Pennsylvanians have several health insurance options through the Affordable Care Act (ACA), Medicaid and the Children's Health Insurance Program (CHIP) during the COVID-19 pandemic. Special Enrollment Periods (SEP) through the ACA are available to consumers who experience various life changes, including the loss of employer-sponsored health care coverage. Medicaid and CHIP coverage are available to families and individuals that meet the eligibility requirements for those programs. PHLP is available to guide and assist displaced employees about these coverage options. Visit our COVID-19 Resource Center for FAQs and updates.
Below is a summary of coverage options:
COBRA. COBRA, a federal law, allows affected employees to keep their health insurance coverage after being laid off, or loss of coverage as the dependent of a covered employee. If an individual elects COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, they are required to pay 100 percent of the premiums, including the share the employer used to pay, plus a small administrative fee.
Marketplace. Coverage through the Health Insurance Marketplace (Healthcare.gov) may be an affordable alternative to COBRA for many people who have lost employer-sponsored coverage, especially in the event a consumer is eligible for tax subsidies, which can significantly lower the monthly cost of coverage. Many consumers who enroll through the marketplace get financial assistance to help pay for out-of-pocket costs like co-pays and deductibles, in addition to the monthly premium subsidies. Applicants for Marketplace coverage can visit www.healthcare.gov.
Individuals and families can sign-up for marketplace coverage, outside of the annual open enrollment period, if they experience a life change that qualifies them from a Special Enrollment Period (SEP). These circumstances include the loss of health insurance provided by an employer, which many individuals may experience during the COVID-19 outbreak. You have a limited amount of time, no more than 60 days from the loss of health insurance coverage, to be eligible for a SEP for the Marketplace. (If you lost your health insurance coverage in mid-March, for instance, your 60-day deadline would be coming up as soon as mid May. Be sure to act quickly!)
The Pennsylvania Insurance Department developed an FAQ that provides information and answers to common questions related to insurance coverage and COVID-19.
In late March, Governor Wolf sent a formal letter to federal agencies requesting that Healthcare.gov be re-opened to individuals who are uninsured or underinsured in response to the COVID-19 outbreak. This would be in addition to the current allowances for Special Enrollment Periods. Unfortunately, the Trump administration has not agreed to that request. Thus, it is important to remember that you have a limited amount of time to apply for Marketplace coverage.
Medicaid & CHIP. Coverage may also be available through Medicaid (also known as Medical Assistance) or the Children's Health Insurance Program (CHIP). Both programs enroll individuals throughout the year and do not have a limited or special enrollment time. There are income limits for Medicaid, but all children qualify for coverage through CHIP. Depending on household income, the cost for CHIP will vary. Pennsylvanians can apply online for both Medicaid and CHIP at www.compass.state.pa.us. Both Medicaid and CHIP will cover COVID-19 testing and treatment, and prior authorization will be lifted for some services, such as chest CT scans. More information on COVID-19 guidance and resources related to the Department of Human Services' programs is available here.
For more information about insurance coverage options upon loss of a job, see Community Legal Services' fact sheet here.
Need more help?
As COVID-19 spreads, PHLP is committed to making sure those with Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) coverage have services; to securing insurance coverage for the uninsured; and to keeping consumers informed. Visit our COVID-19 Resource Center today for the latest COVID-19 updates, state policy documents, and Frequently Asked Questions.