The Affordable Care Act (ACA) could play a key role as millions of American lose their jobs and their health insurance coverage due to the Coronavirus (COVID-19) pandemic. Here are ways you may be able to obtain health insurance or help paying for coverage during the COVID-19 crisis.
Ordinarily, you may obtain ACA coverage only during the annual open enrollment period, which is during November and December of each year. However, after the open enrollment period ends, you may purchase individual coverage for yourself and your family if you have a “qualifying life event.” This includes losing your existing health coverage because you were laid off from your job, you quit your job, or your work hours were reduced below the level required for you qualify for employer-provided coverage. This rule also applies if you obtain coverage though the employer of a family member—usually your spouse.
Depending on your estimated 2020 income, you can enroll in regular ACA coverage. Or, if your estimated income is low enough, you may qualify for state Medicaid coverage.
Twelve states have their own ACA exchanges (also called marketplaces) to which you apply. The other states use the federally run exchange at healthcare.gov. You’ll have to submit documents showing you lost coverage and the date it ended. A notice from your former health insurer or employer is acceptable. For detailed guidance, go to the Getting health coverage outside Open Enrollment page at healthcare.gov.
You usually have 60 days from the day you lose your coverage to enroll in regular ACA coverage. But you can enroll in Medicaid in your state at any time after you become eligible.
Health insurance is no longer mandated for individuals in the vast majority of states, so some people don’t have any coverage at all. If you’re one of these, you may be able to obtain ACA coverage through your state exchange right now without waiting for the next open enrollment period.
Twelve states and the District of Columbia run their own ACA exchanges and are able to establish their own open enrollment periods. You can find links to these state exchanges at The marketplace in your state page at healthcare.gov.
Most of these states are classifying the Coronavirus pandemic as a special enrollment event to allow uninsured state residents to obtain coverage. You don’t have to have symptoms of Coronavirus (COVID-19) to get coverage. Your coverage starts the first day of the month after you choose your plan.
The states currently offering open enrollment (and their deadlines) include:
The 38 states that use the federally run exchange (www.healthcare.gov) cannot establish their own open enrollment period for the uninsured due to the Coronavirus. The federal government will have to do so for all these states. The Trump Administration is currently considering this possibility. Check the federal ACA website at healthcare.gov to keep abreast of the latest developments.
If you obtain health insurance through your ACA exchange, you may qualify for tax credits to cover much of the cost of the premiums for yourself and your family. To qualify, your family income can’t exceed four times the federal poverty level. In 2020, a family of four can have an income up to $104,800 and qualify. An individual can earn up to $51,040. The amount of your credit depends on your household size, income, and the cost of health insurance where you live.
Unless you direct otherwise, the credit is paid directly to your health insurance company, not to you when you enroll in your health insurance plan. This means that you do not need to wait until your taxes have been filed and processed to receive the credit; nor do you need to pay the full premium when you purchase health insurance and then wait to be reimbursed. You don't need to owe any income taxes to receive your full premium tax credit.
If you already have health insurance coverage through your state exchange and are paying premiums, you may qualify for premium tax credits or increased credits if you expect your 2020 income to decline. You must notify your exchange of your lower income and it will increase (or begin) your premium credits, thereby lowering your monthly premium payments. You can find guidance on how to estimate your income for ACA purposes at the healthcare.gov How to estimate your expected income page.