Can You Get Health Insurance Subsidies If You Buy Off-Exchange?
Consumer Reports has no financial relationship with advertisers on this site.
Q: I buy my health insurance privately through an insurance company, not the Affordable Care Act exchanges, and don't get a financial subsidy toward premiums. If I lose my job next year, can I sign up for an ACA plan and maybe get some financial help?—E. Madian, Oregon
A: Unfortunately, no. That's because if you become unemployed, it is considered a special "qualifying event" only if you get health insurance through your employer. If you lose job-based health insurance, you can purchase ACA insurance outside of the open enrollment period, which ends this year on Dec. 15.
Because you buy your insurance directly from an insurer and not through an ACA exchange, you'll have to wait until the next open enrollment period to buy an ACA plan. Whether you're eligible for a subsidy will be determined by your income at that time.
If you think that losing your job is a real possibility next year, you still have the option to get coverage for 2018 through an ACA exchange, but you have to act quickly. Here's an argument in favor of doing this: With an ACA plan, you'll be able to apply for a subsidy within the plan year if your income suddenly changes.
On the other hand, if your job situation stays the same, your current off-exchange insurance may be a better deal, assuming you don't currently qualify for an income-based subsidy for an exchange plan.
That's especially true of ACA plans being sold for next year because the Trump administration cut off the funding that insurance companies were counting on to help cover the subsides for some exchange plans, causing them to raise premiums on those plans. In addition to finding a more affordable plan off-exchange, you might also find one that more doctors take.
If you decide to stick with your current private insurance and wind up losing your job, there's another possibility to consider, and that's Medicaid. If your income drops below a certain threshold, it's possible you'll qualify for this government health insurance program.
Many states, including your home state of Oregon, have expanded their Medicaid program to cover more low-income people. Oregon residents with an annual income of up to 138 percent of the federal poverty level ($16,642 for an individual or $33,948 for a family of four) are eligible for Medicaid.
Oregon runs its own ACA exchange, but it uses the federally run HealthCare.gov platform for sign-ups. Click here to see whether you're eligible for Medicaid where you live.
More from Consumer Reports:
Top pick tires for 2016
Best used cars for $25,000 and less
7 best mattresses for couples
Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Copyright © 2017, Consumer Reports, Inc.
