*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 in income for Medicaid or CHIP. The additional compensation is included in income for Marketplace financial assistance.
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
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.
The Marketplace allows you to purchase health insurance for you and your family. 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 Reduction (CSR).
What is 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 for 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 a 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 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 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 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 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.
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
If you do not qualify for Medical Assistance, you should contact the Marketplace to determine if you qualify for additional APTC. 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.