is health coverage overlap bad?

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woolie
Posts: 29
Joined: Sat Jan 12, 2019 10:17 am

is health coverage overlap bad?

Post by woolie »

Would appreciate any experience with moving from one plan to another, and especially if being covered by two different plans simultaneously is problematic.
Here's my situation.
I was laid off from megacorp in mid-July. Very nice severance package which includes COBRA. I can stay on the PPO health insurance at essentially the same rate for 20 weeks. After that period, I can still remain on that PPO plan but would be paying full freight (employer's premium contribution as well as my own) and during my exit interview they told me I could find much more affordable coverage on the individual ACA market (I live in Massachusetts, so this would be the MA Health Connector).
So far, so good, the butt-kicker is that DS needs a knee operation, due to an injury sustained in June. It's not urgent, but needs to be done. It is an ACL replacement, which has a long recovery. We scheduled it with the orthopedist for Dec. 23, which will allow him to do the first part of the recovery during the holiday break, and go back to his dormitory in mid-January without crutches. So this is really the ideal time to do the operation, considering his health and the desire to keep him on track at school.
I can foresee these possibilities for my coverage situation:
1) I sign back on with my former employer. I'm not worried about coverage in this case, as it would be the same system and HR can help resolve any glitches.
2) At the end of 2019 I am either still unemployed, or underemployed, or employed by a firm so small it doesn't have its own plan, so am therefore buying a plan on the individual ACA market. This seems to be straightforward scenario - I make damn sure my current coverage stays active through the end of the year, and sign up for coverage starting Jan. 2020 on ACA. Current plan pays for the operation, and new plan pays for the follow-up visits and PT sessions.
3) Before the end of 2019, I sign on with a different megacorp, with a different plan. I would like to think this is the most likely scenario, it is certainly the one I am trying hardest for. Assume I start a new job, with new coverage, on October 1. Should I keep my current plan, and sign up for the new employers' group plan as well? Would doing so put me in a catch-22 where both insurance plans refuse to pay for the operation in December? I know that in theory pre-existing conditions have to be covered, but I would not be surprised if they try their best to wriggle off the hook for a new participant having an operation immediately after joining. I would consider it money well spent if I paid up to $2000 in "unnecessary" premiums to be double covered the last few months of 2019, if it meant I would not get stiffed on a $30k operation.
4) Same as (3) but I don't join the new group plan until Jan. 2020. This avoids the double-coverage situation of (3) but opens up the possibility that my current PPO plan would refuse to cover the operation, because I had an opportunity to get other coverage but declined to do so.

Anyone else had a situation like this? Is being double-covered with health insurance a good or a bad thing?
codedude
Posts: 69
Joined: Thu Jan 26, 2017 9:15 pm

Re: is health coverage overlap bad?

Post by codedude »

woolie,

Overlapping coverage is not a great thing, it is more of a hassle. One of them is the primary and the other secondary. All claims need to be submitted to the primary, and the balances need to be submitted to the secondary, probably by you. If you are paying for the premiums, I would just keep one and let the other go. Your fear of an insurer not covering just because you joined recently are probably unfounded as long as the plan covers preexisting conditions.Just make sure you always have at least one insurance policy covering your family at all times.
Laren
Posts: 79
Joined: Mon Nov 19, 2007 12:06 am

Re: is health coverage overlap bad?

Post by Laren »

I think that once you start group health insurance with a new employer, you're not eligible for COBRA anymore, so you wouldn't be able to overlap in that case.

In my state, the ACA plans are seriously inferior to group health insurance plans because the provider networks are tiny. The coverage may be similar, but some or all of your doctors may very well be out of network. The plans are all HMOs with each network limited to one county, and include only a small subset of doctors in that county. If you don't find new group health insurance, I'd seriously consider staying on COBRA as long as you can if there is an ongoing issue.

I really miss my old health insurance!
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woolie
Posts: 29
Joined: Sat Jan 12, 2019 10:17 am

Re: is health coverage overlap bad?

Post by woolie »

I read the terms of my COBRA coverage carefully today, and confirmed that double coverage isn't actually possible. The terms state that continuation coverage will be terminate if any beneficiary becomes covered under another group health plan, or by Medicare.

So, if I am able to land a job with benefits before the end of the year, I'll need to check pre-existing coverage as well as their provider network carefully, and then either sign up with the new group policy or keep going with the COBRA plan.

Thanks, this is a question that's been gnawing at me for over a month, it really helped to talk it through on this forum.
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Watty
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Joined: Wed Oct 10, 2007 3:55 pm

Re: is health coverage overlap bad?

Post by Watty »

I used COBRA when I retired. Here are a few tips.

Be proactive and stay on top of when you need to do any paperwork or payments. My COBRA was administered by a separate company who did the minimum they legally could and it was clear that they would have loved for me to miss a payment so that I could be dropped from COBRA. Make sure that someone will make the COBRA payments if you and any spouse are both in the hospital like after a car accident. Verify that any automatic payment actually happened. Once you are dropped from COBRA for non-payment it is virtually impossible to get back into it.

Something to watch out for is that even though you are under COBRA you will likely have an open enrolment period, probably in November, just like you were still an employee. At that point the rates and even the insurance companies can change. I don't remember the details but I did not get the open enrolment paperwork until long after the employees did and I had to ask for it. I don't think I got the new payments slips for the next calendar year until well into January but I was still responsible for getting the payment to them before January 1st.

There was also a fourth company that administered by COBRA prescriptions and I had to deal with them too. They "accidentally" canceled by drug coverage at least three times. I was able to get it straightened out in a day or two each time but it is best to get prescriptions refilled several business days before you need them just in case there is a glitch. At least once I ended up at the pharmacy being told that I did not have coverage and I would need to pay cash if I could not wait a few days to get it filled.

Something else to watch out for is that I had Blue Cross under COBRA and when that ended I was looking at an ACA Blue Cross plan so I thought it would be easy to just switch to that. It turned out that the ACA plan had a different network of doctors even though it was still "Blue Cross" and none of my doctors were in-network under the new plan.

Whenever you do switch insurance be sure to verify that your doctors are still in-network even if the insurance company is the same.
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