View Full Version : Cobra insurance question
EarthJourney
01-26-2006, 10:43
Hi all,
I'm very new to this board so forgive me if this question has been already been asked several thousand times :o . In fact, the question will show my naivity regarding insurance.
I'm contemplating a thru-hike in '07. I'm hoping my employer will let me take a 6 mos. sabatical (that's a whole other issue/thread...). During that time I'm hoping to keep my insurance (I know, I'll be paying for it).
What can you tell me about "Cobra"? I realize I'll need to talk to my company about this - but for the time being I don't want to alert them to my potential plans in ~15 mos., not yet anyway
I'm just trying to gear up on how this works so I can go into the talks with a better understanding and idea of what it's going to cost.
Oh boy.....COBRA is a total pain in the.......
First, it HAS to be made avaliable to you. Only if you quit or are let go. So a time-off, you would still be covered on the regular play (much better). You must start paying for it and it has a term limit (usually 12 to 18 months). It is expensive! Plus, for some reason, it is a total pain. The best advice I got was from a doctor! Pay two months the first time! The billing of these companies is horrible. My service (when I had it), changed their company doing the collections. The company LOST EVERYONE. Well, the default is "first of the month, cut off everyone who did not pay". They cut off EVERYONE! Took about two months to get it all back. We had to refile every bill! From talking to others, this is NORMAL!
They also did things like: I would mail the check on the 15th. They would deposit it on the fifth???? And then take a month to notify the provider to pay the bills (after I had to refile them).
Once the billing company screwed it up, they claimed they could "only send a "ok to process" " once a month!!! so, their screw up meant we were paying out of pocket the entire month. then, re-filling everything. And getting reimbursed about 20 days after that. So, we were paying for the service and collecting benefits about 60 days later.....
There are better ways. I can send you a link to a company that offers insurance to self-employed people. It is reasonable, but it is a Texas company. I'm in the computer business and a lot of independent contractors have to cover themselves. Know any around you? They can show you some companies for coverage.
There are better ways. I can send you a link to a company that offers insurance to self-employed people. It is reasonable, but it is a Texas company.
Could you post a link for this company, or at least send it via PM? I too am self employed, and always looking for better rates/coverage.
Thanks
COBRA is great but expensive. I used it, and you have got to get every form, signature, compliance date, etc right, or you will get screwed. You should be able to get the same coverage as provided by your company.
If you are in good health and young, you can probably get your own low priced (read high deductable) policy if COBRA fails.
Stag
I am taking a leave without pay (LWOP) in 07' for my thru and I will be keeping the insurance company I use now. The only difference will be that I have to pay the part the employer pays while I am away. Then, when I get back, the employer is going to pay their share again. (If I come back, but that's another topic all together.) Since you are in a similar situation, you could probably swing it in the same manner. I hope that made sense.
JimSproul
01-26-2006, 11:41
I just finished paying for 16 months of COBRA. You will pay the same FULL AMOUNT that your company pays. In my case it was $1200 a month for a husband, wife and kids.
Blue Cross Blue Sheild has a website where you can price individual policies with a wide range of deductables. Also check out a company named Fortis.
Here are some issues to consider:
1. Pre-existing conditions ARE convered by COBRA (that is why we kept it)
2. If you keep COBRA your Primary Care Doctor does not change, important if it is a PPO.
3. Some plan requre a referral from your priamry care doctor for any treatment to be fully covered. May be a problem on the trail.
4. If you pick a plan that has a high deductable (larger risk for you) and no coverage for office visits etc you can reduce cos. For example, a Blue Cross policy, with a $5000 deductable and no office visits would have saved us $800 per month! (but My daughter's health issues would not have been covered for the first year)
rgarling
01-26-2006, 13:04
As JimSproul said, examine how your current policy will work while you are on the trail. If you are healthy, you may find that you can get better coverage at a lower price than your current policy.
Blue-Cross, Blue-Shield is what my boys ended up with when they aged out of our family policy. The preferred-provider network is quite large, and coverage seems fairly good.
