Many married professionals who have children choose to work for large companies that have employer-sponsored health insurance. Under normal circumstances, this can enable a spouse to work in a part-time position not offering employment benefits in order to spend more time caring for the children. Indeed, the US Bureau of Labor Statistics reports that – in 49.4 percent of two-parent families with children in 2019 – both parents were employed. Due to the economic downturn resulting from the current Covid-19 pandemic, many employed adults with children have been “laid off” from employment with a consequent loss of employer-sponsored health insurance.
For this or some other reason, you may not have been eligible to purchase health insurance from a federal exchange (mandated by the Affordable Care Act [ACA]) in the past – but now find yourself needing to purchase health insurance to cover your family through the federal exchange marketplace. Therefore, understanding the federal exchange health insurance coverage options to compare the potential costs is vital before enrolling. (Due to the impending US Supreme Court decision regarding the constitutionality of the ACA, the continued existence of the federal exchanges in 2021 is not certain as of October 2020.)
Understanding Your Family’s Overall Financial Resources
One of your considerations in choosing a health insurance plan on the federal exchange to cover your family will be how high a monthly premium you (and your spouse) can afford. While paying for a high deductible health insurance plan for your family (e.g., “gold” plan) may seem money-wasting, it may actually reduce your “out-of-pocket” annual costs if each member of your family normally needs medical care and periodic physician visits in the course of a given year.
A federal government website describes the four health insurance options offered on the federal exchange marketplace as follows:
Bronze: lowest monthly premium (insurance company typically pays 60 percent of your costs).
Silver: moderate monthly premium (insurance company typically pays 70 percent of your costs; you must choose a silver plan to be able to acquire cost-sharing reductions – termed a subsidy – if eligible under the ACA to receive them).
Gold: high monthly premium (insurance company typically pays 80 percent of your costs).
Platinum: highest monthly premium (insurance company typically pays 90 percent of your costs).
If you have a potentially-hereditary disorder that is also diagnosed in one or more of your children (e.g., Type 1-diabetes or Crohn’s disease), the co-pays and other “out-of-pocket” expenses related to the diagnosis and treatment of all family members with that disorder may nullify the potential savings from choosing a “bronze” health insurance plan. In contrast – if your children at home are young adults and all family members are typically in excellent health – you may find a “bronze” health insurance plan is acceptable for you.
Since severe Covid-19 symptoms are more common in people with pre-existing autoimmune disorders or asthma, ensuring that all family members have health insurance during this pandemic time period – if someone in your family has an autoimmune disorder or asthma – is even more crucial due to the heightened probability of needing medical care if infected with this highly-contagious virus.
Federal Exchanges and Special Enrollment Periods
While the federal exchange open enrollment period for 2021 commences on November 1 and ends on December 15, 2020, one of the qualifying events that entitles you to enrollment during a 60-day special enrollment period under the ACA is the loss of employer-covered health insurance due to job loss.
According to a Centers for Medicare and Medicaid Services (CMS) publication, two of the other qualifying events that entitle you to use of a special enrollment period is a change in your household size (e.g., getting married or having a baby) and change in your primary residence (e.g., moving to a house in a new zip code).
The Risk of Not Having Health Insurance During Covid-19 Pandemic
The Commonwealth Fund documented in 2019 that two-thirds of uninsured adults had not even investigated obtaining health insurance from the federal exchange marketplace – but only one-third of these uninsured adults perceived that they were not able to afford such insurance. Purchasing a new home or saving for retirement is frequently viewed as being a higher financial priority than purchasing health insurance.
While the federal CARES Act enabled governmental payment of Covid-19 testing in people exposed to the virus – and many insurance companies have waived the co-pays for treatment of Covid-19 patients – the persistent symptoms experienced by people following Covid-19 infection suggests that ongoing physician follow-up will be needed for post-hospitalized Covid-19 patients for years to come. Therefore, having health insurance that covers everyone in your family is critical during this pandemic.
At UrHealth Benefits, we want to aid you in choosing health insurance coverage for your family that will meet your needs during this Covid-19 pandemic.