Preparing for Employee Health Coverage Losses
How Employers Can Support a Healthy Workforce Post-COVID-19 Public Health Emergency
Over 300,000 Oklahomans are expected to lose Medicaid/SoonerCare this year. Loss of Medicaid triggers a special enrollment period (SEP) for employer plans and through the Health Insurance Marketplace at HealthCare.Gov. Employers can help keep employees and their households covered by being aware of what is required of employers and what options are available to employees.
What Do Employers Need to Know?
Oklahomans who lose SoonerCare—but who may be eligible to purchase coverage through their employer—probably don’t know that they need to alert their employer to their need. Approximately 35,000 individuals will lose coverage on the first of each month from May 1 through January 1, 2024. Those with household incomes exceeding the income eligibility levels are prioritized to lose coverage first, and Medicaid enrollees with high-need or young children in the home are scheduled to retain coverage longer.
Employees and family members who are eligible for coverage under a health plan offered by employers qualify for special enrollment in that plan if they lose eligibility for Medicaid. Employees usually have 60 days after they lose eligibility in Medicaid to request special enrollment in an employment-based plan. However, if an employee or family member loses eligibility for Medicaid before July 10, 2023, they can request special enrollment in the employment-based plan until at least September 8, 2023. Questions? Contact the Employee Benefits Security Administration at askebsa.dol.gov or 1-866-444-3272.
Employee Options For Medical Coverage
Employees notified by the state Medicaid agency, the Oklahoma Health Care Authority (OHCA), that they may be ineligible should first update their address, income, missing documents, and other required information to verify whether they are eligible. Children may remain eligible even if adults lose coverage.
Health Insurance Marketplace
Most (4/5) Oklahomans who are eligible for discounts for Marketplace plans can pay monthly premiums under $20 a month. Many have options at $0/month. A special enrollment period is open for Marketplace-eligible consumers who submit an application before July 31, 2024 and attest to loss of Medicaid coverage.
HealthCare.gov or talk to a navigator at 833-465-7526
Employees whose Medicaid coverage ends on or before July 10, 2023, can request special enrollment in their employment-based plan until at least September 8, 2023. Coverage lost after July 10 will trigger a 60-day special enrollment period for employees to request to participate in an employer plan for themselves and/or their household members.
Employees should request special enrollment after losing coverage.