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5 Types of Clients Who Could Qualify for ACA Coverage

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What You Need to Know

  • The workplace has changed. A lot.
  • That has changed the kinds of coverage many clients need.
  • COBRA can help some, but ACA plans are often cheaper.

The events of the last two years have caused many individuals and families to reevaluate their priorities and explore their options.

More of your clients may be retiring, cutting back on their working hours, freelancing or otherwise customizing their work situation to better suit their needs. These clients might be happy to learn that they also have more options than they previously thought when it comes to health care coverage in the year ahead.

An estimated 12.1 million uninsured Americans are eligible to purchase health coverage through the Affordable Care Act (ACA) Marketplace. Many don’t take advantage of this coverage because they are under the false assumption that qualifying for Medicare or Medicaid is a prerequisite.

Not only do ACA plans offer coverage for those who don’t qualify for government assistance, but they also may be more cost-effective than COBRA and employer sponsored insurance. The open enrollment for ACA plans is Jan. 15 — in other words, Saturday — the past few weeks have been the time to tell uninsured or underinsured clients about this opportunity.

But some states have regular open enrollment periods that are running past Jan. 15, and others are offering residents broad access to special enrollment periods.

We’ve identified prime candidates for conversations about the ACA plan opportunity.

1. A person working part-time in a job that doesn’t offer insurance.

Part-time is a great schedule, offering workers a way to earn money and be productive while also having enough time to pursue their hobbies, pick up a few hours at another job or care for members of their family.

One downside? Federal law does not require employers to provide part-time staff health benefits, so many do not offer it. Clients in this situation might find that ACA coverage is cost-effective while also offering 10 essential benefits like hospitalization, preventive care and mental health services.

2. A business owner with no employees.

With the number of new businesses opened exceeding 500,000 in 2021, the entrepreneurial spirit is alive and well in the United States. Business owners can make their own hours and add their personal touch to products and services.

However, finding coverage for a business can be hard, especially if your client is the sole owner and operator. A business owner with no employees may want to see if there’s an ACA health insurance plan that works for them.

3. Freelancers, gig workers or consultants.

The pandemic accelerated the growth of the gig economy, and the impact was felt immediately, with the number of gigs completed daily rising 25% in March 2020. It also led to widespread acceptance of remote work, boosting demand for freelancers and making it relatively easy for those who deal in intangibles, like consultants, to continue to serve clients.

People in these types of occupations should consider ACA coverage. They may even be eligible for tax breaks on premiums if they’re self-employed!

4. Retired but not old enough for Medicare.

COVID-19 pushed three million Americans to retire early, leading to many early retirees not yet qualifying for Medicare. A newly retired person can find many plan options through the ACA marketplace and may qualify for financial help — when an individual enrolls, they can apply for a premium tax credit that can be used to lower the cost of their monthly premium.

On top of that, those who pursue health coverage through the ACA marketplace won’t be denied for preexisting conditions.

5. Someone who has recently lost or resigned from their job and lost health coverage.

Do you know that ACA coverage typically costs less and provides coverage longer than COBRA? More importantly, does your newly unemployed client know?

The stress of losing a job or deciding to resign is often made more difficult with the knowledge that it affects health coverage. An ACA plan may ease this burden for clients that have recently lost health coverage due to a layoff or resignation.

The COVID-19 crisis was a wakeup call of sorts, highlighting alternatives to traditional career paths as well as the inequities of health coverage. The ACA marketplace can provide health care coverage to the millions of Americans who are uninsured. Some of them might even be clients of yours.

While some of your clients may face qualifying life events in the year ahead, the open enrollment period, going on now, is the most critical window to encourage individuals and families to get their health insurance coverage in place for 2022.

Start the conversation today to help your clients plan for the health care needs of themselves and their families. You can direct them to visit HealthCare.gov to review plan options or a visit specific carrier’s individual and family plans websites to learn more about how the coverage works.


Fountain pen (Image: iStock)Paul Wingle is vice president, individual & family plans at Aetna, a CVS Health company.