Lost my job, eligible for discount on my out-of-pocket health insurance?

August 2, 2017 12:47 PM

I've been paying out of pocket for a health insurance plan on my own, and then I lost my job. Am I eligible for any sort of discount on the plan? Details below.

I was laid off from my job as of June 30. I did not get my health insurance through my employer, because the insurance sucked and had a super high deductible, so I got a plan I found on healthcare.gov. However, I went directly through the insurance company instead of healthcare.gov because the government website was giving me problems at the time. I pay $350/month for this no-deductible "gold" plan. I should also note, in case it matters, that I *technically" was a freelancer for this company, but I was on a contract, received a salary and they did offer a (terrible) health insurance plan, so I think I was an employee. Now that I am jobless and collecting unemployment, which has been approved, can I get the cost of my health insurance plan discounted at all? Am I too late? How much would the discount be? What is the threshold to qualify for any sort of subsidies? How do I apply for a discount? I am in Oregon, if that makes a difference. Thanks!

posted by AspirinPill to Health & Fitness (9 answers total)

It doesn't matter that if you were a 1099 or a W2 employee. You can only get the tax credit (the discount) if you meet income requirements for the whole year, and there are different level of tax credit depending on your income -- ie if the cut off is $30K or whatever to get tax credit level X, you get it for the whole year as long as your overall income is under that amount.

It works the other way too. I was out of a job for the first four months of the year once, and got a tax credit on my healthcare plan. But then I ended up making over the income limit to receive it by the end of the year and I had to pay back all the tax credits from the first part of the year.

You should be able to go online and update your income and it will tell you what your plan options are and how much tax credit you will get. I think it varies by state.
posted by ananci at 1:19 PM on August 2, 2017 [2 favorites]

Unless they have changed the rules, (seriously doubtful,) unless you got your plan through healthcare.gov you will be unable to get the tax credit. (I made the same mistake.) I believe that being laid off and qualifying for unemployment may qualify as a life event that allows you to purchase insurance outside of the normal enrollment period. If this is the case you can buy insurance now through healthcare.gov and depending upon your expected income this year get a premium tax credit which would reduce your out of pocket cost.
posted by Pembquist at 2:04 PM on August 2, 2017 [1 favorite]

Response by poster: Well, I made over $30k between January and June while I was unemployed. I also hope to get a job before this year ends that also put my total income this year higher. So I am hearing that I probably wouldn't qualify for the Obamacare subsidies either way then?

Once upon a time when I was laid off in NY (pre-Obamacare), I was entitled to a cheap(er) health insurance plan through a program called Healthy NY. It was based on your current income. Do programs like that still exist or has Obamacare replaced everything? Again, I am in Oregon but I'm generally just wondering if I should look for state-based programs rather than the federal one, then?
posted by AspirinPill at 2:15 PM on August 2, 2017

$30K was just an example -- you have to go to the website and find out what the exact levels are for your state, and it's not an all or nothing thing -- you can get your entire premium paid for if your income is low enough, and the more you make the less of a reduction you'll get, up to some point where you no longer qualify.

You do qualify for a special enrollment period since your income has changed. Whether or not you qualify for a tax credit, or how much of one you might receive, is based on your yearly income and location.

Yes to looking for a local alternative, it can't hurt. California has something similar, not sure about Oregon.
posted by ananci at 3:04 PM on August 2, 2017 [1 favorite]

Best answer: You would qualify for subsidies if your total income (for the year) is less than 400% of the poverty line. So, if you are single, that's around $48,000 for 2017. (The $30K number may be from a previous year.) But, you would need to buy that off the exchange rather than the private market.

There are some specific state and even local programs (like Healthy SF), which are all going to work different ways. For example, Healthy SF does not technically qualify as insurance even though it provides health care, so people on that still have to pay the penalty. I would certainly look into state and local-based programs just to see what's available in your area, since it doesn't hurt to check!
posted by rainbowbrite at 3:05 PM on August 2, 2017

If you do end up buying new insurance through healthcare.gov, your low income might qualify you for cost-sharing reductions, as well as the tax credit. Cost-sharing is only available on silver plans, but very worth it.
posted by still_wears_a_hat at 3:07 PM on August 2, 2017

The bigger issue at this point is you may be out of the qualifying period to choose the insurance, most QLE periods only last 30 days. It's definitely still worth a look, but you may be too late, as it is now after August 1.
posted by RhysPenbras at 7:37 AM on August 3, 2017

Best answer: For most healthcare.gov special enrollment periods you actually have 60 days to enroll after the qualifying event date.

I think you should try to apply for a special enrollment period through healthcare.gov based on that life event (change of job / loss of income) and see what happens. My colleagues and I have been running into issues with getting an SEP opened due to income changes but it may work for you (and if it doesn't, no harm no foul).

Also, I'm assuming your income is still above the Medicaid cutoff (about $1400/mo for a single person with no dependents) but if not, you can apply for Medicaid at any time, and then when your income changes again you can go back on the exchange or on your new employer's coverage.
posted by tivalasvegas at 10:53 AM on August 3, 2017 [1 favorite]

Response by poster: Thanks for the responses. It looks like I am on the cusp of being eligible for some benefits, based on what I've already earned and what I'd earn even just continuing on unemployment benefits. But if I do get a new job, I will definitely be over the 400% limit. I do qualify for a special enrollment period and I was able to re-open my application, but I don't see any more affordable plans for what I want.

Oregon does have a program called the Oregon Health Plan, but it's only for the very poor (138% of the poverty level) and only covers the basics. Being unemployed and paying out of pocket sucks, but it appears I don't really fall into the category of people who need the assistance, so it was worth checking, but I'll continue to just pay out of pocket as I was already doing.
posted by AspirinPill at 11:08 AM on August 3, 2017