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Anyone Here Know Cobra Health Insurance Laws?

muscle96ss

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To make a long story short, my wife lost her job to CV-19 back in June and her new job does not offer health insurance yet. Since I have extensive continual health issues, we had to continue with the Cobra policy from her previous employment; even though it is very expensive. Also we have met the out of pocket maximum for the year, so I have no co-pays, Rx co-pays, or anything more that we have to pay out of pocket for the remainder of the year(or so I thought). Now we find out that her employer is changing to a completely different policy starting November 1st(instead of the beginning of the year like most normal places do). So, we are told that if we want to continue with the Cobra, we have to switch to a Cobra of one of their new policy options instead of continuing on with what we currently have(which does not offer us the same BCBS policy that all my Mayo Transplant docs are on. That makes no sense to me since it would be stupid to start all over with the deductible and out of pocket maximum in November, just to have to start over again 2 months later in January(as well as I need the same docs). In addition, we didn't consider other options back at the end of June, because we thought that it would be more cost effective in the long run considering we had met the out of pocket maximum. Can someone who understands the process explain how the fact that her ex-employer is changing policies then comes back to effect us? I guess I don't understand how once we are approved for Cobra, it has anything further to do with her previous employer.
 

showstopper83

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To make a long story short, my wife lost her job to CV-19 back in June and her new job does not offer health insurance yet. Since I have extensive continual health issues, we had to continue with the Cobra policy from her previous employment; even though it is very expensive. Also we have met the out of pocket maximum for the year, so I have no co-pays, Rx co-pays, or anything more that we have to pay out of pocket for the remainder of the year(or so I thought). Now we find out that her employer is changing to a completely different policy starting November 1st(instead of the beginning of the year like most normal places do). So, we are told that if we want to continue with the Cobra, we have to switch to a Cobra of one of their new policy options instead of continuing on with what we currently have(which does not offer us the same BCBS policy that all my Mayo Transplant docs are on. That makes no sense to me since it would be stupid to start all over with the deductible and out of pocket maximum in November, just to have to start over again 2 months later in January(as well as I need the same docs). In addition, we didn't consider other options back at the end of June, because we thought that it would be more cost effective in the long run considering we had met the out of pocket maximum. Can someone who understands the process explain how the fact that her ex-employer is changing policies then comes back to effect us? I guess I don't understand how once we are approved for Cobra, it has anything further to do with her previous employer.
I'm a former health insurance broker... If you lose your group health insurance, by law they have to continue to offer you COBRA coverage for up to 18 months after... If you have pre-existing conditions being covered by your old plan, keep it.

If not, shop something else. It's only really meant for people to not have to lose crucial coverage on pre-existing conditions if they lose their job... Otherwise, you're paying a ton more when you get start a fresh policy and pay way less.
 

muscle96ss

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I'm a former health insurance broker... If you lose your group health insurance, by law they have to continue to offer you COBRA coverage for up to 18 months after... If you have pre-existing conditions being covered by your old plan, keep it.

If not, shop something else. It's only really meant for people to not have to lose crucial coverage on pre-existing conditions if they lose their job... Otherwise, you're paying a ton more when you get start a fresh policy and pay way less.
I don't think you understand my question or concern. We are offered the Cobra for 18 months and are on the Cobra. But they want to change the actual policy we are on to a different insurer(BCBS to UHC) in November. The main issue is that we have already met the out of pocket maximum for the year with the BCBS so instead of paying $0 out of pocket in November and December for medical expenses; we will be paying a ton. And I am questioning the legality of forcing us to change companies and policy.
 

maldorf

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I don't think you understand my question or concern. We are offered the Cobra for 18 months and are on the Cobra. But they want to change the actual policy we are on to a different insurer(BCBS to UHC) in November. The main issue is that we have already met the out of pocket maximum for the year with the BCBS so instead of paying $0 out of pocket in November and December for medical expenses; we will be paying a ton. And I am questioning the legality of forcing us to change companies and policy.
Thats a really bad dilemma. Sorry you have to face that shit.

I was on cobra for about 2 months once and it paid for my first heart attack, bill was $120,000. Scary time for us. My wife had just lost her job. One thing I learned is that you can go on cobra retroactively. At the time I had chosen to go without insurance because I was healthy. i had the heart attack and in the hospital I told my wife to get us on cobra. There was no problem for us to get on it. So it covered the large hospital bill even though we were not enrolled when it happened. Just something to throw in there for you.

