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While many Utahns face the possibility of losing employer-sponsored health insurance due to pandemic layoffs , The Utah Health Policy Project (UHPP) says there are still options for people that need coverage.
Low-income Utahns can apply for Medicaid and Children’s Health Insurance Program (CHIP), which are public health insurance programs available through a partnership between state and federal governments.
To qualify for Medicaid in the state, you have to live in Utah and be a U.S. citizen or legal resident with a monthly income below the eligibility limit. Because Utah moved to a fully-expanded Medicaid program in January, anyone earning less than 138% of the federal poverty level — $17,608 for an individual or $36,156 for a family of four — qualifies. CHIP is for children in families earning up to 200% of the federal poverty level, or $25,520 for an individual and $52,400 for a family of four.
When Medicaid first expanded, most Utahns were required to fill out 48 job applications and report back to the state, “which is obviously a pretty burdensome hole to jump through to get your health insurance,” Stacy Stanford, health policy analyst, said in an interview. “Luckily the state has put a pause on that work reporting requirement ... during the pandemic."
During the COVID-19 pandemic the state has also waived premiums for the CHIP and Medicaid programs, meaning there is no monthly out of pocket cost for these programs and the cost of appointment copays are very low.
Stanford said the copay is about $4 for an appointment, $4 for a prescription and $75 for a hospitalization.
UHPP is trying to send the message that the Medicaid program has changed during the pandemic. “You might have applied six months ago, a year ago and been denied," Stanford said. “That doesn’t mean that you’re not eligible today.”
If you’re eligible for Medicaid or CHIP, you are guaranteed to keep your insurance through the end of the public health crisis. “Basically if somebody is eligible for Medicaid if they get in, their application is approved and they get signed up, the state cannot disenroll them for any reason," Stanford said. “Unless they move out of the state or they die.”
If you need assistance signing up for a health insurance plan, the Utah Health Policy Project is helping Utahns remotely during the pandemic using phone appointments, video chat assistance and screen sharing.
Sarah Leetham, Healthy Kids Program Director said the virtual platform is asking more of clients because they may need to use technology in new ways, but UHPP is guiding Utahns through the process.
“The Medicaid enrollment process can be pretty complicated, and that’s really what makes our work unique and important. ... We can advocate during that Medicaid process for those clients," Leetham said in an interview. "So we can really be there for that whole case, maybe in a way that our clients don’t know to advocate or don’t know what questions to ask.”
UHPP is available Monday through Friday, 9 a.m. to 5 p.m. “The silver lining with remote enrollment is we can really be flexible with our appointments and sometimes clients may need evening appointments or weekend appointments and we are flexible,” Leetham said.
She said it is especially important for families to make sure their kids have health insurance. “What we know is when parents are covered, kids are more likely to be covered, and I think the alternative can be said.” When kids don’t have health insurance they might miss their wellness checks, annual vaccinations and other health checkups.
Roughly 33,000 Utahns may not qualify for Medicaid coverage, according to a recent report by QuoteWizard — but there are other affordable options.
If your income is too high for Medicaid, and you don’t receive insurance through your employer, you can enroll in the Affordable Care Act (Obamacare) Marketplace, a network of private insurers offering plans to individuals and families.
Marketplace plans are available for anyone, with subsidies for Utahns earning up to 400% of the federal poverty line, or $51,040 for an individual and $104,800 for a family of four.
Open enrollment for the Marketplace coverage is available every year for about six weeks in November and December. To enroll in coverage right now you have to be eligible for a Special Enrollment Period (SEP), which are allowed people who have significant life changes, including losing employer-sponsored insurance.
“Unfortunately it’s not a qualifying life event if you just lose your job," Stanford said." Losing your job alone isn’t a trigger, it’s if you lose job-based insurance."
If your hours have been reduced or if you can no longer afford your premium, you may also be eligible for a SEP.
If you are not eligible for any health insurance coverage, Community Health Centers are available throughout the state that may be able to provide free or low-cost care for uninsured patients, as well as financial assistance programs through hospitals and providers, according to UHPP’s website.
You can find more information on health insurance options on the Utah Health Policy Project website.