What To Do If You’ve Lost Your Employer-Sponsored Health Insurance
If you’ve recently lost your job or been furloughed, or if you expect to be, you may have questions about how to keep health insurance coverage. This page is intended to provide information that can help you understand your options. And, you can contact OHA for answers to your questions about your specific situation, or refer to some of the other resources on this page.
For those who qualify, HUSKY is one of the very best insurance choices, because it is virtually free. It provides comprehensive health benefits with no premiums and minimal or no copays or out-of-pocket costs. In addition, HUSKY can cover you retroactively from the date you apply, up to 90 days earlier, depending on when you became eligible. This means that you may be able to get outstanding medical bills paid through HUSKY. The one weakness is that not all providers accept HUSKY. However, even if your provider is not accepting new HUSKY patients, they may (if asked) agree to continue serving existing patients who switch to HUSKY.
Applying for coverage through Access Health CT (the Obamacare exchange - see the “Buying Your Own Health Insurance section below) includes a check to see whether you are eligible for health insurance under HUSKY. HUSKY is the name for Connecticut’s Medicaid and CHIP (Children’s Health Insurance Program) programs. HUSKY is available to people who meet certain monthly income criteria, which varies depending on the makeup of the household. For example, higher income limits apply to families with dependent children, and in some cases, children may qualify for coverage but their parents won’t. For more detailed information about eligibility for the different HUSKY programs, and the benefits of each, please visit one of the following links:
It is important to remember that HUSKY eligibility is determined on the basis of monthly household income, whereas eligibility for subsidies on the Access Health CT Exchange, discussed below, is based on projected annual income. If you are recently unemployed, your new monthly household income (which includes unemployment benefits) may be significantly lower than predicted by your estimated annual income. If you believe that you qualify for HUSKY, but AHCT did not enroll you, or if you are enrolled but are having trouble accessing benefits through HUSKY, please contact OHA for assistance.
COBRA – Continuation Coverage
If your employer offers a health coverage benefit, a Federal law called COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1988) requires them to provide you with the option to remain enrolled in the same benefit for a number of months, but you have to pay the full premium – both what you previously paid, plus what your job was paying for you. This is called “Continuation Coverage.” COBRA is worth considering carefully, though other options may be cheaper, as explained below.
COBRA – What is Covered? – COBRA is a continuation of the coverage you received as an active employee, so you should continue to receive the same benefits. For example, COBRA should cover the same doctors and other providers, and you will have the same cost shares (deductibles, copayments and coinsurance). All the same drugs should be covered. You should get credit under COBRA for any deductibles that you already paid during the same plan year.
COBRA – How much does it cost? – You may find that Continuation Coverage costs more than what you were paying for the same health plan as an employee. This is because most employers cover a big part of the premium for their employees, although you may not even know this because your pay stub only shows your portion of the premium. But when you switch to COBRA, your job is no longer required to make these premium payments for you, meaning you have to pay the full amount by yourself. You may find that COBRA is not as affordable as some of the other options available to you.
However, the decision on whether or not to take COBRA sometimes is more complicated than just comparing premiums and benefits. You will need to take into account how much you have already paid in deductibles under your employer’s plan. If your deductible is paid off, or if you just have a little bit more to pay on the deductible, it may be worth it to pay a higher premium for the rest of the year, instead of switching to another option and starting to pay off an entire new deductible from scratch.
Make sure you can afford COBRA before you sign up for it – as explained below if you start with COBRA then stop because it costs too much, you may not be able to get other insurance until there is an open enrollment period.
COBRA – How Long Does It Last? – COBRA normally can last for 18 months, but under Connecticut law, some COBRA plans must provide coverage for 30 months. If you have questions about COBRA, contact OHA for assistance.
COBRA – Deadline to Enroll – COVID NOTE – Under normal circumstances, you must elect COBRA within 60 days of losing your employer-based coverage. Upon making that election and paying the premium, your COBRA coverage applies retroactively to the date you lost coverage. Recent Federal regulations have suspended the operation of a number of deadlines that apply to health coverage, including the deadline to enroll in COBRA within 60 days. Please contact OHA for assistance if you have lost your employer-sponsored health coverage after March 1 and would like to enroll in COBRA.
