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Marketplace Matters: Losing Job-Based Coverage


{music} Hi, I’m Denice Sieron with the Centers for Medicare & Medicaid Services. Welcome to Marketplace Matters, a series to help those who assist consumers with their Marketplace questions. Today’s subject: Losing Job-based Coverage. This information focuses on the Individual Marketplace, and what consumers who lose their job-based health coverage need to know to make informed health insurance decisions. If you lose your job-based health insurance, you have two primary options for health insurance coverage: A Marketplace plan or COBRA continuation coverage. This presentation will walk you through a scenario that will help address some questions that may come up when counseling consumers who lose their job-based coverage. First… What can you do if you’re losing your job-based coverage? Sarah and her entire department were unexpectedly laid-off. She lost her job-based coverage as a result. What does Sarah need to know? She can buy an individual plan through the Marketplace. She may also have the option of keeping her job-based health insurance for a limited time through a program called COBRA continuation coverage. Let’s talk about her first option, getting an individual Marketplace plan. Since Sarah lost her job-based coverage, she qualifies for a Special Enrollment Period, and can choose to buy health insurance through the Marketplace. She’ll have 60 days to enroll in the Marketplace from the time her coverage ends, which may or may not be the last day of employment. She should keep any documentation she has about her loss of coverage to request a Special Enrollment Period. By completing one application through the Marketplace, Sarah can find out if she qualifies for tax credits that can lower her monthly premiums and lower out-of-pocket costs, depending on her household size and income. She can apply at HealthCare.gov or by calling the Marketplace Call Center at 1-800-318-2596. When filling out the Marketplace application, she should choose “No” when answering whether she currently has health coverage. Sarah has a second option of keeping her job-based health coverage for her and her family through COBRA continuation coverage. COBRA is a federal law that may let Sarah pay to keep her employee health insurance for a limited time, usually 18 months after her employment ends or she otherwise loses coverage. If Sarah buys COBRA continuation coverage, she’ll have to pay the entire monthly premium, plus a small administrative fee. Her former employer no longer pays any of her insurance costs. She also won’t be able to get any of the lower costs on premiums and out-of-pocket costs that she may be eligible for through the Marketplace while she has COBRA continuation coverage. If Sarah’s COBRA coverage ends outside of Open Enrollment, she’ll qualify for a Special Enrollment Period, and can enroll in a private health plan through the Marketplace. However, if she ends her COBRA coverage early outside of Open Enrollment, she won’t be able to enroll in a Marketplace plan until the next Open Enrollment period. What happens if you go without coverage? If Sarah doesn’t have health coverage, she may have to pay a fee when she files her taxes. She will also have to pay all the costs for her health care. Can you get coverage outside the Marketplace? Sarah can choose to buy individual insurance outside the Marketplace directly from an insurance company or with the help of an agent or broker. But she won’t have access to lower costs on her monthly premiums. Keep in mind, not all plans she can buy outside the Marketplace meet the health care law’s requirements for minimum essential coverage. Insurance plans must tell you whether they provide minimum essential coverage. All Marketplace plans offer minimum essential coverage. If you’re a professional learning about the Marketplace and helping people apply, you can get the latest resources at Marketplace.cms.gov. You’ll find resources for assisters, training modules, videos, frequently asked questions, and official consumer resources. You can also sign up to get email updates. Don’t miss key dates and information about the Marketplace. Here’s how to stay connected…

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