Ditto the above advice. When we looked at Cobra vs. an individual policy for our family, the individual policy came out slightly cheaper, and much, much less trouble.
BE AWARE
If you are currently in a group plan and elect to leave that plan and go to an individual ppolicy... if you or anyone else that is covered had a chronic illness, it is very likely that the individual policy will not cover that illness. Then when you go back on the group plan, it won't cover that person's illness for a period of time because it will be considered a "pre-existing condition".
I would love for someone who is in the insurance business to tell me that I am wrong. My son left the company that he is with and has chronic asthma. He elected not to do the COBRA thing and now the individual plan that he is one will not cover his asthma.
bulldog49
01-26-2006, 15:23
You are correct Zeke.
COBRA simply allows you to remain in your company's plan but you, instead of your employer, have to pay the premium.
Whether or not going to another policy is cheaper or not depends on things like your age and health vs the experience rating for your company.
If you are in a plan with a lot of older employees and you are healthy and young you might be better off to go elsewhere. If the opposite is true or you have pre-existing conditions you probably are better off remaining in your current plan.
dje97001
01-26-2006, 15:40
Cobra is indeed extremely pricey. I think the policy we're looking at through Golden Rule is going to cost for 6 months what Cobra would have for 1 (granted cobra would give us much lower deductibles--Golden rule seems to have some good options for catastrophic coverage). But if we have such a major issue that we cant pay out of pocket (from our hike-savings) then our hike will likely be over anyway. So that decision was surprisingly simple.
Toolshed
01-26-2006, 15:41
Might I point out that if you decide to elect COBRA (you may not have the option), you are electing the same coverage that your employee has negotiated with the Managed Care Organization - Usually a nice policy with lots of bells and whistles - Low Copays, Low or no deductibles, Medical Riders, Optical riders, and an Rx Drug Plan.
As Bulldog states, if you are young and healthy forget the COBRA and go somewhere else. You can get a simple traditional indemnity plan (Such as a BCBS indemnity plan) which covers catastrophic illnesses or injuries for much less - You are pretty much covered by an associated BCBS plan regardless of where you go as well. You'll have to pay out of pocket for your medical - PCP visits, some Specialty visits and any Rxs; However, for Hopsital coverage once you pay a Deductible and Copay (Usually $200-$500 Deductible and then 80/20 Copay thereafter) you can bank the rest of the premium. . If you are willing to take a risk, I would go for this. Odds are if you come down with something and need a PCP visit and and Rx, you are only out a few hundred $$$.
Think of it from this perspective - A high premium affords you the luxury of almost blanket like coverage of medical and hospital care - Whether you need it or not, it is there - No risk is involved, but there may be some provider restrictions.
A low premium plan affords you catastrophic coverage with usually unlimited provider restrictrions, however, you are taking a gamble - It might be a pretty safe gamble if you are young and healthy, but it is still a gamble.
Good Luck with your decision..
Toolshed
01-26-2006, 15:45
P.S. I almost forgot, Usually you have up to 60 days to elect Cobra Insurance, so if you get 2 months down the trail and nothing has happened, you are 1/3 through your hike and the risk lessens to sign up with traditional indemnity.
If something happens within 60 days you can enroll in COBRA for the coverage- Some plans vary, but the last few COBRA plans I have had options for have had the 60 days clause in effect.
EarthJourney
01-26-2006, 18:42
Okay, this is the stuff I was looking for!
Thanks for all the input!
I am planning a hiking trip to Nepal and India. I plan to get Cobra insurance while I am in India. I hear there are alot of them there and their bite can be not only painful but often fatal so I want to have plenty of Cobra insurance.
http://www.texascattleraisers.org/
Our entire issue, was always with the in-between billing company. We stayed with it, because we had the entire family covered, with pre-existing conditions that would NOT be covered if we switched to private insurance. Our doctors, co-pays, deductibles, all stayed in place. It was just dealing with that billing company! After six months of NOTHING but screw ups (on their part...), I took the advice and paid TWO months. Then, on the 15th of every month, I was really paying about six weeks ahead!!!
