If you’ve lost your job and employer-provided health care coverage as a result of the COVID-19 pandemic, Bill Botts wants to help you understand your options.
Botts is a local certified enrollment navigator for the Affordable Care Act. Normally, the people he helps sign up for health coverage through the ACA Marketplace must enroll between Nov. 1 and Dec. 15, but because of the COVID-19 pandemic, that narrow window is now wide open.
Botts, who works out of the Lloyd P. Moss Free Clinic, expects a significant increase in enrollment from people who have lost their jobs because of the outbreak.
“We’re expecting the dam to burst,” he said.
According to the Virginia Employment Commission, more than 410,000 Virginians have filed for unemployment benefits over the past four weeks, and Health Management Associates, a research and consulting firm, estimates between 12 million to 35 million people across the nation could lose workplace coverage nationwide as a result of the pandemic.
Botts said most people who lose their job are aware of the need to file for unemployment benefits, but many may not understand all their health care coverage options.
Navigators such as Botts help consumers understand those options and find affordable health care coverage that best meets their family’s needs. Rules have changed in recent years, with the biggest coming as a result of Virginia expanding Medicaid coverage last year, which opened up the program to people with household incomes below $24,300 a year.
Those with incomes above that are eligible for the ACA Marketplace, where premiums, deductibles and co-pays vary based on income and size of household. Government subsidies can help with some of the costs and are available for household incomes of up-to around $70,000.
Botts cautions those applying for coverage that many boxes must be checked and many details could be overlooked if a navigator isn’t providing guidance throughout the process.
“Their eligibility is going to be determined by income, which can become a very complicated question,” said Botts. “It’s even more complicated than it usually is.”
Botts said there are specific calculations used to determine one’s income between the various programs, and cited an example in which an employee lost a job on March 15.
In this case, Botts said the individual would include 2.5 months of annual income for the Marketplace, but for Medicaid, only half a month of earned income would be reported. In another example, Medicaid would include Virginia unemployment insurance as part of one’s annual income, where the Marketplace counts both state unemployment and the $600 per week unemployment supplement provided by the federal government under the Coronavirus Aid, Relief and Economic Security Act.
Stimulus bills cover the costs of diagnosing and testing for COVID-19 and will pay for a vaccine once one is developed, but Botts said those bills do not address the costs of treating the respiratory disease caused by the coronavirus.
Botts said current estimates for outpatient COVID-19 treatment range from $10,000 to $20,000, while treatment that requires hospitalization runs in excess of $70,000.
“There’s no federal requirement for insurers to cover this, or federal money to cover it, but a handful of states have required coverage, or partial coverage for treatment, without cost-sharing, and some insurance companies have,” Botts said.
He added that the AHIP.org website hosts a list of insurance companies and the levels of cost-sharing they will provide.
“That assumes you have insurance,” said Botts. “If you’re terminated and let go, and lose your health insurance, you have three options: You can go to COBRA, which is not a meaningful option because the premiums are too high; you can go to either Medicaid or the Marketplace; or you can do nothing and hope the federal government will have a treatment option in the third bill.”
The Lloyd F. Moss Free Clinic at 1301 Sam Perry Blvd., is ordinarily staffed by one paid employee and six volunteer part-time navigators. During the COVID-19 pandemic, all navigators are helping customers remotely. To schedule an appointment, call 540/741-2447.
The office covers residents in Virginia’s Planning District 9, which includes Culpeper, Fauquier, Madison, Orange and Rappahannock counties; Planning District 16, which includes Fredericksburg and Caroline, King George, Spotsylvania and Stafford counties, and Planning District 17, which includes Lancaster, Northumberland, Richmond and Westmoreland counties.
James Scott Baron: