Cobra - might you be an expert

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Tim18
Posts: 69
Joined: Sun Jul 21, 2013 11:51 pm

Cobra - might you be an expert

Post by Tim18 »

Hi

A few months back I posted : http://www.bogleheads.org/forum/viewtop ... 2&t=142537 and the help was great for COBRA. So now I am part of the COBRA rules, having terminated my job (because of cancer) to retire. My policy has continued with the provider of health services to my prior company. I pay 100% for the coverage and I assume my prior employer has some overhead too. This set-up should have taken me to my 65 birthday (I am not 63 and 9 months away).

So to be clear: there is A) health care provider (Cigna PPO) who provided services to B) company that aggregates small business who then offer, among many things, health insurance to C) these small businesses and their D) employee.

Now a hitch; my prior employer may drop coverage to employees (small company of 3/none who purchase healthcare now). Me, the newly retired guy is the only person using it. So employer says they may/will drop the health care option totally which I have been told will cause me to fall off and not have coverage.

My retirement was a qualifying event. I was good to go for 16 months. But here is where I need informed info. If the original business that I worked for drops all health care options for their employees is that a COBRA event in some fashion for me that allows me to go forward in some way with my current coverage; or does my coverage simply end because my former employer will not offer health care to anyone?

Who am I tied to? If that tie breaks (see above) is there a way to continue on with same policy?

I am on GA/FL line, living in GA but all medical services done in Jacksonville. I need a policy that will allow this to continue.

If you know how events like this can best be handles I will appreciate you direction. I very much need coverage that can get me to Jacksonville Mayo.

Tim
absolutFinance
Posts: 165
Joined: Fri Jan 03, 2014 2:08 pm

Re: Cobra - might you be an expert

Post by absolutFinance »

you may want to ask your prior employer if they have verified that it is legal for them drop insurance when they have an obligation to provide COBRA enrollment for former employees.
SedanLove
Posts: 6
Joined: Sun Nov 02, 2014 10:44 am

Re: Cobra - might you be an expert

Post by SedanLove »

I can't help you very much - I have been wanting to look into Cobra myself for retirement.
I *thought* that once under Cobra, you would be safe to continue, as you would be paying the premiums yourself.
You may have already seen this, but here's a link to a booklet from the DOL.
http://www.dol.gov/ebsa/pdf/cobraemployer.pdf

As you can see it's for employers but has some useful info.
I'm sure there will be plenty here who can help.
Hope things work out.
Tanelorn
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Joined: Thu May 01, 2014 9:35 pm

Re: Cobra - might you be an expert

Post by Tanelorn »

I don't know for sure, but it seems from some reading that if the company has no longer has a group health plan (because they drop it or go out of business for example), they are not required to offer continuing coverage via COBRA. Also, it seems that COBRA only covers companies with at least 20 employees.

I'm not sure why your company would drop the health care plan just because you're the only one on it, but it sounds like you could be stuck if they do. Since you pay the COBRA premiums yourself, plus up to 2% extra for admin, I would think you would not be a financial drag on the company but I don't really know.

I am also not sure how being part of an employer group might effect this. It's possible that Cigna is still offered to the employer group, if not to your small business, but that this would still allow COBRA coverage to continue. It sounds like this would be a question for HR at the employer group rather than at your company.

Good luck.
AviN
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Re: Cobra - might you be an expert

Post by AviN »

Tim18,

I'm not sure about COBRA laws, but you may want to investigate purchasing health insurance on your state's Affordable Care Act exchange. You may be eligible for subsidized coverage depending on your income. Even without subsidized coverage, the plans have adjusted community rating which means (a) you won't pay more for having cancer and (b) you will pay more given your age, but probably less than the actuarially fair amount.

Avi
bluemarlin08
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Joined: Wed Aug 29, 2007 12:18 pm

Re: Cobra - might you be an expert

Post by bluemarlin08 »

COBRA is for groups with over 20 employees. Sign up for ACA but, make sure the company you choose covers your providers as in network. Blue Cross usually only covers providers in state as in network.
Spirit Rider
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Re: Cobra - might you be an expert

Post by Spirit Rider »

Yes, COBRA is only required for employers with over 20 employees, but many small business insurance plans include it regardless.

The federal COBRA law itself only requires the company to provide access to the current employee plan. If the company terminates its employee plan, the COBRA benefits also terminate. Insurers will provide conversion to an individual plan in different ways. Anywhere from direct conversion to full medical underwriting and paying an individual rate. Check with the insurance provider.

Also, some states (including my own) have supplemental COBRA laws that require the insurance company to continue to provide COBRA benefits at the same rate as the company when a plan is terminated. Check with your state laws regarding COBRA.
Tanelorn
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Re: Cobra - might you be an expert

Post by Tanelorn »

AviN wrote:Tim18,

I'm not sure about COBRA laws, but you may want to investigate purchasing health insurance on your state's Affordable Care Act exchange. You may be eligible for subsidized coverage depending on your income. Even without subsidized coverage, the plans have adjusted community rating which means (a) you won't pay more for having cancer and (b) you will pay more given your age, but probably less than the actuarially fair amount.

