By ROLF LOWE
The COVID 19 pandemic has had a significant impact on health care providers of all sizes and practice areas. While non-essential services came to a halt during the early part of the pandemic creating a sudden income loss, the loss of insurance coverage for existing and potential patients due to a job loss, reduction in income or reduction in hours worked could have a lingering effect on patient visits for routine care and serious health conditions. Fortunately, the Health Insurance Marketplace created by the Affordable Care Act and the Medicaid program allow individuals who have lost their health insurance to find low or no cost options for health care coverage.
Providers typically verify insurance coverage when a patient shows up in the office for a scheduled visit. In the wake of the COVID 19 pandemic that practice needs to evolve. Providers need to be proactive and reach out to patients and inform them of potential alternatives for health care coverage in the event they do lose coverage. While there were significant job losses resulting in a loss of health care coverage early on in the pandemic, many employers took advantage of the Payroll Protection Program in the CARES Act to keep staff on payroll and maintain benefits, but the funds from the program will not last forever and there will certainly be patients that will lose their coverage in the coming months. Providers who are not already offering information and assistance on obtaining alternate coverage to their patient base should consider incorporating it into their practice fundamentals, utilizing emails, social media and office visits to let patients know if they do lose their coverage there are potential alternatives in the Marketplace and Medicaid program.
Open Enrollment is typically the only time an individual can sign up for coverage through the Marketplace and is available from Nov. 1, 2020 through Dec. 15, 2020. However, individuals who have lost coverage during the COVID 19 pandemic may be eligible for Special Enrollment into the Marketplace or qualify for Medicaid and the Children’s Health Insurance Program. Special Enrollment in the Marketplace is available to individuals who have experienced a qualifying life event, including loss of health care coverage, moving, getting married, having a baby or adopting a child. The type of qualifying life event will determine the time period an individual has to enroll in a plan, but it is typically 60 days before, or 60 days after, the qualifying event. Enrollment in Medicaid and CHIP is available anytime of the year, but enrollment is dependent on meeting the eligibility requirements under the program.
Michigan residents looking to enroll in a marketplace plan can visit ww.healthcare.gov to determine their eligibility. The Michigan Department of Insurance and Financial Services is also available to answer questions and aid individuals looking to obtain coverage. Michigan residents can contact DIFS toll free by calling 877-999-6442 or by email at DIFS-HICAP@michigan.gov. Individuals who think they may be eligible for Medicaid or CHIP coverage can visit the Michigan Department of Health and Humans Services (MDHHS) website at www.michigan.gov/mdhhs and use the MI Bridges online application process or download a fillable paper application. MDHHS also has online tools and community partners to assist individuals in navigating the Medicaid and CHIP enrollment process.
While a provider may not participate in a Marketplace or Medicaid health plan network, taking the time to help patients identify potential coverage sources and provider networks to maintain healthcare coverage will likely mean the patient will continue to seek and receive medical care. Certainly, keeping patients coming in for visits may benefit an individual provider’s bottom line, but keeping patients coming in for routine visits and when they are not feeling well, regardless of where they are seen, is a benefit to the patient and our healthcare system by reducing the need for costly procedures and services if health problems go left unchecked. Offering information to patients about enrollment in the Marketplace or Medicaid program may also benefit a provider down the road, since the patient may eventually be covered under a health plan the provider is in network with and return to the practice.