Can I Get ObamaCare if I am on COBRA?
Now that the open enrollment period has started, it's important to know your options for enrollment and things to consider if you are currently enrolled in COBRA Insurance. Under the COBRA guidelines, you cannot have an additional Obamacare or ACA plan while still enrolled with COBRA.
Enrolling in Obamacare with COBRA
According to the COBRA insurance database, individuals who are already enrolled in a COBRA plan cannot enroll in an additional plan through the ACA. You must drop your COBRA plan to sign up for an ACA-based plan. Then you must be eligible to sign up for ACA care during the open enrollment period, November 1, 2022 – January 13, 2023.
Outside of the option enrollment period, there are a couple of stipulations that must be met for you to switch from a COBRA plan to an ACA enrollment:
- You have used up all of your COBRA coverage (the plan is expiring)
- Have a qualifying life event (QLE) that makes you eligible for a Special Enrollment Period
The qualifying life events (QLE) that make you eligible for a Special Enrollment Period:
Below is an outline of the four categories classified as qualifying life events that would make you eligible for a special enrollment period. Under each category is a list of QLE examples.
Loss of Qualifying Health Coverage
If you lose your health coverage for any of the following reasons, you are automatically eligible to apply for the SEP:
- Losing coverage from your parents (such as when an individual turns 26)
- Loss of eligibility for Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP)
- Losing employer-sponsored health insurance
- Losing student health insurance
Change in Household Structure
If the number of individuals in your household changes, you may have different healthcare needs and thus may not be suited for your former insurance plan. In this case, you also qualify to search for a marketplace plan under the SEP. Qualifying household changes include:
- Having a baby
- Getting married/divorced
- The death of a previously covered family member results in you no longer being required for your current plan.
Changes in Residence
When you change your residence, you may not qualify for some health insurance plans, and/or there may be no providers in your area. You will qualify for a SEP if you meet any of the following criteria:
- Changing zip codes or counties
- Moving work locations as a seasonal worker
- Being a student that is moving to or from school
- Moving to or from a shelter (such as a homeless shelter or women’s shelter)
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Miscellaneous Qualifying Life Events
Other QLEs that make an individual eligible for the SEP include:
- Becoming a United States citizen
- Leaving jail or prison
- Income changes that qualify or disqualify you from your current insurance
- Starting or ending service as an AmeriCorps or Peace Corps member (i.e., seasonal employment) as well as a VISTA or NCCC member
- Gaining membership to a federally recognized indigenous tribe
- Claiming status as a Corporation shareholder under the Alaskan Native Claims Settlement Act (ANCSA)
- Newly acquired access to an individual coverage health reimbursement arrangement (HRA) or a qualified small employer health reimbursement arrangement (QSEHRA).
How to unenroll from COBRA?
To cancel your COBRA coverage, you must notify your previous employer and plan administrator ( who provided you with COBRA) of your desire to terminate the insurance plan. After your request is submitted, your previous employer should send you a letter confirming the cancelation of your COBRA plan. In addition to the termination letter, you will receive a certificate of creditable coverage.
What Should I Consider When Enrolling in an ACA Plan
There are a few factors to consider before you choose and enroll in an ACA marketplace plan:
Your Budget
Before you select a plan, have an idea of how much you want to spend on coverage. When looking at multiple plans, compare factors such as monthly premiums, deductibles, copays, and coinsurance. Also, utilize the online savings estimate and cost calculator to get a better idea of your bottom line.
Provider Preferences
Certain plans limit your choices of providers and may charge you a higher rate for utilizing out-of-network providers. On the contrary, some plans might have out-of-network benefits that allow you to see any provider. The different types of plans are listed below.
Types of Health Insurance Plans
Health Maintenance Organization (HMO) | This plan typically has lower premiums, out-of-pocket costs, and flexibility in choosing providers. You will have to pay completely out-of-pocket for out-of-network providers. |
|---|---|
Point of Service Plan (POS) | This plan usually has higher premiums because they cover out-of-network providers and have a higher cost for in-network care. |
Preferred Provider Organization (PPO) | This plan allows you to choose physicians out-of-network without referrals. It is a good option if you can afford high premiums and need frequent care. |
Exclusive Provider Organization (EPO) | This plan is not commonly chosen and only covers in-network services. |
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Picking the Best Plan
The ACA marketplace has four health plan categories or metal tiers: bronze, silver, gold, and platinum. Each tier has a different ratio for how much of your healthcare cost will be paid by you and how much will be covered by your insurance.
| Plan | Best Suited For | Insurance Company Covers | You Cover |
|---|---|---|---|
| Bronze | those who are fit and healthy and want to protect themselves from worst-case medical scenarios | 60% | 40% |
| Silver | those who might need a little more medical attention than the average person | 70% | 30% |
| Gold | those who will need frequent access to care (e.g., chronic conditions) | 80% | 20% |
| Platinum | those who will need frequent access to care and are willing to pay higher premiums in exchange for the majority of medical expenses covered | 90% | 10% |
COBRA and Obamacare Enrollment FAQ(s)
Below are frequently asked questions about COBRA insurance and enrolling in Obamacare plans.
Are There Plans I Cannot Enroll in Because of COBRA?
No. If you are currently enrolled or were previously enrolled in a COBRA plan, there are no restrictions on the plans you can choose from on the ACA marketplace. However, before selecting a plan, make sure you think about your budget and compare the out-of-pocket cost, deductibles, premiums, and copays of each plan.
If My COBRA is about to end, When Can I Sign Up for an ACA Plan?
If your COBRA plan expires, you can enroll in an ACA marketplace plan during the open-enrollment period and with a special enrollment period. Running out of COBRA coverage is classified as a QLE and allows you to choose a plan during the special enrollment period.
Can I Switch From COBRA to ACA?
If your COBRA plan is not running out, but you want to switch to an ACA plan, there are some restrictions. You can sign up for an ACA marketplace plan while still on COBRA during the open enrollment period. However, you must drop your COBRA coverage the day your marketplace coverage is set to start.
If you voluntarily drop your cobra coverage outside of the open enrollment period or stop paying premiums, you will not be eligible for the special enrollment period. You must wait until the next open enrollment period to sign up for an ACA plan.
Bottom Line
Although you cannot have COBRA coverage while also enrolled in an ACA plan. Now is the perfect opportunity to examine the pros and cons of switching from your COBRA plan to an ACA marketplace option. The open enrollment period will end on January 13, 2023. After this deadline, you can only switch if you meet the criteria for a qualifying life event.
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Originally from Houston, Texas, Alexandra is currently getting her Master's in Public Health with a health policy certificate at Columbia University. One of her life goals is to own her own art gallery!
