Frequently Asked Questions:
Health Insurance Options for Utahns in the Age of COVID-19
COVID-19 is having an immediate impact on Utah’s economy, causing a surge in unemployment claims, as thousands of Utahns face reduced income and increased financial instability. While our state grapples with this crisis, it is important to highlight the health care safety nets in place that families can lean on during this time. Many people will qualify for programs they previously did not have access to.
Confused? See below to get answers to questions and find health insurance coverage near you.
OPTIONS AND ELIGIBILITY
Q: What health care programs are available outside of insurance through an employer?
A: Medicaid and CHIP are public health insurance programs available to low-income Americans through a partnership between state and federal governments, while the Obamacare/Affordable Care Act Marketplace is a network of private insurers offering plans to individuals and families directly, rather than through employment.
Eligibility for enrollment in these programs, and eligibility for subsidies to assist with premiums and cost-sharing on the Marketplace, is based on the Federal Poverty Level (FPL). Medicaid is available for people earning up to 138% FPL. CHIP is for children in families earning up to 200% FPL. Marketplace plans are available for anyone, with subsidies for those earning up to 400% FPL. Subsidies are calculated on a sliding scale, so lower-income people receive more assistance.
Q: Who is eligible for Medicaid in Utah?
A: To be eligible for Medicaid, you must live in Utah, be a U.S. citizen or legal resident, with monthly income below the eligibility limit. Utah expanded Medicaid on January 1st, 2020, which means the program is available to more people, and it is much easier to qualify. Individuals making less than approximately $1,500/month, or a family of four making less than approximately $3,000/month are eligible. See here for full eligibility guidelines.
Parents should also check what programs their children qualify for. If a child does not qualify for Medicaid, they may qualify for CHIP, which has a higher income threshold.
Medicaid is always open for enrollment- so apply now if you think you may be eligible!
Q: Do I have to be working/applying for work in order to get Medicaid?
A: Due to COVID-19, Utah has suspended the Medicaid work reporting requirement. (Also known as “community engagement” or “work effort”). Medicaid members do not need to register for work and do not need to complete the assessment, training programs, or job searches. There are fewer paperwork barriers as a response to this pandemic. If you are eligible for Medicaid, you are guaranteed to keep your coverage through the end of the COVID emergency.
Q: What if I am not eligible for Medicaid, but I still need insurance?
A: If your income is too high for Medicaid, and you do not receive insurance through an employer, you are likely eligible for subsidized ACA/Obamacare Marketplace insurance.
Open enrollment for the Marketplace coverage is available annually for roughly six weeks in November and December. To enroll in coverage outside of that time period, individuals must be eligible for a Special Enrollment Period (SEP). SEPs are given to those who have had significant life changes such as getting married, having a child, losing health insurance, or moving.
If you have recently lost your job AND your employer-sponsored insurance, then you are eligible for a Special Enrollment Period.
If you have had your work hours reduced, or if you can no longer afford your premium, you may also be eligible for an SEP, and could move into a more affordable insurance option. See healthcare.gov for more information. Take Care Utah is available to help Utahns navigate options available.
Q: What health care options are available if I am not eligible for any health insurance coverage?
A: There are Community Health Centers available throughout the state that may be able to provide free or low-cost care for uninsured patients, as well as financial assistance programs through hospitals and providers.
Q: How do I apply for a Special Enrollment Period (SEP) for a Marketplace plan?
A: The entire Marketplace application, including SEPs, can be found on Healthcare.gov. Local assistance is available through Take Care Utah. Health Access Assisters can clarify SEP eligibility, as well as provide guidance on health plan options.
Q: What should I do if I am enrolled in a Marketplace plan and have a decrease in income?
A: Any household income changes should be updated on your Marketplace application as soon as possible. (through healthcare.gov) These changes — like higher or lower-income, adding or losing household members, or getting offers of other health coverage — may affect eligibility for coverage and subsidies. A reduction in your income will likely reduce the cost of your Marketplace plan by increasing your subsidies.