Joining the Insurance of a Parent, Spouse or Partner
If you’ve lost your employer-sponsored health insurance but your spouse or partner (or parent, if you are under 26 years old) is eligible for coverage through their employer, you will likely be able to enroll in their insurance.This may be the case even if your spouse or partner (or parent) is not currently enrolled in their job’s health insurance. Your spouse or partner (or parent) should promptly (within 30 days of loss of coverage) speak with their employer about enrolling. Generally, enrollment in the new employer coverage will be effective at the beginning of the next month.If you or your spouse (or parent) have questions or require assistance, contact OHA for help.
Buying Your Own Health Insurance
Connecticut has established Access Health CT (AHCT) as its official health insurance marketplace under the Affordable Care Act, also known as Obamacare. Individuals (and small employers) can use AHCT to purchase health insurance for themselves and their families. Individuals and households in 2020 are eligible for subsidies if their annual income is projected to be under approximately $50,000 for an individual, or $104,000 for a family of four. In some cases these subsidies result in health insurance with very low premiums and relatively low cost-shares (deductibles, copayments and coinsurance). Only insurance sold through AHCT is eligible for these subsidies. Applying through the AHCT website will also help determine if you or any of your dependents may qualify for free coverage through HUSKY, as discussed above.
If you do not qualify for any subsidies on AHCT, you can still pay the full price to buy a plan through AHCT. People who qualify for subsidies will almost always be better off buying a plan on the Exchange. But if you do not qualify for any subsidy, you should know that some insurance companies also offer plans outside the exchange, either through brokers or directly through the insurance company. In a few cases, these off-exchange plans may be a better deal than plans bought through AHCT. Contact AHCT via the AHCT website or Call Center (855-805-4325) to connect with a qualified broker.
You can enroll in a plan through AHCT only: 1) during general open enrollment, which typically begins in November of each year, or 2) by qualifying for a Special Enrollment Period due to a life change, such as moving, getting married or divorced, or the loss of other qualifying coverage (for example, losing insurance you had through your job). Your Special Enrollment Period runs for 60 days from the qualifying event, but you should act promptly to enroll in order to avoid any break in coverage. Enrollments in AHCT health plans typically are not retroactive.
If you previously elected COBRA and later cancelled it before it expired, you are not considered to have lost qualifying coverage and therefore do not qualify for a Special Enrollment Period (unless your employer was paying some or all of your COBRA premiums). This is true even if you cannot afford your monthly COBRA payment and stop paying. You will have to wait until general open enrollment or until you have another event which qualifies you for a Special Enrollment Period, in order to enroll in coverage through AHCT. Expiration of COBRA (e.g., after the full 18, 30 or 36 month eligibility period) does qualify a you for a Special Enrollment Period.
Enrollment in AHCT takes effect on the first of each month. If you have lost or will be losing your employer-sponsored coverage, you can enroll up to 60 days after the loss of coverage. If you enroll before or up until the day of the loss of your employer-sponsored coverage, your plan through AHCT will begin on the first day of the following month. This can help you avoid a gap in coverage. If you wait until after your employer-sponsored coverage has ended, you may end up uninsured for a month or more. In most cases, individuals who enroll prior to the 15th of a month begin coverage on the first day of the following month, while individuals who enroll after the 15th of a month won’t start coverage until the first day of the second month (up to 45 days later). Accordingly, this means that it is important to consider your health insurance options as quickly as possible after learning of a potential loss of insurance through your job. If coverage through AHCT will be your best option, it is important to enroll before or soon after you have lost coverage in order to minimize the risk of a gap in health coverage.
If you are over 65, but have until now had insurance through your job, you may not have been required to enroll in Medicare. There is a life-long penalty premium increase for failing to enroll in Medicare at the earliest opportunity when you lose qualifying employer-sponsored coverage. Accordingly, if you are over 65 and have lost employer-sponsored coverage, it is important to enroll in Medicare in order to avoid the penalty.
