ACA Insurance and the Coronavirus

AARPRachelA · ‎08-27-2020

Check out the latest on special open enrollment periods, life-changing events and more ⬇️

I need health insurance now. Can I sign up for a plan under the Affordable Care Act (ACA)?

Maybe. For some people, it's possible to enroll in an ACA plan right now. Typically, enrollment is open only during a set time each year, called open enrollment. However, a life-changing event — such as loss of previous health coverage due to job loss— may qualify you for a special enrollment period.

What if I don't qualify based on a life-changing event and still need insurance?

You may still be able to enroll in an ACA plan, depending on where you live. Though the federal government runs the ACA marketplaces for the majority of states on HealthCare.gov 12 states and the District of Columbia run their own exchanges. And many of them are offering special open enrollment periods due to the coronavirus outbreak.

Which states have reopened enrollment because of the pandemic?

Several states held special open enrollment windows due to COVID-19. The following are continuing to accept new enrollees:

California: through Aug. 31
District of Columbia: through Sept. 15
New York: through Sept. 15

And if I don't live in one of these states and don't qualify with a life-changing event?

The Centers for Medicare & Medicaid Services (CMS), which oversees HealthCare.gov, is evaluating the idea of a special open enrollment for the marketplace, according to a March 23 statement from an agency spokesperson.

AARP sent a letter to Congress on March 25 asking for a nationwide special open enrollment period: “Access to affordable health care coverage is more important now than ever,” said Nancy LeaMond, AARP's executive vice president and chief advocacy and engagement officer. “We continue to strongly support a national special open enrollment period (SEP) to allow those without insurance in this country to get covered. Many state-based exchanges have already enacted these special enrollment periods, but we urge Congress and the Administration to act to ensure that access to coverage be available nationwide."

It's also important to note that those who have lost their jobs and their incomes may qualify for Medicaid — a free or low-cost health program that enrolls applicants year-round.

Will my ACA plan cover coronavirus care?

The symptoms of COVID-19, the illness caused by the new coronavirus, include:

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

The majority of people who get sick with COVID-19 have mild symptoms and are able to recover at home. Some cases, however, are more severe and may require medical attention.

In those instances, all ACA plans are required to cover emergency services and hospitalization. Policyholders, however, may have out-of-pocket costs from coronavirus-related care, depending on their individual plans and any copayment and cost-sharing responsibilities.

I have already tested positive for the coronavirus. Can a health plan deny me coverage?

No. All ACA plans must cover treatment for preexisting medical conditions. And plans can't terminate coverage due to a change in health status, “including diagnosis or treatment of COVID-19,” according to HealthCare.gov.

What will an ACA plan cost me?

There are four types of plans in the ACA marketplace, and your monthly premium and out-of-pocket costs depend on your plan:

Bronze: Lowest monthly premium; highest out-of-pocket costs. Deductibles can be thousands of dollars a year.
Silver: Moderate monthly premiums; moderate out-of-pocket costs.
Gold: High monthly premiums; lower out-of-pocket costs; low deductibles.
Platinum: Highest monthly premiums; lowest out-of-pocket costs; lowest deductibles.

Depending on your household income, you may also be eligible for a subsidy to lower your monthly premium, as well as assistance to help cover out-of-pocket costs.