I wish I could advise you on your situation. I don't understand why the policy is going to end in November. I have never heard of that before. That is bullshit if they expect you to lose your benefit from this year and start over an entire month early. The big question, do you have some expensive medical care coming up in the last 2 months of the year or are you just being safe/proactive? I'm like you and would not want to gamble, that's for sure. Cobra is damn expensive too. I bet you are paying over $1000 a month for it. I cant remember how much ours was, but it was back in 2008 and I think it was close to $1k then.

I would go on the net and look up your state's government. I have a feeling there should be some department there that can answer your question. Companies have always made changes in healthcare for us at the first of the year, January 2021 for you. That part makes zero sense to me. Maybe you need to talk to HR again and get a clearer picture?

I JUST FOUND THIS AND IT LOOKS LIKE A PROMISING RESOURCE FOR YOU. I would use these links to contact a live person.



COBRA: Keeping Health Insurance After Leaving Your Job

Disclaimer: The American Cancer Society does not offer legal advice. This information is intended to provide general background in this area of the law.
The COBRA law gives people in certain situations an option to keep workplace health insurance for a while longer if they can’t get coverage in other ways. Workers need to be aware of health care laws that allow them to find or keep the health insurance they can best afford.
For detailed information about COBRA, call the Employee Benefits Security Administration at 1-866-444-3272 or visit their website at www.dol.gov/ebsa. You can also find a detailed brochure called An Employee’s Guide to Health Benefits Under COBRA.
Another good place to learn more details about COBRA is in your health insurance plan booklet or the person who manages your plan. Most of the specific rules on COBRA benefits can be found in one of these resources.
If you have questions about your state’s requirements about COBRA and health insurance, you can find your state’s insurance department by contacting the National Association of Insurance Commissioners.

So there you have a phone number to call, looks like federal. Then at the end of that quote there is a link to click on to find out about your state. I didnt go any further with it.

Here is the website I found it on.


 

muscle96ss

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Thats a really bad dilemma. Sorry you have to face that shit.

I was on cobra for about 2 months once and it paid for my first heart attack, bill was $120,000. Scary time for us. My wife had just lost her job. One thing I learned is that you can go on cobra retroactively. At the time I had chosen to go without insurance because I was healthy. i had the heart attack and in the hospital I told my wife to get us on cobra. There was no problem for us to get on it. So it covered the large hospital bill even though we were not enrolled when it happened. Just something to throw in there for you.

I wish I could advise you on your situation. I don't understand why the policy is going to end in November. I have never heard of that before. That is bullshit if they expect you to lose your benefit from this year and start over an entire month early. The big question, do you have some expensive medical care coming up in the last 2 months of the year or are you just being safe/proactive? I'm like you and would not want to gamble, that's for sure. Cobra is damn expensive too. I bet you are paying over $1000 a month for it. I cant remember how much ours was, but it was back in 2008 and I think it was close to $1k then.

I would go on the net and look up your state's government. I have a feeling there should be some department there that can answer your question. Companies have always made changes in healthcare for us at the first of the year, January 2021 for you. That part makes zero sense to me. Maybe you need to talk to HR again and get a clearer picture?

I JUST FOUND THIS AND IT LOOKS LIKE A PROMISING RESOURCE FOR YOU. I would use these links to contact a live person.



COBRA: Keeping Health Insurance After Leaving Your Job

Disclaimer: The American Cancer Society does not offer legal advice. This information is intended to provide general background in this area of the law.
The COBRA law gives people in certain situations an option to keep workplace health insurance for a while longer if they can’t get coverage in other ways. Workers need to be aware of health care laws that allow them to find or keep the health insurance they can best afford.
For detailed information about COBRA, call the Employee Benefits Security Administration at 1-866-444-3272 or visit their website at www.dol.gov/ebsa. You can also find a detailed brochure called An Employee’s Guide to Health Benefits Under COBRA.
Another good place to learn more details about COBRA is in your health insurance plan booklet or the person who manages your plan. Most of the specific rules on COBRA benefits can be found in one of these resources.
If you have questions about your state’s requirements about COBRA and health insurance, you can find your state’s insurance department by contacting the National Association of Insurance Commissioners.

So there you have a phone number to call, looks like federal. Then at the end of that quote there is a link to click on to find out about your state. I didnt go any further with it.

Here is the website I found it on.


