Introduction

The health care system is financed by the public and private sectors. Most Americans rely on the private sector to finance their health care coverage even though Medicare and Medicaid, options financed by the government, are heavily utilized. Although we have a health care system supported by both public and private options many people still experience gaps in health care coverage. Employer-sponsored health coverage is a private option that has been the prevailing policy for supplying health care coverage in the United States. Consequently, most gaps in coverage are a result of loss of employment.

With the recent impact the Covid-19 pandemic has had on the job market, this has left many people unemployed and uninsured. Discussed below are options that will help bridge the gap in acquiring health care coverage. 

The Consolidated Omnibus Budget Reconciliation Act (COBRA)

Individuals who lose their employer-sponsor health care coverage can elect to continue their coverage for a limited period as mandated by the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). This Act allows former employees and their dependents to temporarily maintain their health care coverage under certain qualifying events in which they are required to pay some or all the premium. A qualifying event may include but is not limited to termination of employment, divorce from a covered employee, or death of the employee. Health care coverage starts immediately after the ‘qualifying event’ and may last anywhere between 18-36 months.

The Children’s Health Insurance Program (CHIP)

In 1997, the Children’s Health Insurance Program (CHIP) was created for children whose parents’ income level is higher than the Medicaid eligibility threshold. Under this program, health care coverage is provided to children under the age of 19. Medicaid expansion CHIP programs provide the same benefits, but coverage is extended to young adults under the age of 21. There is no enrollment period, you can apply for coverage anytime.

Medicaid

Medicaid is a state and federally funded insurance program established through Title XIX of the Social Security Act, 42 U.S.C. §§ 1396. The eligibility requirements of the program allow members who have low income or who cannot receive health care coverage at no cost. Just like with CHIP there is no enrollment period and, you can apply for coverage anytime.   

The Patient Protection and Affordable Care Act (ACA)

In 2010, the Patient Protection and Affordable Care Act (ACA) was enacted to increase health care coverage in the United States. The main objectives of the ACA are to decrease the cost of health care by expanding the eligibility threshold of Medicaid and to provide access to affordable health care; thus, narrowing the gap created by employer-sponsored health care coverage. The ACA also extends coverage for young adults by allowing them to remain on their parent’s health insurance plan until twenty-six years old.   

The enactment of the ACA created the establishment of health exchanges. A health exchange is a virtual marketplace that offers competitive health insurance plans where you can enroll for coverage. When you begin a new job that will sponsor your health care coverage your enrollment usually becomes effective the day you begin your employment. However, enrollment for a health plan through the health exchange is limited to an open enrollment period.

If you lose your employer-sponsored health care coverage outside of the enrollment period and want a plan through the health exchange you may qualify for a 60-day special enrollment period, without having to wait for the next open enrollment.

Medicare

Medicare is a federally funded health insurance program established through Title XVIII of the Social Security Act and administered by the Healthcare Financing Administration (HCFA). The principal eligibility requirement for participation in the program is that beneficiaries must be 65 years of age or older as opposed to Medicaid beneficiaries in that eligibility is primarily based upon financial income. Once eligible, the beneficiary would receive Medicare Part A and or Part B coverage. Medicare Part A covers inpatient care. Medicare Part B covers outpatient services. Medicare Part D, a prescription drug program, is optional.

The initial enrollment period for Medicare starts three months before and three months after the month you turn 65. If you do not enroll during the initial enrollment period because you are still employed, you may qualify for an 8-month special enrollment period after your employment ends.