In the past two years, we’ve experienced a roller coaster ride in how we work. The pandemic has been a catalyst for job and career changes. Whether you’re switching employers, working for yourself, or joining the gig economy, one of the things you should keep in mind is health insurance coverage. Two-thirds of Americans below age 65, about 156.5 million people, get health insurance from employer-sponsored plans. When a worker quits or is laid off, the entire family can lose health insurance overnight. What parameters do we need to evaluate to minimize the disruption in coverage and maximize the benefit?
1. Stay on the health insurance plan of your current employer through COBRA, for up to 18 months after you quit, even if you have a new job with benefits. You have 60 days to sign up and must pay the full premium, which can be several times your payroll deductions.
2. Transition to a plan provided by your new employer. It’s likely to be administered by a different company (e.g. Blue Cross Blue Shield vs. Aetna) and have a different network from your previous plan. You may have several levels of coverage to choose from. The premium is subsidized by the employer.
3. Tag onto your spouse’s plan, if available, through their employer. One family plan may be more cost effective than two individual plans.
4. Enroll in Medicare if you’re over 65. If you aren’t already enrolled through social security, you have eight months to sign up when you lose employer-sponsored coverage. You can choose the traditional Medicare or a Medicare Advantage Plan. Medicare only covers you, not your spouse or any family member, unless they are also 65 or older.
5. If you’re in-between jobs or starting out with your own business and your annual income falls below 138% of the federal poverty level ($25,268 for a two-person household), then you qualify for Medicaid in Illinois. Medicaid offers excellent coverage with minimal cost-sharing by patients, but not all providers accept the plan.
6. If you’re a contract or part-time worker, your employer doesn’t offer benefits, or the employer’s plan isn’t affordable with adequate coverage, then you can purchase a plan on the marketplace. Government subsidy can greatly reduce your premium if your income is below 400% of the federal poverty level ($73,240 for a two-person household).
7. Similar to car and home insurance policies, you can purchase health insurance from a broker, who’s paid by commission from the insurance company. They have access to both on and off-exchange plans and can find the plan that fits your personal situation.
Things to consider
1. Continuity of care. Will your primary care provider and specialist doctors still be in-network when you change insurance plans? Will you be able to go to the same hospital, pharmacy, rehab or therapist? Marketplace and Medicare plans allow you to check the provider status online. For commercial plans, call the administrator company to confirm.
2. Medical expenses so far and anticipated care needs. What medical services have you used and what will you need for the rest of the year? If you’ve already paid substantially toward this year’s deductible and out-of-pocket max, then continuing in the same plan (e.g. COBRA) means better coverage for the rest of the year than resetting the accounting with a new plan.
3. Coverage and cost-sharing. What are the amounts of co-pay and co-insurance for common things like doctor’s visits and hospitalizations? How much deductible will you pay before the insurance kicks in? What’s the out-of-pocket limit for the year? Do you use special services like allergy shots and infertility treatments? For high-deductible plans, you may qualify for a healthcare savings account with possible employer contributions.
4. Premium. The premium can vary widely even for employer-sponsored plans. Pick one that fits your monthly budget while still providing adequate coverage. Remember the premium is tax-deductible unless your employer is withdrawing it pre-tax from your paycheck.
Health is our best asset that allows us to explore exciting career opportunities and start new ventures. Having the right health insurance plan in place to protect ourselves and our families gives us the peace of mind to embark on the next journey.
Qing Yang and Kevin Parker are a married couple and live in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. She is an anesthesiologist at HSHS Medical Group. Parker has helped formulate and administer public policy at various city and state governments around the country. He is formerly the group chief information officer for education with the Illinois Department of Innovation and Technology. This column is not intended to substitute for professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the views of their employers.