPUC payment until July 25, 2020.
Click here to find out how to calculate your weekly benefit rate:
The Pennsylvania Department of Labor & Industry sends unemployment benefits and FPUC benefits in separate payments in alternating weeks. Include both amounts as unemployment benefits through July 25th when you apply for APTC. After July 25th, you will receive unemployment compensation on a bi- weekly basis because the FPUC benefits end.
If I have a Marketplace health insurance plan currently and I've lost income due to COVID-19, what should I do?
If you or someone in your household recently lost income due to the COVID-19 pandemic or any other reason that you expect will reduce your 2020 earnings, you may qualify for additional financial assistance or for lower-cost coverage through Medical Assistance (Medicaid or CHIP). The best way to find out if you are eligible for Medicaid Assistance is to visit the commonwealth's COMPASS tool at www.compass.state.pa.us.
If you do not qualify for Medical Assistance, you should make changes to your Marketplace application to determine if you qualify for additional Advanced Premium Tax Credits (APTC), and cost-sharing reductions to lower the cost of health care services. When you signed up for your health insurance on the Marketplace you used estimated projections of your income for this year. Those projections help determine financial assistance that may be available to help pay premiums. By updating your current income, your financial assistance will be updated accordingly.
There are a couple of ways to update your income. You can:
1. Update your information by phone.
Contact the Marketplace Call Center by calling 1-800-318-2596 (TTY)1-855-889-4325. Someone is available to assist you 24 hours a day, 7 days a week (except holidays)
2. Update your information online. For screen-by-screen directions click here
Because of the Federal Pandemic Unemployment Compensation (FPUC), my yearly income will be higher than I estimated when I enrolled in Marketplace coverage. Should I tell the Marketplace?
Yes. If at the end of the year you've taken more premium tax credit in advance than you're due based on your final income, you'll have to pay back the excess when you file your federal tax return.
There are other health insurance options available if you lose health insurance that your employer was providing. You can find help by visiting www.insurance.pa.gov/4healthins. Our webpage provides a way to compare Marketplace plans in your area by using Consumers' Checkbook. You can find a navigator or local agent by clicking below the blue map of Pennsylvania. Finally, there are videos available to help you learn more about health insurance.
The Pennsylvania Association of Community Health Centers (PACHC) is the Commonwealth's recipient of a grant to be a navigator for health insurance. Exchange assisters are available throughout Pennsylvania, at no cost, to assist you in navigating and enrolling in the Health Insurance Marketplace, Medical Assistance (MA), including Medicaid and CHIP, and Medicare.
You may also use the Commonwealth's COMPASS tool, available at www.compass.state.pa.us, if you believe you may be eligible for Medical Assistance. COMPASS is an online tool for Pennsylvanians to apply for many health and human service programs like Medicaid and CHIP.
Here is a list of exchange assisters in your area. You can also search by using the find a health center page. If you have additional questions or need further assistance, please contact the PACHC's Navigator Hub at 1-866-944-CARE (2273).If you need health insurance before your Marketplace coverage takes effect and a COBRA/mini-cobra plan is not available, ask the employer's insurance company and your local Blue Cross or Blue Shield company whether you are able to get a "conversion" policy. Note that there are special rules that limit their availability, and they generally cost more than COBRA coverage.