Another "trick" they pulled. First few months, I was getting a bill about the 10th, mailing in a check on the 15. Fourth month. No bill. Call them up. "Oh, well, we just decided to quit sending bills" "did you send a letter telling all your customers this?" "no, why?" "because a lot of people won't remember to pay it with out getting a bill" "oh? that would be their problem" click..... OK!!!! They HOPE a lot of people forget. What a busness plan. Cut off your customers!!!!
WHO IN THE HELL WOULD WANT TO OWN A COBRA, LET ALONE INSURE IT!!!!:confused:
LostInSpace
01-27-2006, 18:14
Regardless of what direction you go, if you are going to be out of your home service area for any length of time, make sure you fully understand the intricacies of your insurances’ “emergency coverage.” It may make a big difference in what you have to pay if you have an emergency while on the AT.
<o:p> </o:p>
When I was in <st1:State w:st="on">Montana</st1:State> and needed emergency care, I went to an <st1:place w:st="on"><st1:PlaceName w:st="on">Urgent</st1:PlaceName> <st1:PlaceName w:st="on">Care</st1:PlaceName> <st1:PlaceType w:st="on">Center</st1:PlaceType></st1:place> nearby for treatment, and I knew my policy covered “emergency care”. At the time I did not understand that under my coverage by UnitedHealthcare, treatment is only considered “emergency care” if you receive the treatment in a “hospital emergency room.” If I had insisted on going 65 miles to the nearest hospital by ambulance, or maybe medivac, UnitedHealthcare would have paid the full bill. As it were, they considered the treatment as out-on-network, non-emergency, and I was thereby responsible for about 95% of the charges.
<o:p> </o:p>
(Next time, provided the emergency is not seriously life-threatening, I just may take the ambulance ride. Stupid policies like the one I had contribute to high healthcare costs. Small wonder that hospital emergency rooms are often misused.)
Toolshed
01-27-2006, 22:02
At the time I did not understand that under my coverage by UnitedHealthcare, treatment is only considered “emergency care” if you receive the treatment in a “hospital emergency room.” If I had insisted on going 65 miles to the nearest hospital by ambulance, or maybe medivac, UnitedHealthcare would have paid the full bill. As it were, they considered the treatment as out-on-network, non-emergency, and I was thereby responsible for about 95% of the charges.
<o:p> </o:p>
(Next time, provided the emergency is not seriously life-threatening, I just may take the ambulance ride. Stupid policies like the one I had contribute to high healthcare costs. Small wonder that hospital emergency rooms are often misused.)
Lost,
My wife has held roles of Manager, Director and Vice President of Network/Hospital contracting at several HMO's (Most recently UHC) - therefore, let me be the first to apologizefor your bad luck. In any event, I would strongly recommend that folks striking out on their own, read their policies and riders and ask specifically about any terms and conditions that are not understand. My staff writes Pharmaceutical Contracts for National accounts and I still get stumped by things they bring to me that they've found during our negotiations.
Hi all,
I'm just trying to gear up on how this works so I can go into the talks with a better understanding and idea of what it's going to cost.
Hi, EarthJourney. I spent 15 yrs in the insurance industry, so let me provide a little information.
The term "COBRA" is an acronym for the federal legislation which required employers to offer insurance to ex-employees: the Consolidated Budget Reconciliation Act of whatever year it was passed (1982, maybe?). In the legislation the government required that employers provide access to group insurance to ex-employees who have no other access to insurance. Employers (or their insurance carriers if they're not self-insured) can charge up to 102% of the total monthly premium (that's what they pay plus what their employees contribute) for this insurance. Employers were required to offer this coverage for 18 months after the employee was let go, and are required to notify ex-employees of access to COBRA coverage within a certain time period. You should be able to calculate what this will cost by looking at what you contribute for insurance, plus what your employer pays, then add 2% of the total. It becomes very expensive because you end up paying the full premium - what you've been paying in employee contributions, plus what the employer has been paying.
