In mid-March, when COVID-19 cases began to spread more quickly throughout the United States, non-essential back surgeries and other procedures were postponed in many areas. This left people with chronic back pain waiting even longer for relief from their symptoms.
As the coronavirus pandemic begins to wane over the next few months, these procedures will once again be offered. But people who have lost their job due to the pandemic may find themselves without health insurance
to cover the cost of their back surgery or a family member’s procedure.
If you’ve lost your employer-sponsored or other health insurance, there are several options that you can pursue. However, you should move quickly to check these out, especially if you have a procedure scheduled.
Look at family coverage
Depending on your circumstances, you may be able to access employer-sponsored coverage through a family member’s plan.
Spouse. If your spouse has health insurance through their employer, check to see if you can be covered under that plan.
If you are under 26 years old, you may be able to be covered by one of your parent’s health insurance. This benefit was expanded under the Affordable Care Act
(ACA), also known as Obamacare.
Check your eligibility for Medicaid
, author of The Health Care Consumer’s Manifesto: How to Get the Most for Your Money
, says depending on your situation, you may qualify for Medicaid, a joint federal and state program
that provides very-low or no-cost coverage to people whose income is below a certain level.
However, “you may have a harder time getting to see your preferred surgeon or provider, as Medicaid provider networks can be more limited,” she says.
Eligibility is based on your current monthly income. So if you had a job last month, but not currently, you may still be eligible for Medicaid.
Use the health insurance marketplace
If you have lost your employer-sponsored health insurance, but don’t qualify for Medicaid, you might want to consider the ACA marketplace. The ACA offers subsidies
that reduce the monthly premiums and out-of-pocket costs of people with moderate or low income.
One of these is the premium tax credit, which reduces the monthly payment for health insurance plans purchased through the marketplace. This credit can be applied to any level plan — bronze, silver, gold, or platinum.
These plans differ in the monthly premiums and your out-of-pocket costs. Plans with lower monthly costs tend to require you to pay more out-of-pocket for your care (deductibles, copayments and coinsurance).
To be eligible for the premium tax credit, you have to have a household income from one to four times the Federal Poverty Level
, or $25,750 to $103,000 for a family of four. Some people may also be eligible for a cost-sharing subsidy. This would reduce the amount you pay for deductibles, copayments and coinsurance.
have their own marketplace. If you live in another state, you can apply for insurance through the federal HealthCare.gov
Normally, you can only purchase health insurance through the marketplace in November and December. But Dr. Michael D. Miller
, a health care and life sciences consultant, says if you’ve lost your job, “you are eligible to sign up for ACA insurance because loss of insurance in the middle of the year is a ‘qualifying event
have also reopened their open enrollment for people who have lost their employer-sponsored insurance due to the coronavirus pandemic.
Consider extending your insurance
“If money is not an immediate concern, or if you cannot find any plan that your provider accepts, COBRA may be your best option,” says Gordon.
, which stands for the Consolidated Omnibus Budget Reconciliation Act, allows workers at companies with 20 or more employees to extend their health insurance coverage for up to 18 months after they have lost their job.
However, Miller says “an ACA plan may have a lower premium, since the COBRA premium will be the full amount — combining [the employee’s] monthly premium plus the employer’s contribution.”
In 2019, annual premiums for family health insurance were $20,576 on average
— including both the employee’s and employer’s contribution — according to the Kaiser Family Foundation.
If you’ve lost your health insurance, don’t delay looking for new coverage, especially if you already have back surgery scheduled. “There is a 60-day window for people to sign up for COBRA or ACA insurance after their insurance ends because they lost their job,” says Miller.
With the ACA marketplace, if you miss this deadline, you may have to wait until the open enrollment period in November.
Make sure your surgeon is “in-network”
Most insurance plans have a limited network of providers. Miller says you should make sure that your surgeon is in-network on whatever plan you choose, “otherwise the health insurance may not pay for anything.”
If you go with COBRA, you will continue on the same health insurance plan, so it won’t be an issue. But if you are switching to a Medicaid or ACA marketplace plan, you will need to check to see if your provider is in-network.
Gordon recommends calling your doctor’s office and asking the staff which health insurance plans they accept. She says it’s important to ask about specific plans, because insurers may have multiple ones with different provider networks.
Once you’ve found a plan that looks like it will work, Gordon suggests calling the insurer to confirm that the plan will cover the procedure and your surgeon.
“Most health plans require some kind of pre-approval for surgeries or other major procedures,” she says. “You don’t want to go to the trouble and expense of signing up for new insurance only to have them deny your request for services.”
If you can’t or don’t want to switch providers, Gordon says another option is to try to negotiate with your providers, asking them what they would charge for the procedure if you paid cash.
“If none of that works for you, you may need to reschedule the procedure for a time when you may be able to regain insurance through a job,” says Gordon. “Or, you may want to look at other providers who may accept whatever new insurance you find.”
Updated: August 6, 2020