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1 1 (May 04, 2020)

handle is hein.crs/govdabo0001 and id is 1 raw text is: ,..........s - r',, Se. Updated May 4, 2020 Health Insurance Options Following Loss of Employment Many Americans have health insurance coverage that is provided through an employment setting. In light of the economic repercussions of the COVID-19 pandemic, many Americans may lose the jobs through which they receive health insurance. Such individuals may need to identify another source of health insurance to remain enrolled in plans that cover COVID-19-related services. Three potential comprehensive coverage options for these individuals include the Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage, individual health insurance coverage, and Medicaid. An individual's eligibility for these coverage options depends on a number of factors (e.g., economic circumstances, family composition, federal/state policies). Even if an individual is eligible for such coverage, the costs associated with some options may be prohibitive given the individual's loss of income due to unemployment. This In Focus provides a brief overview of eligibility, benefits, and costs associated with these different health insurance coverage types. For married couples in which one spouse's job loss results in the loss of his/her (or his/her family's) health insurance coverage, the spouse (or family) may be able to enroll in coverage through the other spouse's employer if the other spouse is working and his/her employer offers health insurance coverage. In general, employers offering health insurance benefits to their employees are obligated to offer employees, who lose coverage (not sponsored by the employer) and meet certain criteria, a special enrollment period (SEP) through which the employee (and/or family) may enroll in the working spouse's employer coverage. COBRA provides certain former employees, their spouse, and their dependent children with temporary access to the former employer's health insurance. (Certain current employees may also be eligible.) To be eligible for COBRA continuation coverage, an individual must satisfy the following criteria: (1) work (or be the spouse/dependent child of someone who works) for an employer that must offer COBRA continuation coverage, (2) experience a qualifying event, and (3) be covered by his/her former employer's sponsored health plan on the day before the qualifying event occurs. All employers that sponsor health insurance benefits are subject to COBRA requirements, except employers with fewer than 20 employees; church plans; and federal, state, and local governments. In general, most large employers will be subject to COBRA requirements as a result of being subject to the employer shared responsibility provisions, which incentivize large employers to offer health insurance coverage to their full-time employees. Under COBRA, an employee's voluntary or involuntary termination (for any reason other than gross misconduct) is considered a qualifying event for the former employee and his/her spouse or dependent child if such event causes a loss in the former employer's sponsored coverage. Generally, a qualified individual must be allowed to elect COBRA coverage within (at least) 60 days from the later of: the date coverage would be lost due to the qualifying event or the date the beneficiary is sent notice of his/her right to elect COBRA coverage. No days will count toward this timeline until 60 days after an announced end of the COVID-19 national emergency (or another specified date). COBRA coverage must be identical to the coverage available to similarly situated active employees. This is often the same coverage that the individual previously had. For terminated employees, coverage generally may last for at most 18 months. Employees may terminate their coverage at any point, and employers may terminate COBRA coverage early for specified reasons (e.g., an employer ceases to maintain any group health plan due to going out of business). Employers are not required to pay the cost of COBRA coverage, though they may choose to do so. As such, COBRA continuation coverage may be more expensive than other coverage options. Employers are permitted to charge the covered individual 100% of the premium (i.e., both the portion paid by the employee and the portion paid by the employer), plus an additional 2% administrative fee. 4,dWdu,'He~ h-mkuLrance Corag Individuals and families may purchase individual health insurance coverage directly from an issuer in the individual market. The individual market includes the health insurance exchanges (marketplaces), but individuals also can purchase coverage outside of the exchanges. In general, individuals may purchase individual health insurance coverage sold in the state in which they reside. For exchange coverage, state residents also must be citizens or have other lawful status, and they must not be incarcerated (except those pending disposition of charges). \\\ \q\ ppmg\ \ \,\qN,'\,\w-'N 010 gm ILI

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