Be aware that some employers require, that if you elect to accept COBRA coverage, that you take all benefits - life, disability, health, dental, etc. This becomes very expensive. I believe some employers have the right to allow you to only elect health, or other coverages.... Again, check your employee handbook.
I agree with others that you should be able to find individual insurance for much less than what you will pay under COBRA (and I'm not sure if you'll actually be eligible for COBRA if you're taking a leave of absence - this may be covered in your employee handbook - check that...). Group insurance is usually very good coverage that employers carry because they have to compete for employees. Individual insurance may require medical underwriting, which presumably you'll pass (since you are planning a thru-hike), which is less expensive than the typical employer's group coverage...
Is COBRA complicated? Well, yeah. Anytime the federal government meddles in the private marketplace, things get complicated!
Cheers!
Steve
As JimSproul said, examine how your current policy will work while you are on the trail. If you are healthy, you may find that you can get better coverage at a lower price than your current policy.
Blue-Cross, Blue-Shield is what my boys ended up with when they aged out of our family policy. The preferred-provider network is quite large, and coverage seems fairly good.
I am self-employed. Check out BCBS (Blue Cross - Blue Shield) Right Value Plan. There is no deductible, I pay a $40 co-pay for most things, or a 40% co-payment for others -- but I do not go to see allopathic doctors very much (medical providers). It has reasonable benefits, and a reasonable cost. Depending on your age and sex, it will cost more or less. These are Georgia numbers for a healthy, no-risk female in her 40's. If you are younger - male or female - it will cost less.
Stay AWAY from things like MEGA health insurance, marketed to to self-employed or individuals. The benefits suck, when you read the fine print.
On that note, with insurance - and I am sure SteveJ will agree, you HAVE to read the fine print. You are paying for a product; you need to know what you are buying.... :p Sue
Twofiddy
01-31-2006, 09:50
COBRA is great but expensive.
Stag
I'd like to know how many of you people have actually tried to get a real health insurance policy latley.
My self, 27 and healthy, it is $16,000 per year for a stand alone policy. My father who is 56, will pay $24,000 per year when he retires.
And you people think that $250-$500 per month for a cobra policy is expensive. PLEASE!!
COBRA COVERAGE is good for 18 months any time that your insurance from your job stops for any reason.
GET THE COBRA COVERAGE FOR HIKING it will work the same as your current plan. I would suggest getting enrolled in the more expensive option before you switch to COBRA COVERAGE that allows you to go out of network if you have an HMO
my cobra was $1000 a month, then went to $1200. When my wife got converted back to employee, it dropped to the $200 for the family! Better than a raise!!!!
Hi,
I just thought I would chime in here. I am in process of looking into insurance for my upcoming thru hike and beyond as I will be leaving my place of employment to do it..and hence leaving the group plan.
I have spoken with an insurance agent just the other night he seems very knowledgable though he of course IS a salesman.
He told me that 1) Cobra is expensive ---you pay the whole premium plus what the company contributes and 2 if you are on cobra..and your doctor determines you have a health conditon (say high BP, high Cholesterol, and number of medical ailments), when the cobra 18 months is up you may not be able to get individual insurance due to the pre existing condition(s) that arose during the period of cobra coverage.
Can some one verify this? It seems that individual private health insurance is only available at reasonable cost to those who are most likely not to ever need to use it!
David
My self, 27 and healthy, it is $16,000 per year for a stand alone policy.
My daughter, who is 26, has an individual policy with BCBS of NC for $150/month. You need to move to NC, or something!
Could you post a link for this company, or at least send it via PM? I too am self employed, and always looking for better rates/coverage.
Thanks
This is MEGA - stay away if you can! :eek: The fine print shows that it is not all it is cracked up to be! I tried it - and cancelled it when the paperwork came and I saw it really does not cover what you thought it does. It really is true that you get (or don;t get) what you pay (or don't) pay for!
A better bet is to check out www.e-healthinsurance.com (http://www.e-healthinsurance.com) and get lots of quotes - they give you all the info you could want! ;) Sue