If you are unable to afford your premium, there is a 3-month grace period during which you will not lose your coverage. Some states and insurers are extending the grace period throughout the COVID-19 crisis. Contact your insurer if you are experiencing difficulty affording your Marketplace premium.
Q: How do enhanced unemployment, pandemic unemployment, and other COVID stimulus benefits impact health insurance eligibility?
A: The extra $600 per week in unemployment or pandemic unemployment benefits do NOT count for Medicaid and CHIP eligibility, but will be included in income for the sake of ACA Marketplace eligibility. Baseline unemployment/pandemic unemployment benefits do count as income for Medicaid, CHIP, and Marketplace.
If you have questions about how to report your unemployment income please contact Take Care Utah!
The $1200/$500 stimulus payments do not count toward any means-tested program like Medicaid, CHIP, Marketplace, etc.
Q: How do I apply for Medicaid?
A: Medicaid and CHIP are available at any time to anyone who qualifies. There are no open or closed enrollment periods. Click here to access the online Medicaid application. If you have questions, Take Care Utah offers free enrollment assistance to anyone in Utah and has remote options.
Q: If I am offered COBRA, can I also qualify for a Marketplace premium subsidy?
A: If you lose employment and are eligible for COBRA, then you are also eligible for an SEP to enroll in a Marketplace plan, which would likely be much cheaper. You may qualify for an attractive subsidy on the Marketplace, while COBRA is full-price, meaning that there is a significant potential for savings if you opt for Marketplace coverage.
Please contact Take Care Utah for assistance navigating post-employment insurance options.
Q: If I have a short-term health plan, can I enroll in a Marketplace plan instead?
A: In order to switch from a short-term health plan into a Marketplace plan, you would need to experience a qualifying life change to trigger a Special Enrollment Period. Since short-term plans are not linked to employment, job loss would not trigger an SEP for short-term plan enrollees.
However, you may be eligible for Medicaid or CHIP, which are open for enrollment all year.
Q: What if I still have questions? Where can I go to get help navigating health insurance?
A: Take Care Utah is a network of enrollment assisters with expertise in Medicaid, CHIP, and marketplace eligibility and enrollment. Amid the COVID-19 crisis, our network has set up remote enrollment capabilities. This includes phone appointments, video chat assistance, and screen sharing capabilities. Enrollment options can change depending on community needs and client accessibility. Take Care Utah also has many languages available. Check out our website to be connected to an Enrollment Assister.
ACCESS TO COVID-19 TESTING AND TREATMENT
Q: Is testing and treatment for COVID-19 covered?
A: Congress has passed two COVID-response bills, which include directives mandating full-coverage of COVID-19 testing for all Americans. This made testing free for patients. You may still receive a bill, since your insurance company will be charged, however, your out-of-pocket share should be $0.
Treatment coverage depends on your insurance. The Utah Department of Insurance has created this website to track changes to benefit packages.
Q: If I am uninsured and cannot enroll in a public program, is there help for COVID-19 treatment costs?
A: Utah has not yet implemented policy changes to cover treatment for uninsured people.
Under a new program, providers can request reimbursement from the federal government for treatment provided to uninsured patients, however, this does not guarantee free or low-cost care.
There are Community Health Centers available that may be able to provide free or low-cost treatment for uninsured patients, as well as financial assistance programs through hospitals and providers.
If you are uninsured and seek treatment for COVID-19, contact your treatment provider’s financial office to apply for financial aid.
Q: Can receiving COVID-19 testing or treatment have an impact on a future public charge assessment?
A: The Department of Homeland Security encouraged anyone who needs treatment for COVID-19 to seek it, without worry that it will impact their public charge assessment.
We recognize that recent changes to the public charge rule have caused widespread fear among immigrant communities.
From Protecting Immigrant Families: “The USCIS has announced that testing, prevention, or treatment for COVID-19 will not be used against immigrants in a public charge test. Immigrant families should seek the care they need during this difficult time.”