What Kind Of Health Insurance Can You Get When Cobra Runs Out?

Like many people today, you either voluntarily or involuntarily terminated from your last employer. At the time of your employment separation, you may not have had other options for health insurance coverage. To maintain your current level of benefits and bridge the gap until your next fabulous job offer comes along – you agreed to enroll in and handsomely pay for, the privilege of continuing your current health insurance plan through the Consolidated Omnibus Budget Reconciliation Act (COBRA). Now that it’s about to expire, it pays to know your health insurance options after COBRA.

HOW LONG IS COBRA?

COBRA beneficiaries are eligible for group coverage during the 18 month period immediately following a qualifying event, often due to a reduction of hours or employment termination. It is also important to note that a second qualifying event during the initial period of coverage may provide a beneficiary a maximum of 36 months (or 3 years) of coverage. For further detail go to: http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

OPTION 1: EXTENDING YOUR COBRA COVERAGE

This is a viable option for people who became disabled during the first 60 days of their coverage.

• Obtain a ruling from the Social Security Administration indicating you became disabled during the first 60 days of COBRA coverage
• Forward a copy of your Social Security ruling letter to your health plan administrator within 60 days of receipt, and prior to expiration of your 18-month period of coverage
If these requirements are met, you and your family will qualify for an additional 11 months of COBRA continuation coverage. Note: Health plans can charge up to 150% of the premium cost of your policy for the extended period of coverage.

OPTION 2: CONVERT YOUR COBRA INTO AN INDIVIDUAL POLICY

Many health plans permit COBRA participants and beneficiaries to transfer group health coverage to an individual policy. If this choice is available, an eligible beneficiary who pays for COBRA coverage must be given the choice of converting to an individual policy at the end of the COBRA coverage period. The alternative to convert and enroll in a conversion health plan must be provided within 180 days (or 6 months) before COBRA coverage ends. However, you will forfit this privilege, if you voluntarily discontinue COBRA coverage or stop paying your COBRA premiums. Remember that stopping payments will eliminate your special enrollment right, based on your loss of eligibility for coverage.

OPTION 3: PURCHASE YOUR OWN INDIVIDUAL POLICY

Health insurance can be complicated and confusing, but it pays to know your health insurance options. Wouldn’t it be great if you had an expert on your side? A simple way to understand your unique needs and recommend the perfect health plan tailored to your unique situation — all in just 10 minutes? That expert is just a mouse click away. Go to http://www.vimo.com
If you have questions about the differences between a Fee-for-service plan, a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) or a Point of Service (POS) plan, Vimo will explain the differences and help you evaluate your options.

OPTION 4: THE PUBLIC INSURANCE OPTION

Can’t afford the high monthly payment of a individual policy? Don’t overlook the Public Insurance Option. The government provides health care coverage if you meet the qualifications, through Medicaid, Medicare, and special interest programs. These safety-net programs provide medical care for those in need, even if they have no insurance or money. Facilities accepting public insurance include community health centers, public hospitals, school-based centers, public housing primary care centers, migrant health centers and special needs facilities. To find a facility near you, contact your local or state health department or visit the Bureau of Primary Health Care.

If you do not qualify for these government programs due to your income level, but still cannot afford to pay for health insurance or costly medical care, below are additional places to find assistance:

Free clinics. Go to the Free Clinic Foundation of America for a directory at http://medkind.com.

Prescription drug assistance. For prescription drug resources, check out: http://www.disabilityresources.org/RX.html.

If you have Cancer. There are government sponsored programs and volunteer organizations that can help. For a list of resources, contact the National Cancer Institute at: http://www.cancer.gov/cancertopics/factsheet/Support/financial-resources.

If you have HIV. The federal Ryan White CARE Act funds services for those with HIV/AIDS who have little or no insurance and limited income. For more information, go to http://hab.hrsa.gov. Additional resources can also be found at http://www.aids.gov.

Low-Cost Health Insurance Options. Some labor unions, professional clubs, associations, and organizations offer private group insurance to its members.

High Risk Pools. Some who have been denied health insurance due to a medical condition may be able to obtain coverage through State “High Risk Pools.” More than 30 states provide this temporary insurance, contact http://www.healthinsurance.org/riskpoolinfo.html

OTHER VALUABLE THINGS YOU SHOULD KNOW:

Certificate of Creditable Coverage: All group health plans are required to furnish members with a “certificate of creditable coverage” documenting the individual’s prior creditable coverage with the existing health plan. This certificate can be used as evidence of prior coverage for your new health plan and to reduce the length of a preexisting condition exclusion period if one may apply. This certificate is given free of charge and provided:

• Automatically (a) when you lose coverage under the plan or you become entitled to elect COBRA, and (b) when your COBRA continuation coverage ceases; and
• If requested, before you loose coverage or within 24 months of losing coverage.

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) Is There to Help You:

HIPAA is a federal law that:

• Limits the ability of a new employer plan to exclude coverage for preexisting conditions.
• Provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events.
• Prohibits discrimination against employees and their dependent family members based on health factors, prior medical conditions, previous claims experience, and genetic information; and
• Guarantees certain individuals will have access to, and can renew individual health insurance policies.
• For more information about HIPAA and how it protects you and your family, go to http://www.cms.gov/hipaa/hipaa1/content/more.asp.

HIPAA works along with state laws that, while similar to HIPAA, may offer more liberal protections. Contact the National Association of Insurance Commissioners at www.naic.org to ask about how the laws apply where you live.

Preexisting Conditions:

Under HIPAA, a health plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Make note of these key HIPAA mandates:

• A preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in a plan.
• Try to avoid a significant break in coverage (63 days is the rule) if you want to be able to count your previous coverage. If you have a break shorter than 63 days, coverage you had prior to the break is considered“creditable coverage” and can be used to offset a preexisting condition exclusion period. Days spent in a “waiting period” for coverage, cannot be used as credit, but are not counted toward the significant break (63 days) you are trying to avoid.
• A group health plan can not require you to pass a physical exam before you are eligible to enroll.
• A health plan can require you to fill out a health care questionnaire prior to enrollment, as long as it does not use individual’s health information to restrict enrollment or charge you more.

Once COBRA ends you have options, but understanding your rights and responsibilities will support your ability to bridge the gap and ensure you remain protected. Start today by going to the websites listed above to explore all of the options available to you. Seek help when you need it and take back your power.

Related posts:

1. How Do Conversion Policies For Health Insurance Work?
2. What Are Employer Obligations When Offering Health Insurance?
3. How Soon Can I Start To Use Health Insurance When I Buy It?
4. How To Get Group Health Insurance?
5. Who Offers the Best Health Insurance?

Tags: cobra, consolidated omnibus budget reconciliation act, health insurance, healthcare insurance, medical insurance