What if I lost my job and health insurance and don’t know when I’ll be employed again?

Contrary to hours being cut but remaining employed, when it comes to losing employment (and health benefits) altogether, there’s a little bit more action to take. The following information is from healthcare.gov:

If you lost your job-based health plan: You may qualify for a Special Enrollment Period if you lost health coverage through your employer or the employer of a family member in the past 60 days OR you expect to lose coverage in the next 60 days, including if you lose health coverage through a parent or guardian because you’re no longer a dependent. Note: Losing coverage you have as a dependent doesn’t qualify you for a Special Enrollment Period if you voluntarily drop the coverage. You also don’t qualify if you or your family member loses coverage because you don’t pay your premium.

If your employer reduced the hours you work and you’re enrolled in a Marketplace plan: Update your application immediately within 30 days to report any household income changes. You may qualify for more savings than you’re getting now.

If you were furloughed: In some situations depending on the status of your health coverage from your employer, you may qualify for a Special Enrollment Period. You may be eligible for a premium tax credit to help pay for Marketplace coverage too.

If you have COBRA continuation coverage:

– If you’re entitled to COBRA continuation coverage after you lost your job-based coverage, you may still qualify for a Special Enrollment Period due to loss of coverage. You have 60 days after your loss of pre-COBRA job-based coverage to enroll in Marketplace coverage. You may also qualify for premium tax credits if you end your COBRA continuation coverage.
– If you’re enrolled in COBRA continuation coverage, you may qualify for a Special Enrollment Period if your COBRA continuation coverage costs change because your former employer stopped contributing, so you have to pay full cost.

If you lost your job, but didn’t also lose health coverage, because your former job didn’t offer coverage: You generally won’t qualify for a Special Enrollment Period. By itself, a job loss (or a change in income) doesn’t make you eligible for a Special Enrollment Period to enroll in Marketplace coverage… It’s the loss of coverage that does.

What should I do if my income has changed due to Covid-19 and I have a subsidized health plan with the Marketplace?

A subsidized health plan is a policy provided by the Marketplace with a discounted premium, since a portion of it is covered by the government. Eligibility is based on whether or not the insured’s household income qualifies. There is certain criteria for those that are single and those with other dependent family members in their household. It is extremely important that the applicant provides true and accurate information regarding their income, as that is what determines how much help they receive.

It’s also imperative that the insured then updates any changes to their income throughout the year of the policy’s coverage. In situations where their income increases, their subsidy may decrease and vice versa. The penalty for not keeping this information up to date is that a portion of the subsidy could be owed back at tax time if they failed to provide the right information earlier in the year.

The only instance in our current situation that does NOT need to be reported as an income change is the “economic impact” stimulus check that some recently received from the government. That is not required to be considered as true income.

With the current pandemic of Covid-19, there are unfortunately many people that have either had their income decreased, hours cut, or even lost their job altogether. If this happened or happens to you, contact the Marketplace or your agent immediately to update all income information and keep it as accurate as possible, no matter how many times it may change.

COBRA and Medicare… Oil and vinegar or two peas in a pod?

There are lots of things that are consistent when it comes to Medicare. It runs very smoothly, is a pretty well-oiled machine, and policy holders are overall very pleased. But we also see a lot of uncertainty or overwhelm when trying to fully understand it all. It can be intimidating with the regulations and guidelines to follow that could result in financial penalties if not abided by appropriately. But it doesn’t have to be scary or stressful. That’s what we’re here for.

One of the areas that can seem confusing is when people are approaching age 65 (Medicare eligible) and planning to no longer work. There are options to select COBRA coverage, essentially extending the employer’s group coverage, or enroll in Medicare. Here, we’ll break this down as simply as possible to provide a little guidance.

First, let’s be sure we’re on the same page with what exactly COBRA is. COBRA (Consolidated Omnibus Budget Reconciliation Act) gives employees the right to choose a continuation of the previous employer’s group health plan for a limited time. Usually, that time frame is 18 months but may be extended up to 36 months in some situations. There may be some instances where the coverage changes slightly and the premium is usually a little higher than it was for an active employee prior to retirement, up to 102% of the cost of the plan. Employers with 20 or more full time equivalent employees are generally required to offer COBRA. Spouses can also be eligible for COBRA if:

• The covered employee either voluntarily or involuntarily leaves the job
• The covered employee’s number of hours are decreased making them ineligible for benefits
• The covered employee becomes eligible for Medicare
• Divorce or legal separation from the covered employee
• Death of the covered employee

A commonly used term when entering the Medicare world is “creditable coverage”. This is referring to coverage outside of Medicare being qualified to take the place of Medicare so that there are no late enrollment penalties if you don’t enroll on time. “Creditable” also means that the coverage is expected to pay on average as much as the Medicare coverage would. COBRA is NOT considered creditable for Part B of Medicare. Only active employer group coverage for an employee still working would suffice for that. Regarding Part D prescription drug coverage, it is plan specific whether or not it’s creditable.

