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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Recently in COBRA Continuation of Benefits Category


Drop COBRA Now?

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Question: My COBRA coverage won’t expire for another 9 months. It’s very expensive. Can I drop it and enroll in Covered California now?

Answer: Yes. During Open Enrollment, you can sign up for a Covered California plan even if you already have COBRA. After Open Enrollment ends (January 31,2017), if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period. Only expiration of your COBRA coverage triggers a special enrollment opportunity.


COBRA Dependent Coverage

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Question: Can i cancel cobra and keep my wife covered under cobra who has a preexisting condition?

Answer: The former employee (husband in this case) must be covered under COBRA continuation coverage in order for any dependent to be COBRA covered.


Question: I currently am 100% covered by my employer but will be going part-time My employer will not pay any of my health insurance costs as a part-time employee. To make ends meet I will need to also be self-employed. I have a pre-existing condition that requires very pricey drugs. Is my best option to elect COBRA and hope that they don’t repeal the health care act so that I can get affordable coverage in 2014?

Answer: Yes. Your best option is to elect COBRA. It will cover you until you can enroll in guaranteed health insurance coverage available through your state health insurance exchange in January 2014. If your income is still on the low side by then, you will probably qualify for a subsidy to help pay your premium. And of course, your preexisting conditions will no longer affect the availability or cost of health insurance.


Question: I am planning to retire soon. I been with the same company and on the same insurance plan for 25 years. Can I change my insurance from a company group coverage to an individual coverage. I was told recently that I could not. Can you help.

*Answer: * When you retire (assuming you are not yet 65), you’ll be offered COBRA health insurance. It’s the same coverage you had on the group plan but your employer will no longer be paying for it. It usually comes as a shock to most people when they find out just how much the full premium is. You can stay on COBRA for up to 18 months. Alternatively, you can decide to apply for individual health insurance instead of COBRA. Unlike COBRA, you may choose coverage that’s in line with your budget. Here’s the big obstacle - you must pass the stringent underwriting guidelines to qualify for individual health insurance. It’s been my experience that people of retirement age very often fail to qualify for individual coverage.

One way or another, if you can make it to January 2014, when the guaranteed issue and community rating provisions of the Affordable Care Act (ACA) take affect, you will no longer have to worry about preexisting conditions. You will be able to purchase individual health insurance coverage at the same rate as everyone else in your age and ZIP code demographic. In addition, you may qualify for a federal subsidy that will pay some of your premium. So do what you have to do to get through the next few months. Things will get better.


Continuation of Coverage

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Question: If you loose insurance coverage due to layoff and you are being treated at the time does company have to cover you?

Answer: Yes. Upon termination, your company is responsible for making COBRA coverage available to you. However, it is your responsibility to make the entire premium payment to maintain that coverage. If you do so, coverage for your ongoing treatment will be seamless.


Does employer contribute to COBRA?

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Question: Is an employer responsible for a portion of a terminated individual’s deductible in a group HDHP?

Answer: The employer is not responsible for any part of your COBRA premium, but you asked about the deductible which adds an interesting angle. If your employer was reimbursing some portion of your out-of-pocket medical expenses (below the annual deductible) while you were employed, it’s possible that there is a Health Reimbursement Arrangement (HRA) in place which would spell out whether former employees are to be covered by the HRA while on COBRA.


Question: My wife lost her job and the medical insurance was through her employer. My job offers it but they are making me wait 6 months in my new position before I can sign up. Is that legal in Minnesota? Thank you, Jason.

Answer: Yes. Employers can set the new-hire waiting period up to 6 months before becoming eligible for the company’s health plan. Suggest you take your COBRA health insurance option for 6 months until you are covered under your employer-sponsored group plan.


Diagnosed with Cancer While on COBRA

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Question: I have recently been diagnosed with breast cancer. I am currently on COBRA. What happens to me when it expires.

Answer: I’m so sorry about your bad news. At least your ability to remain insured is protected by federal laws. However you must take the right steps to protect your rights. First and foremost, stay on COBRA until your coverage expires. If you do that you will qualify for HIPAA guaranteed coverage after your COBRA coverage expires. Most health insurance companies who market individual health insurance offer HIPAA qualified coverage. HIPAA guaranteed plans are usually high deductible plans at a substantial rate-up over the standard rate for a “healthy” applicant. You may be able to purchase a HIPAA plan from your current insurer, but can shop for HIPAA plans from any other carrier in your state. Contact them directily about 60 days before your COBRA expires.The PCIP plan will not work for you because they require an applicant to be uninsured for 6 months prior to enrollment. In January 2014, your preexisting condition will no longer be a consideration in obtaining health insurance thanks to the Affordable Care Act. I wish you the best of luck.


Question: Do you have to be an “uninsured” resident of Utah for 12 months? I am uninsurable but currently have cobra through my husband. When it runs out how much would the premium be for the high risk insurance? What is it based on?

Answer: That is correct. The HIPUtah Major Risk Health Insurance plan requires that you be uninsured for 12 months before applying. So that’s not for you. When you have exhausted your COBRA benefits, you will qualify for federal HIPAA coverage. That’s high deductible coverage offered through the insurance carriers in each state by federal law.You may be able to purchase a HIPAA plan from your current insurer, but can shop for HIPAA plans from any other carrier in your state. It’s more expensive than regular individual health insurance, but they must cover you. Remember you only have to get to January 2014 - two years form now - when you will no longer have to worry about being “uninsurable” and can buy health insurance without regard to your pre-existing medical conditions at the same price as everybody else. Hang in there. It will get better.


Question: I have been diagnosed with breast cancer and I am covered under my husband's current COBRA coverage. What happens to me when the COBRA coverage ends in November?


Question: What options do I have for getting individual health coverage. I am 59 5'3" and weigh 175. I have HBP under control with medication. My COBRA ends 8/25/2011. Got any suggestions?


QUESTION: My wife is 12 weeks pregnant, and her COBRA insurance expires in July (7 mos. into pregnancy). My COBRA insurance also expires in July. Will she be able to get a different insurance policy?


Question: My Cobra will expire on 4/30/09 and I will not turn 65 until Aug of 2010. Can I contact someone to continue Cobra or an Individual plan? Should I contact the current carrier I have had for the past 15 months?


COBRA & Individual Family Plan

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Question: My husband was laid off from his job. We are offered the COBRA coverage from his previous employer. I will be electing the COBRA coverage because I am 8 months pregnant. My husband and son are going to look into getting an individual family plan instead of electing COBRA through his prior employer.

Is this an option for our family? Can my husband and son get an individual family plan while I am on COBRA along with our newborn (once he is born)? After the birth, and if everything is fine with both myself and newborn would we be able to also change to an individual family plan?


COBRA options

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Question: I need your help to know what to do. I have the option of taking Cobra but its super expensive. First off why? Is my former employer taking a cut or what? Next is it a good idea to take the Cobra even though itcosts so much? I have a new job starting soon but I don't want to go uncovered.

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