Lapse In Health Insurance Between Jobs Penalty – A lapse in health insurance coverage occurs when you lose your job-based health insurance or other health coverage and do not immediately enroll.
The penalty for not having health insurance while working can be different from country to country and from healthcare system to healthcare system. The individual mandate provision of the Affordable Care Act (ACA) is frequently linked in the United States to the penalty for not having health insurance while working.
What Is Lapse In Health Insurance Between Jobs Penalty
Even though there is no penalty for not having insurance, not having it can still have financial and health-related effects. If you do not have insurance, you might have to pay for healthcare services on your own which can be expensive.
There may be a number of options available to you to guarantee continuous coverage during job transitions such as:
- Benefits from COBRA: You may be eligible for continuation coverage under COBRA if you were previously covered by a health insurance plan sponsored by your employer. You will be responsible for the full premium cost, including the portion that was previously covered by your employer, but COBRA allows you to maintain the same coverage that you had while employed.
- Exceptional enrollment times: A special enrollment period (SEP) in the Health Insurance Marketplace (also known as the exchange) begins when an employee loses their employer-sponsored health insurance in the United States. You will be able to enroll in a health insurance plan for yourself during this time instead of the usual open enrollment period. In order to avoid a coverage lapse, it is important to act quickly during the SEP.
- CHIP or Medicaid: If you have children, you may be eligible for the Children’s Health Insurance Program (CHIP) or Medicaid—government-funded healthcare for low-income individuals and families—based on your income level and state of residence. Health insurance coverage is offered through these programs at a low cost or for free.
Health insurance for the short term
Short-term health insurance is another option for bridging the gap between jobs. These plans are usually only good for a short time, like a few months, and they are made to cover you for a while until you find a better option that lasts longer.
READ: Temporary Health Insurance Between Jobs
As healthcare systems and regulations can vary, be sure to check the specific rules and regulations that apply to your country or region. For specific, situation-specific advice, it is best to talk to an insurance or healthcare professional.
Beginning in 2020, residents of California are required to:
- Be covered by health insurance that meets the requirements;
- Pay a state tax return penalty; or
- Receive an exemption from the requirement to have coverage.
When you file your state income tax return in 2023 for the year 2022, the penalty for not having coverage for the entire year will be at least $850 for each adult and $425 for each dependent child under the age of 18 in the household. A penalty of at least $2,550 would be assessed to a four-person family that is uninsured for the entire year. The California Franchise Tax Board will impose the penalty. Visit the Franchise Tax Board’s website and use their Penalty Estimator Tool for information about the penalty, including the amount your family may owe for not having coverage.
When you switch jobs, how does health insurance work?
Before you are eligible for health insurance at your new job, you might have to wait for a certain time. But even during that time, you will still need health insurance. Through COBRA continuation coverage, most people choose to keep their former employer’s health insurance. However, after leaving a company, job changers will be responsible for paying the premiums on their own.
A person is without health insurance during a health insurance lapse between jobs.
In order to avoid any gaps in coverage, people who lose their health insurance coverage should take steps to obtain new coverage as soon as possible. Individuals who require health insurance coverage have a variety of options, including private health insurance plans, government-sponsored health insurance programs, and short-term health insurance plans.
Options available if you need health insurance but do not have any money at the moment
If you do not have any money at the moment and want to get health insurance, you can do so, but your options may be limited.
Medicaid would be the best option for people without a job. Each Medicaid program is designed to provide medical insurance to low-income individuals and families and searching online is the easiest way to find and apply for your state’s Medicaid program. You can enroll your children or minor dependents in your state’s Children’s Health Insurance Program (CHIP) if you meet the requirements.
Coverage Gaps among People with Pre-Existing Conditions
The American Health Care Act (AHCA) which has been approved by the House of Representatives, includes a contentious provision that would permit states to waive community rating in the individual insurance market. Under this provision, insurers in states with community rating waivers can adjust premiums based on a person’s health status for enrollees who have not had insurance in the past year for at least 63 consecutive days. The higher (or lower) premiums based on health status would be in effect for the entire plan year (or the rest of the year if people sign up during a special enrollment period), after which enrollees would be eligible for a community-rated premium that had nothing to do with their health.
READ: Living Without Health Insurance On Purpose; Why?
A high-risk pool or participation in a reinsurance policy in which payments are made directly to insurers would be necessary for states that waive community rating to subsidize the costs of high-risk enrollees. People who face higher premiums based on their health are not required to set up an alternative source of coverage in their state.
The bill makes $100 billion available to all states for cost-sharing subsidies, high-risk pools, and reinsurance programs, among other things. A federal invisible risk-sharing program that would be comparable to a reinsurance arrangement receives an additional $15 billion. For the year 2020, maternal and newborn care, mental health, and substance abuse services received an additional $15 billion in funding. Also, the AHCA provides states that implement community rating waivers with $8 billion over five years; these assets can be utilized to help diminish charges or pay personal clinical costs for individuals appraised in view of their wellbeing status.
How many individuals might Community Rating Waivers affect?
The number of people with pre-existing conditions with gaps in insurance that would expose them to higher premiums would have a significant impact on the effect that a community rating waiver would have.
Based on National Health Interview Survey (NHIS), that 27.4 million adults nationwide who were not elderly had coverage gaps of at least several months in 2015.
Uninsured and in Need of Help? Know Your Rights!
It does not mean that you are without protection just because you do not have health insurance. You may not be aware of your rights in an emergency because you do not have insurance. If you fall within the definition of an emergency case set by the federal government, you are entitled to treatment in an emergency.
What then constitutes an emergency?
- Any event that is severe or life-threatening;
- Any event in which a person’s bodily functions or organs are seriously impaired;
- Any event in which a pregnant woman is about to give birth.
If your situation qualifies as an emergency, hospitals and emergency rooms must provide adequate care regardless of your insurance status.
Some visits that will not be considered emergencies under the official definition are:
- Prenatal care, wellness checks, screenings, follow-up appointments, or ongoing doctor visits
- Situations that are not considered life threatening such as the flu, colds, rashes, etc.
- Going to an urgent care facility for non-life threatening events
Your hospital may decide to transfer you or let you go after assessing your immediate situation and stabilizing you.
READ: How Long Can You Go Without Health Insurance?
Please remember that just because you go to the emergency room does not guarantee that you will be seen if your situation is not an emergency.
In addition, the visit is not free just because you were treated even though you did not have insurance. You will be liable for the full bill and should resolve a plan with the emergency clinic. Consider asking for discounts or options for charity care to help cover some of the costs. If you do not have insurance, please think about contacting your local Medicaid office to see if you qualify for this coverage.