If your monthly income falls under certain maximum thresholds, you may also qualify for one of the Medicare Savings Programs (MSPs), which can assist with payment of your Medicare premiums, deductibles and coinsurance. For those who don’t qualify for a Medicare Savings Program, you should strongly consider a Medicare Supplement (aka MediGap) plan to help with Medicare’s significant deductibles and co-insurance. If you get Medicare plus MediGap, your co-pays will be much smaller.
Also, you need to select a separate Medicare drug plan, called Medicare Part D, which you will buy directly from an insurance company. As with Medicare itself, there is a life-long penalty if you don’t apply for Part D at the earliest opportunity.
Almost all doctors and hospitals in America will be in-network with Medicare. The wide network and the protection from co-pays is why Medicare plus MediGap is the gold standard for healthcare coverage for seniors in the U.S.
In addition to traditional Medicare, there is also a second way to get your Medicare coverage, called Medicare Advantage (also sometimes called Medicare Part C). It is offered only through private insurance companies, so it almost always has fewer in-network doctors in your home region, and possibly no in-network doctors at all outside your region. In addition to these narrow networks, Medicare Advantage plans typically have high co-pays if you get sick, and the MediGap plans that reduce or eliminate co-pays in real Medicare are not available under Medicare Advantage.
One nice thing about Medicare Advantage is that you usually do not have to get a separate plan for drugs. Also, some Medicare Advantage plans may have extras, like vision or dental, that are not included under traditional Medicare.
One significant risk with Medicare Advantage is that while you can always switch from real Medicare to Medicare Advantage during the annual open enrollment, it is not easy to switch from Medicare Advantage back to real Medicare with MediGap. That’s because once you are on Medicare Advantage for a year or more in most states, when you switch back to real Medicare, the MediGap companies are allowed to charge you more or even deny you if you have a pre-existing condition. Without MediGap, you will have to pay 20% of most medical bills, with no out-of-pocket max. So you may feel locked into continuing with Medicare Advantage, even if you would prefer to switch back to real Medicare with MediGap. Studies have shown that when people get sick, they try to switch back to real Medicare, due to the significant out-of-pocket costs, or the narrower selection of in-network doctors or hospitals. This is less of a problem in Connecticut than most states. If you live in Connecticut, you will be allowed to buy a MediGap plan if you want to switch from Medicare Advantage to real Medicare.
Your Medicare choice is complicated. For assistance with enrolling in Medicare, you may contact your regional CHOICES (Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening) office.
For additional information regarding Medicare, Medicare Savings Programs and MediGap plans, please visit the Medicare website, or see their comprehensive Medicare & You book. Although be aware that in recent years the Medicare & You book has been criticized for downplaying the risks of Medicare Advantage plans. In addition, The Center for Medicare Advocacy has a wealth of information about Medicare and how to enroll. You may also visit Medicare’s Connecticut-specific resource page.
Please contact OHA, if you have any questions about enrolling in Medicare.
Alternative Coverage Arrangements
There are some additional types of insurance, which are sometimes referred to as “junk insurance.” These plans may have cheaper premiums, but do not operate like the normal insurance plans described above. They may not include all of the normal ACA/Obamacare protections. For instance, they may be free to refuse you coverage, or charge you higher premiums, if you have a pre-existing condition. They may not cover common illnesses, conditions, procedures, or drugs. If you get sick during the year, they may be free to kick you out of the plan at the end of the year. They may have high deductibles, and may have annual or lifetime limits. They may also restrict membership to groups such as certain professions, or certain religious faiths. If something goes wrong, state or federal government like the Connecticut Insurance Department may not have jurisdiction to assist you.
All in all, despite the sometimes cheaper premiums, these plans are risky options, and you should consider them only if you: 1) are very healthy, and 2) have plenty of cash saved up to pay out-of-pocket expenses if you or a family member do get sick or have an accident. These alternative coverage options include:
Short-term plans – not currently available in Connecticut