Frequently Asked Questions
General Questions about Health Insurance & COBRA
COBRA is an acronym that stands for the Consolidated Omnibus Budget Reconciliation Act. This is a federal law that provides employees and their families the option to continue their group health insurance coverage for a limited time after they lose their job or experience a reduction in their work hours.
Under COBRA, eligible employees and their dependents can choose to continue their group health insurance coverage for up to 18 to 36 months, depending on the reason for their loss of coverage. However, the cost of this coverage is typically higher than what the employee would have paid while employed, since they are now responsible for paying the entire premium, including the portion that their employer previously covered.
COBRA applies to employers with 20 or more employees, although some states have their own “mini-COBRA” laws that apply to smaller employers. It’s important to note that not all health plans are subject to COBRA, and that not all employees or their dependents will be eligible for COBRA coverage.
Under COBRA, eligible individuals include employees who work for an employer with 20 or more employees and who were previously enrolled in the employer’s group health insurance plan. Additionally, the following individuals may also be eligible for COBRA coverage:
- Spouses and dependent children of employees who were previously covered under the employer’s group health insurance plan and who would otherwise lose coverage due to a qualifying event.
- Retirees who were previously covered under the employer’s group health insurance plan and who would otherwise lose coverage due to a qualifying event.
- Dependent children who were previously covered under the employer’s group health insurance plan and who would otherwise lose coverage due to aging out of the plan.
There are currently 13 states that operate their own health insurance marketplace instead of using the federal marketplace. These states are:
- New York
- Rhode Island
- Washington, D.C.
Subsidies for health insurance plans are financial assistance provided by the government to help individuals and families afford health insurance. These subsidies are available to eligible individuals who purchase health insurance through the Health Insurance Marketplace established by the Affordable Care Act (ACA).
There are two types of subsidies available for health insurance plans:
- Premium Tax Credits: These subsidies are designed to help eligible individuals pay for their health insurance premiums. The amount of the premium tax credit is based on a person’s income and the cost of health insurance in their area. The credit is applied directly to the person’s monthly health insurance premium, reducing the amount they have to pay out of pocket.
- Cost-Sharing Reductions: These subsidies are designed to help eligible individuals reduce their out-of-pocket costs, such as deductibles, copays, and coinsurance. The amount of the cost-sharing reduction is based on a person’s income and the plan they choose.
To determine if you are eligible for a health insurance subsidy, you can use the Health Insurance Marketplace’s eligibility calculator on healthcare.gov. The calculator will ask you to provide some basic information such as your income, household size, and state of residence.
To be eligible for a health insurance subsidy, you must meet certain income requirements. Generally, individuals and families with incomes between 100% and 400% of the federal poverty level (FPL) may be eligible for premium tax credits. For 2022, the FPL for a single person is $13,590 and for a family of four is $28,110.
In addition to income requirements, you must also be a US citizen or lawfully present in the US, not be currently incarcerated, and not have access to affordable, minimum essential coverage through an employer or government program such as Medicaid or Medicare.
If you are eligible for a subsidy, you can apply for it when you enroll in a health insurance plan through the Health Insurance Marketplace. The subsidy will be applied to your monthly health insurance premium to lower the cost of your coverage.
An open enrollment period for health insurance is a specific period of time each year during which individuals can enroll in or make changes to their health insurance coverage. The open enrollment period is typically set by the federal or state government, and it is an opportunity for individuals to shop for new health insurance plans or make changes to their existing coverage.
For plans purchased through the Health Insurance Marketplace, the open enrollment period typically runs from November 1 to December 15 of each year, although some states may have extended enrollment periods. During this time, individuals can enroll in a new health insurance plan, switch to a different plan, or renew their existing plan.
Outside of the open enrollment period, individuals may only be able to enroll in or make changes to their health insurance coverage if they experience a qualifying life event, such as getting married, having a baby, losing job-based coverage, or moving to a new state.
It’s important to note that if you do not enroll in health insurance during the open enrollment period or a special enrollment period, you may have to pay a penalty fee when you file your taxes. However, some individuals may be exempt from the penalty fee, such as those who cannot afford coverage or have certain religious exemptions.
If you lose your job and your job-based health insurance coverage as a result, you may be eligible for a special enrollment period to enroll in health insurance outside of the regular open enrollment period. Losing job-based coverage is considered a qualifying life event that triggers a special enrollment period, which allows you to enroll in a new health insurance plan or make changes to your existing plan.
You typically have 60 days from the date you lose your job-based coverage to enroll in a new health insurance plan through the Health Insurance Marketplace. If you miss this window, you may have to wait until the next open enrollment period to enroll in coverage, unless you experience another qualifying life event.
It’s important to note that if you are eligible for COBRA coverage through your former employer, you may choose to continue your job-based health insurance for a limited time. COBRA coverage can be expensive, as you are responsible for paying the full cost of the premium plus an additional 2% administrative fee, but it can provide temporary coverage until you can enroll in a new health insurance plan.
There are several qualifying life events that may allow you to enroll in or change your health insurance coverage outside of the regular open enrollment period. Some of the most common qualifying life events include:
- Losing job-based health insurance: If you or your spouse lose your job and your job-based health insurance coverage as a result, you may be eligible for a special enrollment period.
- Getting married or divorced: If you get married or divorced, you may be eligible for a special enrollment period to enroll in a new health insurance plan or make changes to your existing coverage.
- Having a baby or adopting a child: If you have a baby or adopt a child, you may be eligible for a special enrollment period to add your new dependent to your health insurance plan.
- Moving to a new state: If you move to a new state, you may be eligible for a special enrollment period to enroll in a new health insurance plan or make changes to your existing coverage.
- Losing Medicaid or CHIP coverage: If you or your child lose Medicaid or CHIP coverage, you may be eligible for a special enrollment period to enroll in a new health insurance plan.
- Losing other health insurance coverage: If you lose coverage under another health insurance plan, such as a spouse’s plan or a student health plan, you may be eligible for a special enrollment period.
The Health Insurance Marketplace, which is accessible through Healthcare.gov, is a government-run platform that allows individuals to shop for and enroll in health insurance plans. While Healthcare.gov provides a lot of useful information about health insurance options, some individuals may prefer to use the services of Jamie, Health Insurance Advocate, because it’s easier to use and provides a mix of ACA and private health insurance plans.
Additionally, Jamie provides personalized assistance for those that need it. From Jamie, an individual may request to speak with a licensed health insurance agent from the When team. The licensed agent can work with you one-on-one to understand your unique health care needs and financial situation, and help you find the best health insurance plan for your individual circumstances.