MARY LOUISE KELLY, HOST:
The coronavirus pandemic is a public health crisis, also an economic crisis. Nearly 10 million people have filed for unemployment benefits in just the last two weeks, and no job often means no health insurance. So what are the coverage options for those newly jobless or for those who never had insurance to begin with? - questions for NPR health policy reporter Selena Simmons-Duffin.
Hey, Selena.
SELENA SIMMONS-DUFFIN, BYLINE: Hi, Mary Louise.
KELLY: So for the millions of people who have just filed for unemployment, what are their coverage options?
SIMMONS-DUFFIN: So like all things health insurance, it's a bit complicated. It depends on where you live, but there are three big buckets to look at. And the first is COBRA; so if you worked for an employer with 20 or more workers, you have access to COBRA. It's basically exactly the same coverage that you had before, but it can be really expensive - hundreds of dollars in premiums - and your employer isn't chipping in to defray that.
Then the second thing is Obamacare insurance exchanges. Losing job-based coverage is a qualifying event, so you can shop for a plan there. The third option is Medicaid, so the rules about who qualifies varies from state to state, but it's based on monthly income. You have to make less than $1,400 a month for yourself or $3,000 a month for a family of four in most states to qualify.
KELLY: It sounds a little daunting with all of those buckets and so many things to look at and check on. Where do I go just to find out what I can get?
SIMMONS-DUFFIN: If you qualify for COBRA, you will be contacted. But if not, you should just start with healthcare.gov, and that'll direct you to the right place for your state.
KELLY: OK. What about another group of people - people who maybe didn't have coverage to begin with before this pandemic? That's a number - that's, like, 27 million people who didn't have insurance.
SIMMONS-DUFFIN: Yeah, it's really a lot of people. So 6 million of that 27 million actually do qualify for Medicaid. They just don't know it. So they can go and enroll at any time. Beyond that, if you don't qualify for Medicaid, then you might be able to go to the Obamacare exchanges. A dozen or more states that run their own marketplaces have opened what's called a special enrollment period. So if you live in one of those states, you can shop there. You don't have to prove you just had a job loss or something like that.
KELLY: Oh, OK.
SIMMONS-DUFFIN: In states that don't run their own exchanges, there's a bit of a problem. The Trump administration has decided not to open a federal special enrollment period, and that means there are probably several million people who will fall into a coverage gap and not be able to enroll in Medicaid or an Obamacare marketplace plan.
KELLY: There was an exchange about that yesterday during the White House press briefing, and Vice President Pence got asked about it. He didn't really answer the question, as I recall. President Trump jumped in and said, it's something we're going to look at, but no specifics.
SIMMONS-DUFFIN: Yeah. It's a reminder of the politics here. The very law that expanded Medicaid and created these insurance exchanges is the Affordable Care Act - Obamacare. So Trump feels he was elected in part on his promise to get rid of that law. Congress wasn't able to do it back in 2017. The administration is still fighting to strike it down now in court. This fall, the Supreme Court is planning to hear the Trump administration's arguments against the law. So this might all explain the reluctance here to make use of Obamacare by making a special enrollment period that could be seen as an admission that the law is helpful during this crisis.
KELLY: Last question, Selena - what if I'm one of the lucky ones who has insurance but then I'm unlucky and I get the coronavirus and I get COVID-19 and I get sick? What is covered?
SIMMONS-DUFFIN: So testing is covered if you can get a test. It's still not very widespread. Congress passed that into law that it must be covered. Treatment is still an open question. If you do end up in the hospital, even with insurance, you might end up paying thousands in deductibles or co-pays. A few insurance companies are waiving those patient costs, and others might follow suit. There is one more worry here I wanted to mention. Hospitals and doctors can also bill patients directly. Those are surprise bills or balance bills. That has not been addressed by Congress, so that's another worry for folks in addition to all the other worries.
KELLY: All righty (ph). Thanks, Selena.
SIMMONS-DUFFIN: Thank you.
KELLY: NPR's Selena Simmons-Duffin. Transcript provided by NPR, Copyright NPR.
