When a union goes on strike it can be difficult for union members and those trade members associated with the union to keep paying their health insurance premiums with either reduced or no income. There are options to maintaining health insurance if you know the rules of the health insurance game. These rules revolve around Special Enrollment Periods with the qualifying event of loss of coverage.
Medi-Cal Can Help During Strikes
Perhaps one of the least mentioned benefits of Covered California is the income protection feature. When an individual’s or family’s monthly income takes a dip, it can be reported to Covered California and the premium tax credit subsidy will increase to lower the health insurance premium. The downside is if the income drop is low enough, the individual or family may find themselves eligible for Medi-Cal. However, MAGI Medi-Cal, which is no cost to those eligible, helps preserve cash and allows you to re-enroll in private health insurance once the income goes back up.
Decrease Of Income May Make You Medi-Cal Eligible During A Union Strike
For example, there may be a catering company or equipment rental company that derives the bulk of their revenue from supplying union production jobs with food or material. If the union goes on strike, the job sites no longer need the catering or rental equipment. The owners of those companies may have to temporarily let go of some of their employees who were servicing the union production sites.
If the affected employee has insurance through Covered California, they can report the decrease of income. If the household income drops to zero, the family will be determined eligible for Medi-Cal. If the income is lower, but bolstered with unemployment benefits, if the strike is long, the individual or family may see a commiserate increase in the monthly tax credit to lower the health insurance premium to an affordable level.
Qualifying Events And Special Enrollment Periods
Medi-Cal enrollment is open year round. Private health insurance, either through Covered California or off-exchange directly with a carrier, is not open year round. You need a qualifying event in order to make you eligible for enrollment outside of the Open Enrollment period that happens each fall in November. A qualifying event entitles the individual or family to enroll during a Special Enrollment Period (SEP). The SEP is good only for 60 days from the date of the qualifying event.
Failing To Pay Premiums Is Not a Qualifying Event
If you have health insurance directly with a carrier, not through Covered California, there is no income protection. You must make your monthly premiums. If you fail to pay for your health insurance for more than one month, the health insurance is terminated. Once it is terminated you cannot re-enroll without that qualifying event for the SEP. A qualifying event is the loss of coverage. Loss of coverage must be the involuntary termination of health insurance, this usually happens when some leaves a job and their employer sponsored group plan is cancelled. Simply cancelling or failing to pay your health insurance premiums leading to the termination of health insurance is NOT a qualifying event.
Regardless of whether you are in Covered California or have health insurance directly with a carrier, if your income is low enough, you can qualify for Medi-Cal. Here are a couple of scenarios for maintaining health insurance using Medi-Cal through a prolonged strike.
Adjusting Income Through Covered California
Pat is an hourly employee who supplies union jobs with rental equipment. The union working on the job goes on strike. Pat temporarily loses the job. Pat reports the income change to Covered California and Pat becomes eligible for Medi-Cal. After two months, the strike ends and Pat goes back to work. The increased income is reported to Pat’s local county Medi-Cal office and they determine the household income is too high for Medi-Cal. Pat’s Medi-Cal enrollment is terminated. The enrollment was involuntarily terminated, which is a qualifying event for a SEP. Pat is released from Medi-Cal and can then re-enroll in a private health plan with the tax credits under the SEP rules.
Enrolling In Medi-Cal With Private Health Insurance
Jessie works for a catering company supplying a union work site with snacks during production. Jessie has health insurance directly with a health insurance company. When the union goes on strike, there is no way Jessie can pay the monthly health insurance premium. Jessie can apply to Medi-Cal because the household income has dropped to zero. Once Jessie is set up with Medi-Cal, the private insurance can be terminated. Three months after enrolling in Medi-Cal, the strike is settled and Jessie returns to work. Jessie reports the increased household income to Medi-Cal. Because the income is above the Medi-Cal eligibility limit, Medi-Cal informs Jessie that the Medi-Cal health plan will be terminated at the end of the month. The termination is “loss of coverage” and eligible for a SEP. Jessie can use the Medi-Cal termination notice to re-enroll in the previous private health insurance plan or through Covered California. But Jessie must have the termination notice to verify the qualifying event of loss of coverage.
Medi-Cal is not perfect insurance for everyone. Many doctors don’t accept Medi-Cal, but it will cover any emergency situation. If you have Medi-Cal you can still see other doctors, but you may have to pay the full price for the office visit if the doctor or provider is not in the Medi-Cal HMO network.
Leverage Medi-Cal To Conserve Cash During A Strike
The main point of the Medi-Cal transition for workers affected by a union strike is that it gives the ability to return to the private health insurance market once their incomes go back up. If you let your health insurance terminate for lack of payment, and you don’t enroll in Medi-Cal, you can’t get back into the private health insurance market until next open enrollment. Once Medi-Cal terminates your enrollment, you have 60 days under the SEP period to enroll in a private health plan.
[wpfilebase tag=list id=396 pagenav=1 /]