Real life example: Bill decides to retire right at age 65. He’s been on his employer’s group plan for 25 years. He can elect COBRA to keep that plan but also needs to enroll in Medicare, now that he’s eligible. Medicare would then become his primary. If he didn’t enroll in Medicare and stayed just on COBRA, he could face a substantial gap in coverage. Let’s say he sees a doctor, they bill Medicare A&B for the standard 80% payment but he doesn’t have any Medicare. So then they bill COBRA, who could pay just 20% of the total cost or possible nothing at all, since they’re secondary with him being 65+ now and he technically doesn’t have any primary coverage. Bill could now be stuck with a bill (see what we did there?) for 80-100% being his responsibility to pay out of pocket. So, Bill, lesson learned… what he should have done is upon retirement, enroll in Parts A&B as soon as he stopped working and then compared his COBRA coverage and premium to that of a supplement or advantage plan to decide on the best secondary coverage.

A few things to consider if you’re going to stop working or are 65+ with COBRA:

• What are the options for your spouse or family?
• Is your employer’s COBRA coverage “creditable” for Medicare?
• What is the cost of COBRA vs a Medicare supplement or advantage plan?
• You have 8 months from when you stop working to enroll in Parts A&B without penalty

It may seem like a lot but this is a big transition from working to not, so don’t take it lightly. We can help work through the details and relieve some of the stress. The positive part of it all is that there are options for care and you get to pick the best fit for you.

Health insurance options during COVID-19

Unfortunately during the current pandemic we’re experiencing, some people are losing their jobs. While there’s hope to be rehired once this has passed, one of the immediate concerns is the benefits that go along with that job. Here are some options that may relieve a little bit of the worry and fear surrounding this.

Current Options for Health Insurance:

  1. Purchase Individual Health Insurance Plan – Losing a job with employer-provided coverage qualifies for the Special Enrollment Period (“SEP”) exception outside of Open Enrollment. Some may even be eligible for subsidies based on their income, which would offer premium assistance.
  2. Temporary Plans – These are also available if someone is only interested in more catastrophic coverage for a short period of time.
  3. Cobra – One’s employer (if they have 20 or more full-time employees) may offer this to extend coverage for up to 18 months after employment ends. It is recommended that anyone eligible for Medicare avoid this option but details can be discussed further on a case-by-case basis.
  4. Direct Primary Care – These are membership based clinics that focus on proactive, preventive care by establishing a relationship and individualized plan of care. They do not accept or file with health insurance companies and don’t include coverage for major health needs or hospitalization. However, it may be worth a conversation to see what they offer since it could be a lower cost option during tough times. Here is a map that shows where DPC’s can be located: https://mapper.dpcfrontier.com/
  5. If 65 years old and Medicare eligible – It’s most important to be timely in applying and seek guidance on Advantage Plans, Supplements, and Prescription Drug coverage. It’s best to start this process around 64.5 to avoid any potential penalties financially.

We are happy to help navigate these options to see which is the best fit for your needs, whether it’s temporary or long-term. Please reach out anytime at (352) 371-7977 or info@mcgriffwilliams.com. Stay safe!

Florida Blue Group Health plan flexibility due to COVID-19

We recognize that some companies may be adjusting to better support their employees during this unusual time. We also know there are a lot of questions surrounding the benefits that are offered to teams and what effects the COVID-19 pandemic could have on those. We hope this helps you understand and navigate through some of the top concerns we’re seeing.

1. Will Florida Blue be extending grace periods beyond 30 days for premium payments?

• Yes. Florida Blue has committed to payment flexibility and no cancellations for nonpayment of premium through May 31, 2020. There will still be past due amounts on invoices that will be due at the end of this period but no coverage will be terminated.

2. Some insurance companies are offering a one-time special enrollment opportunity which will allow employees to come onto the plan or add dependents. Will Florida Blue be offering a special enrollment opportunity to mirror a qualifying event? If yes, does this also allow an employee to drop their plan during this special enrollment period too? Will this allow them to change between plans?

• Yes. For groups that renewed on March 1, we are extending the open enrollment period to April 15. All other groups have 30 days beyond the effective date to enroll their employees. (example: March 15 effective date will have until April 15 to complete open enrollment, April 1 effective date has until April 30, etc) Also, Florida Blue is implementing a special enrollment period from April 1–April 15, 2020 for employees that previously refused coverage or are adding dependents to a contract. Only groups enrolled with Florida Blue prior to March 1, 2020 are eligible for this special enrollment period. It is limited to employees who did not elect coverage or waived coverage prior to March 1, 2020. Dependents (such as spouses and children) can be added if enrolled in the same coverage or benefit option as the employee.

3. If a company is reducing hours and/or laying off staff due to the COVID-19 crisis, are they able to keep their employees covered on the plan?

• Florida Blue has adopted a non-enforcement policy that will apply to currently enrolled eligible employees that will allow them to retain coverage as if they were active employees, even if they are furloughed or drop below the normal minimum hours required to be worked for full time employees (25 hours/week for small employers and generally 30 hours/week for large employers). This non-enforcement policy will apply until April 15, at which time it will be reevaluated. If terminated altogether, the former employee can either elect to continue coverage through COBRA or will qualify for a Special Enrollment Period to purchase an individual plan. If the terminated employee is rehired at a later date, there is no standard waiting period to re-enroll in group coverage but they will still need to meet the normal eligibility requirements.

4. If a company is being forced to shut down by state or government orders, can they keep their Small Group Insurance?

• In order for a group to remain active during this period up to May 31, 2020, the group must retain at least one active employee. Failure to retain at least one active employee will result in the group’s cancellation. The group may make the decision to furlough or lay off employees during this time as well. Ultimately, the group will owe premiums through May 31 for any active employee that remains on the active roster for coverage.