What You Can Do If You’ve Lost Health Insurance During COVID-19
New research shows that millions of Americans have lost their jobs — and their health insurance — since the COVID-19 pandemic began earlier this year.
A joint study conducted by the Employee Benefit Research Institute, the W.E. Upjohn Institute for Employment Research, and the Commonwealth Fund found that up to 7.7 million U.S. workers with employer-sponsored health insurance have lost their jobs during the pandemic.
Those workers are responsible for almost 7 million dependents, meaning that more than 14 million Americans who had health insurance at the beginning of the year no longer have coverage.
“COVID isn’t killing the system,” Dr. Jeffrey Gold, a physician who founded Gold Direct Care, a direct primary care clinic in Marblehead, Massachusetts, told Healthline. “COVID is just exposing the problems that were already there.”
Losing a job with health insurance in the middle of a public health crisis is a difficult position for anyone to be in.
Navigating the confusing world of healthcare in the United States is also a daunting proposition.
However, there are a number of available options for those who are scrambling to find coverage for their families.
A flawed system
“Unfortunately, decades ago it was decided that attaching health benefits to employment was a good idea, and COVID shows why it’s a terrible idea,” Gold said.
“If we have an actual market where people could buy insurance that works for them, and not have it related to employment, we’d have a lot more happy people,” he said. “There are a lot of people at jobs who are miserable, but they stay for the benefits.”
Compounding this issue is the fact that health insurance isn’t necessarily guaranteed to cover all issues that may arise.
“The two biggest fallacies that the government and the insurance companies feed into the public sphere are that if you have insurance, you’re guaranteed quality affordable care, which is not true. We see that every day with people being overcharged or not being able to access care,” Gold said. “And the other corollary to it is that if you don’t have insurance, you can’t get good quality, affordable care, which is also not true.”
While employer-sponsored health insurance might often be less than ideal, it’s still preferable to having no plan for medical care whatsoever.
For the millions of Americans who have been left scrambling after losing their job, researching alternatives can be difficult.
Navigating the maze
Corey Ford, MHA, the director of reimbursement and policy insights at Xcenda, a part of AmerisourceBergen, told Healthline he expects the number of people who enroll in the health insurance exchange market or state-based Medicaid program to increase in the coming months.
“While the pandemic may have shifted the process in which Medicare beneficiaries learn about their options, the Medicare market remains fairly stable,” he said.
For those who have lost health insurance, he suggests visiting the Health Insurance Marketplace online, which offers access to a tool that can help people connect with certified agents who can answer their questions and help navigate the process.
Open enrollment for 2021 runs from Nov. 1 to Dec. 15.
Ford points out that, under the Affordable Care Act (ACA), also known as Obamacare, all plans offered in the Marketplace provide core essential health benefits, including prescription drug coverage.
“People without insurance can visit the Marketplace to evaluate and compare different health insurance options and apply for coverage,” he said. “The Marketplace’s Plan Finder can also help people find private health plans — available outside the Marketplace — that best accommodate their budget and healthcare needs.”
Ford says a few things to keep in mind are that people with chronic conditions or those who have frequent doctors’ appointments may want to explore higher-priced plans that offer lower out-of-pocket costs.
Depending on income level, there are a number of subsidies that can reduce costs.
“Additionally, individuals losing health insurance may qualify for Medicaid, a federal and state program that provides free or low-cost health coverage,” he said. “Finally, individuals losing their employer-based insurance should also discuss COBRA options with their human resources contacts at their previous employer.”
One factor that could influence this landscape, Ford says, is the possibility that the Supreme Court could overturn the ACA. The court will hear arguments on a case involving the ACA Nov. 10.
“The decision will have significant implications on the healthcare landscape in the United States,” he said. “At least 20 million people who buy insurance through the marketplaces or receives coverage through the expansion of Medicaid could lose their health insurance if it’s struck down. Given the magnitude of this decision, it’s imperative for patients and other key healthcare stakeholders to track closely.”
Thinking outside the box
Direct primary care clinics, such as the one Gold runs, operate outside the insurance system and may be a good fit for someone who’s lost health insurance.
“It’s just primary care, and we encourage everybody to have insurance — I’m not going to be able to fix a broken femur — but with good primary care, a good 70 or 80 percent of medical problems can be addressed in that setting rather than a special care hospital system,” he explained. “It’s kind of an anchor to the system.”
Gold notes that his clinic charges a flat, age-based monthly fee. It averages around $75 per month and includes all primary care, including telehealth.
For those medical issues that primary care can’t cover — such as chronic conditions — a doctor can help be an advocate in finding healthcare that works for an individual patient.
“I think it all starts with having a relationship with a primary care doctor,” Gold said. “They can help you navigate the system and the insurance side of it as well. This is nothing against the primary care doctors within the system, but because most are managed by a hospital, they’re not going to take care of the uninsured in an outpatient setting. They’ll send them to a hospital, which often isn’t necessary.”
To find a direct primary care clinic in your area, Gold suggests visiting the mapper on the Direct Primary Care Alliance website.
“I think we all know that the system here doesn’t work, and this is one way of going about fixing it,” he said.
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