Avi
My experience with exchange plans has been quite poor and I would never recommend them for someone with a life threatening condition like cancer. Need a scan for something suspicious? The only place on the plan had a 1.5 month wait list. Billing screwups, never in your favor, happened over half the time and required several hours of hassle to resolve.

If you can afford something better, you won't regret it.
mhalley
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Re: Cobra - might you be an expert

Post by mhalley »

I'm not an expert, but can refer you to one. Andrew Rubin runs a show called Health Care Connect on the Doctor Radio station on Sirius XM. He is an expert in all areas of medical insurance. He takes phone calls, and also answers emails. You can go to his website http://rubinhealth.com/ and email him a question, or call in to the Doctor radio show. His show airs live Thursdays 12pm-2pm EST. call 1-877-698-3627 to ask your question.
I seem to recall him talking about having an all day show coming up soon, but can't recall when that is off the top of my head. Can't seem to find any info about it on the siriusxm website. There is a rebroadcast of his show tonight and Sunday at 10 pm if you have sirius xm, and see when the upcoming all day event is happening.
Mike
technovelist
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Re: Cobra - might you be an expert

Post by technovelist »

I'm pretty sure you are out of luck with COBRA if your (ex-)employer drops health care coverage. At least that's what the documentation said when I was on COBRA a few times in the past, but ACA may have changed that.

You need to talk with a real expert. I see someone has already suggested a public figure who may be able to help, so I would start there.
In theory, theory and practice are identical. In practice, they often differ.
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dm200
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Re: Cobra - might you be an expert

Post by dm200 »

Tanelorn wrote:
AviN wrote:Tim18,

I'm not sure about COBRA laws, but you may want to investigate purchasing health insurance on your state's Affordable Care Act exchange. You may be eligible for subsidized coverage depending on your income. Even without subsidized coverage, the plans have adjusted community rating which means (a) you won't pay more for having cancer and (b) you will pay more given your age, but probably less than the actuarially fair amount.

Avi
My experience with exchange plans has been quite poor and I would never recommend them for someone with a life threatening condition like cancer. Need a scan for something suspicious? The only place on the plan had a 1.5 month wait list. Billing screwups, never in your favor, happened over half the time and required several hours of hassle to resolve.

If you can afford something better, you won't regret it.
My understanding is that "exchange plans" are often identical to plans offered directly.

Also, "exchange plans" have only been offered in the last year AND any actual experience being in one (as a participant) could only have started January 1, 2014 or about ten months ago. It is also the case that "exchange plans" differ widely from one area to another and state requirements and provisions vary from one state to another.
Tanelorn
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Re: Cobra - might you be an expert

Post by Tanelorn »

dm200 wrote:My understanding is that "exchange plans" are often identical to plans offered directly.
Your understanding is incorrect. Google for "narrow networks" and you'll find plenty of problems specific to exchange plans. Even with "name brand" health insurers, the selection of doctors on an exchange plan can be much less than any private or group plan using the same company.
Also, "exchange plans" have only been offered in the last year AND any actual experience being in one (as a participant) could only have started January 1, 2014 or about ten months ago. It is also the case that "exchange plans" differ widely from one area to another and state requirements and provisions vary from one state to another.
I have enough experience with my exchange plan to know I'm very glad I'm not actually sick. Even getting routine care has been a maze of HMO bureaucracy and referral screwups, billing errors, and long waits. Perhaps you have some first hand experience to share with OP?
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Flobes
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Re: Cobra - might you be an expert

Post by Flobes »

Tanelorn wrote:
dm200 wrote:My understanding is that "exchange plans" are often identical to plans offered directly.
Your understanding is incorrect. Google for "narrow networks" and you'll find plenty of problems specific to exchange plans. Even with "name brand" health insurers, the selection of doctors on an exchange plan can be much less than any private or group plan using the same company.
Also, "exchange plans" have only been offered in the last year AND any actual experience being in one (as a participant) could only have started January 1, 2014 or about ten months ago. It is also the case that "exchange plans" differ widely from one area to another and state requirements and provisions vary from one state to another.
I have enough experience with my exchange plan to know I'm very glad I'm not actually sick. Even getting routine care has been a maze of HMO bureaucracy and referral screwups, billing errors, and long waits. Perhaps you have some first hand experience to share with OP?
First hand experience to share: I have enjoyed a very positive year with my ACA Exchange insurance. It is a PPO, and it is the exact same whether purchased on or off the ACA Exchange. I've had no problems with coverage, waits, providers, specialists, diagnostics, scans, labs, tests, Rx, network, pre-approvals, billing or payment. Customer service has been wonderful, friendly, helpful and professional. (And ACA subsidy and cost-sharing benefits have been mighty sweet too!)
Tanelorn
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Re: Cobra - might you be an expert

Post by Tanelorn »

If I get sick, maybe I'll have to move to CO. This stuff can vary a lot by state.
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