Transitioning away from an employer-sponsored health plan? You may find that you’re eligible for subsidized individual-market coverage.
Most Americans under the age of 65 get their health insurance from an employer.
This makes life fairly simple as long as you have a job that provides solid health benefits: All you need to do is enroll when you’re eligible, and if your employer offers a few options from which to choose, pick the one that best fits your needs each year during your employer’s annual enrollment period.
But the downside to having health insurance linked to employment is that losing your job will also mean losing your health insurance, adding stress to an already stressful situation.
The good news is that you’ve got options — probably several, depending on the circumstances. Let’s take a look at what you need to know about health insurance if you’ve lost your job and are facing the loss of your employer-sponsored health coverage.
Enrolling Self Purchased Insurance
If you’ve lost your job-based health insurance, you do not have to wait for the next annual open enrollment period to sign up for a new ACA-compliant plan. You’ll qualify for your own special enrollment period due to the loss of your employer-sponsored health plan.
This will allow you to enroll in a plan through the marketplace/exchange and take advantage of the subsidies that are bigger than ever, thanks to the American Rescue Plan.
If you enroll prior to your coverage loss, your new plan will take effect the first of the month after your old plan ends, which means you’ll have seamless coverage if your old plan is ending on the last day of the month.
Your special enrollment period also continues for 60 days after your coverage loss, although you’d have a gap in coverage if you wait and enroll after your old plan ends since your new plan wouldn’t take effect retroactively.
If you’re in that situation, you might find that a short-term health plan is a good option for bridging the gap until your new plan takes effect.
Short-term plans won’t cover pre-existing conditions and are not regulated by the Affordable Care Act (ACA). But they can provide fairly good coverage for unexpected medical needs during a temporary window when you’d otherwise be uninsured.
Back to top
COBRA vs self-purchased coverage
Alternatively, if COBRA is available, you have 60 days to decide whether you want to take it or not. You can use this window as a bit of a cushion between your old coverage and your new coverage because COBRA takes effect retroactively if and when you elect to use it.
So if you’ll have a one-month gap between your job plan ending and your new plan starting, you could elect COBRA if you end up with medical needs during that month.
The coverage would seamlessly start when your old plan ended, avoiding any gap in coverage as long as you pay all COBRA payments that are due.
If COBRA (or state continuation coverage) is available, your employer will notify you and give you information about what you’ll need to do to activate the coverage continuation, how long you can keep it, and how much you’ll have to pay each month to keep the coverage in force.
COBRA vs individual-market health insurance
Here’s what to keep in mind when you’re deciding between COBRA and an individual-market health plan:
- ACA marketplace subsidies are now available at all income levels, depending on the cost of coverage in your area. And the subsidies are substantial, covering the majority of the premium cost for the majority of marketplace enrollees. Unless your employer is subsidizing your COBRA coverage, you’ll probably find that the monthly premiums are lower if you enroll in a plan through the marketplace, as opposed to continuing your employer-sponsored plan.
- Have you already spent a significant amount of money on out-of-pocket costs under your employer-sponsored plan this year? You’ll almost certainly be starting over at $0 if you switch to an individual/family plan, even if it’s offered by the same insurer that provides your employer-sponsored coverage. Depending on the specifics of your situation, the money you’ve already paid for out-of-pocket medical expenses this year could offset the lower premiums you’re likely to see in the marketplace.
- Do you have certain doctors or medical facilities you need to continue to use? You’ll want to carefully check the provider networks of the available individual/family plans to see if they’re in-network (provider networks can vary significantly between the employer-sponsored and individual market, even if the plans are offered by the same insurance company). And if there are specific medications you need, you’ll want to be sure they’re on the formularies of the plans you’re considering.
- Will you qualify for a premium subsidy if you switch to an individual/family plan? If you do qualify, you’ll need to shop in your exchange/marketplace, as subsidies are not available if you buy your plan directly from an insurance company.
What if I’ll soon be eligible for Medicare?
There has been an increase recently in the number of people retiring in their late 50s or early 60s, before they’re eligible for Medicare. The ACA made this a more realistic option starting in 2014, thanks to premium subsidies and the elimination of medical underwriting.
So if you’re losing your job or choosing to leave it and you still have a few months or a few years before you’ll be 65 and eligible for Medicare, rest assured that you won’t have to go uninsured.
You’ll be able to sign up for a marketplace plan during your special enrollment period triggered by the loss of your employer-sponsored plan. And even if you earned a fairly robust income in the earlier part of the year, you might still qualify for premium subsidies to offset some of the cost of your new plan for the rest of the year.
And marketplace plans are always purchased month-to-month, so you’ll be able to cancel your coverage when you eventually transition to Medicare, regardless of when that happens.
The short story on all of this? Coverage is available, and obtaining your own health plan isn’t as complicated as it might seem at first glance, even if you’ve had employer-sponsored coverage all your life.
Recommended: Best productivity apps to use