When You Lose Your Coverage
What you can do when your insurance is ending?
During these unpredictable and stressful times, we realize many in our community may be faced with the reality of losing their employment. In insurance speak, losing a job is a “qualifying event” that allows you some options for continued healthcare coverage. If you are able to act quickly, many of the options discussed below are available to you if you act within the first 30 days after a job loss.
Immediate Steps to Take
Typically, when you lose employment, your health insurance coverage extends through the remainder of the month, or through some period of time after you cease actively working. You should take advantage of this window to refill prescriptions for insulin and injection supplies, as well as glucose test strips, CGM or insulin pump supplies.
When a state issues an emergency order in response to the COVID-19 outbreak, the declaration may trigger a prescription refill waiver. These waivers allow pharmacies to refill prescriptions early if they deem a medication, such as insulin, is critical to saving a person’s life or maintaining their treatment. You should look into obtaining refills even if the current fill has not yet run out.
You should ask your provider for prescriptions for a 90-day supply for any of these items and have them filled within the window during which you still have coverage. Many insurers are making it easier for people to obtain 90-day fills of their medications and supplies. You should check with your insurer about the specifics of your situation.
Even while still insured, you should take advantage of the insulin manufacturer coupon programs listed on JDRF’s “Help with Costs” page. Before your insurance ends, you should contact the patient assistance programs listed on JDRF’s Help with Costs page that are associated with the insulin that you take and begin the application process. Typically, you can get free insulin through these programs if you are uninsured, but the application process can take time. Try to start applying before your supplies actually run out.
Options for Obtaining Insurance Coverage after Losing Employment
If you lose your job, many insurance plans allow you to be covered by the health plan that covers your spouse, or if you are under age 26 you could be covered under your parent’s plan, even if you are married, although your spouse or children cannot be covered under your parent’s plan. Your spouse or parent should contact their HR department ASAP to inform them of your loss of employment and request for you to be covered. If both spouses or a family were covered under the spouse who becomes unemployed, the other spouse will have an opportunity to obtain coverage for the spouses or family through his/her employer.
The Consolidated Omnibus Budget Reconciliation Act, or COBRA, is an option that provides continued coverage with the same insurance you had with your employer, but you are responsible for paying the entire premium, plus any cost sharing you have. This is likely one of the most expensive options, but allows continuity with the same health plan, same doctors and same pharmacy.
Set up a log-in and explore your options on HealthCare.gov. This year, there will be a special open enrollment period from February 15,2021 to May 15, 2021 for people that live in most states. During this period, you will not need to show proof of job loss or other life changes to sign up for health insurance via HealthCare.gov. Depending on your income while you were employed, you may be able to get tax credits to help you pay for a health plan. You have the option to get the tax credits in one of two ways: every month, directly towards paying your premium, or all-at-once when you file taxes. Importantly, the credits are tied to your actual income and you must “rectify” at the end of the year. If you underestimate your income for the year, you may end up owing tax credits back to the government. Even if you do not qualify for tax credits to help pay your premium, there may be health plans available that cost less than your COBRA coverage. Keep in mind, any deductibles or out of pocket spending maximums will start over if you change health plans (including if you go from an employer plan to a HealthCare.gov plan administered by the same insurance company). For help selecting a plan from among the options available through HealthCare.gov, visit JDRF’s resource on how to choose an insurance plan.
HealthCare.gov can help determine if you (or your children) qualify for Medicaid. Many states make it easier for children to get coverage under Medicaid than adults, so even if you don’t qualify for Medicaid, your child(ren) might.
We hope this information provides you with helpful guidance during an otherwise difficult time. For more information on insurance and type 1 diabetes (T1D), visit our Health Insurance Guide.