Unfortunately, I do have a bunch more expenses expected before the end of the year. I have monthly Rx for life of my anti-rejection medicines. But more importantly I have 2 major surgeries that possibly need to happen.
 

maldorf

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Unfortunately, I do have a bunch more expenses expected before the end of the year. I have monthly Rx for life of my anti-rejection medicines. But more importantly I have 2 major surgeries that possibly need to happen.
Do your monthly meds expire fast and you're not able to get 90 days at a time? I get all of mine in 90 days supply. My most expensive is $650 for 3 months. In the beginning of the year we have to pay all of that. Im sure you are well aware of the yearly deductible. You're probably like me and hit the $4000 by the end of May. I'm about to hit our out of pocket max now too. Ours is $8k.

Call those phone numbers. I think you'll get some answers.
 

showstopper83

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I don't think you understand my question or concern. We are offered the Cobra for 18 months and are on the Cobra. But they want to change the actual policy we are on to a different insurer(BCBS to UHC) in November. The main issue is that we have already met the out of pocket maximum for the year with the BCBS so instead of paying $0 out of pocket in November and December for medical expenses; we will be paying a ton. And I am questioning the legality of forcing us to change companies and policy.
Oh fuck. That's some bullshit. I'm not entirely sure on that matter as I've never come across that.... But it doesn't sound right. You met your out of pocket max, the investor who purchased the policy should not have the ability to re-set the time when the max was met.

Tricky one, I have been out of insurance for years now... I can ask a buddy who still is in the game and see if he has even heard of that.

Could be one of those fine print Affordable Care Act details.

**EDIT** NOT STARTING THAT CONVERSATION!
 
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maldorf

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Oh fuck. That's some bullshit. I'm not entirely sure on that matter as I've never come across that.... But it doesn't sound right. You met your out of pocket max, the investor who purchased the policy should not have the ability to re-set the time when the max was met.

Tricky one, I have been out of insurance for years now... I can ask a buddy who still is in the game and see if he has even heard of that.

Could be one of those fine print Affordable Care Act details.

**EDIT** NOT STARTING THAT CONVERSATION!
Yeah, ive never been in that situation. I was on cobra for about 3 months but it was during the summer and fall. We got lucky and didn't have it at the end of the year .

Another thing regarding my case. For us it was back in 2008 when health care was still great. We had zero deductible and any hospital stay was just $500!! So my $110,000 bill cost us $500. Same with having our babies. I miss those days!
 

muscle96ss

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Do your monthly meds expire fast and you're not able to get 90 days at a time? I get all of mine in 90 days supply. My most expensive is $650 for 3 months. In the beginning of the year we have to pay all of that. Im sure you are well aware of the yearly deductible. You're probably like me and hit the $4000 by the end of May. I'm about to hit our out of pocket max now too. Ours is $8k.

Call those phone numbers. I think you'll get some answers.
I spoke with some people today and the answer that I keep getting is that if the ex-employer changes their policy then there is no policy to Cobra off of. Apparently the whole process is regulated by federal law and there is nothing anybody can do about. Everyone was sympathetic and agreed that it wasn't fair but that it is out of their control. However wife spoke with the people in charge at her ex-employee and they are now saying that if we have met the out of pocket maximum, as long as we can get the EOB's from BCBS that confirm that; they will honor that for the new policy. She has that in writing in an email; so we are going to hold them to it. I still have to have a TURP, chest catheter placement, long-term IV antibiotics for a chronic infection in the tansplanted kidney, and a lumbar fusion with hardware over the next couple of months.
 

maldorf

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I spoke with some people today and the answer that I keep getting is that if the ex-employer changes their policy then there is no policy to Cobra off of. Apparently the whole process is regulated by federal law and there is nothing anybody can do about. Everyone was sympathetic and agreed that it wasn't fair but that it is out of their control. However wife spoke with the people in charge at her ex-employee and they are now saying that if we have met the out of pocket maximum, as long as we can get the EOB's from BCBS that confirm that; they will honor that for the new policy. She has that in writing in an email; so we are going to hold them to it. I still have to have a TURP, chest catheter placement, long-term IV antibiotics for a chronic infection in the tansplanted kidney, and a lumbar fusion with hardware over the next couple of months.
Ok, sounds like you have a suitable answer then. So just get he EOB's, not sure what that stands for, to them like they ask and you should be set. Id still be nervous myself after that and youll want to follow up with them to be sure. Can you log onto your new account on the web and see that your out of pocket max was met?

So as long as you get everything in before the end of the year you should be good to go, or do you get even longer? To me it would reset at the end of the year like normal.
 

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