What if Your Care Recipient Needs New Insurance Coverage?

It was the middle of October, just before Open Enrollment, when Patrick received a company-wide email. “Open Enrollment is coming up, and we are hereby notifying you that our company’s health insurance benefit will now be covering employees only, not immediate family. Employees who wish to continue or add coverage for family members will be responsible for paying the full cost of added premiums.” Patrick was devastated by this news. His wife had been diagnosed with colon cancer and he knew coverage could be expensive, so they needed to quickly identify the best insurance options.

If your care recipient is familiar with this scenario or one similar, there’s no need to panic. Whether they recently lost coverage, are navigating new life circumstances, or haven’t had insurance coverage before, there are many options for securing essential care. Let’s explore how with these six recommendations:

Where to Begin: Tips for Getting Your Care Recipient Insured

1. Consider Medicaid Eligibility

Medicaid is a joint federal and state program that provides free or low-cost coverage for people who qualify. Rules can vary by state, but assistance generally applies to adults living below federal poverty levels, children, elderly adults, and people with disabilities. 

• First, review the eligibility guidelines. Groups benefiting from mandatory eligibility include low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI). 
• In 2023, millions of people lost their Medicaid health insurance coverage because special protections put in place during the COVID-19 pandemic ended. If your care recipient was affected, they may still be eligible under new rules or qualify under other categories such as disability or age.

2. Review Medicare Options

If your care recipient is 65 or older or has a qualifying disability, they may be eligible for Medicare. Medicare is a federal program that covers hospital care (Part A), medical services (Part B), and prescription drugs (Part D). A Medicare-approved alternative offered through private insurers, Medicare Advantage, bundles Original Medicare coverage with optional benefits.

• Make sure to review your care recipient’s eligibility, especially if they are near age 65 or have recently become eligible due to health conditions. 
• Is your care recipient already enrolled in Medicare? During Open Enrollment, you’ll be able to review their plan and switch if needed, or add more coverage.

3. Check for Local and State Programs

The Affordable Care Act (ACA) set up insurance marketplaces that help people find affordable coverage. It also established essential health benefits, ensuring that all plans cover important services like preventative care, hospital stays, and prescription drugs.

• If your care recipient doesn’t qualify for Medicaid or Medicare, review health plans available through HealthCare.gov or your state’s insurance marketplace. 
• These programs offer financial assistance based on income level to make coverage more affordable. 

4. Consider Using a Health Insurance Navigator or Advocate

Navigating health insurance may feel like a full-time job, but there are professionals who can help. A health insurance navigator or advocate will guide you through your care recipient’s options and help you apply for coverage during Open Enrollment. 

• Many of these services are free or low-cost and will save you time and stress.
• These experts can be particularly helpful if your care recipient is dealing with complications like pre-existing conditions or finding a plan after a layoff.
• Use the "Find Local Help" tool on HealthCare.gov to search for navigators in your area. Local hospitals should also be able to offer recommendations. 

5. Explore COBRA Coverage

If your care recipient recently lost employer-sponsored health insurance due to a job loss or cut in hours, Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage might be an option. COBRA allows your care recipient to continue their previous health insurance for a limited time.

• Your care recipient’s employer's HR or benefits department is legally required to provide them with COBRA information, so check the mail or their benefits portal for more information. 
• The U.S. Department of Labor also provides helpful information on COBRA if you’re waiting on information from an employer.
• COBRA coverage is often more expensive than what your care recipient paid during employment because their former employer no longer contributes to the cost.
• COBRA might be a good temporary solution while you explore long-term options for your care recipient.

6. Explore Short-Term Health Plans

If your care recipient needs immediate coverage while looking for longer-term options, short-term health insurance plans might be worth considering. These plans are designed to provide coverage for unexpected accidents or illnesses.

• While not available through the Health Insurance Marketplace, short-term plans can be easily purchased through private insurance companies or agents. Many well-known insurance companies offer them as well.
• Short-term health plans typically don’t cover pre-existing conditions and may offer limited benefits compared to traditional health insurance.

Note: In some cases, you don’t have to wait for Open Enrollment to get new healthcare coverage for your care recipient. If they have recently experienced certain life events, they may qualify for a Special Enrollment Period. Qualifying events include losing job-based insurance, moving to a new state, having a baby, adopting a child, or getting married.

Looking Ahead

In 2022, nearly 28 million Americans didn’t have health insurance (CDC.gov). If your care recipient is currently without coverage, it’s easy to feel overwhelmed and confused about how to help them secure benefits. But, as that statistic shows, you’re not alone—and you’re not without options for finding coverage. With Open Enrollment on the horizon, you’re choosing a great time of year to begin the process. By following the tips mentioned, you will be better prepared to find a solution that suits your care recipient’s healthcare needs as well as their budget.