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You lost your work with health insurance, what are your options to obtain health insurance?

When one loses their job with health insurance, next to finding a new job, an important aspect to consider is how to find suitable health insurance for you and your family. With the Implementation of the Affordable Care Act and the mandate of carrying health insurance or otherwise possible paying a tax penalty, this is highly important.

Loss of Work what happens with my health insurance >

You have the option of enrolling in COBRA continuation coverage, or possibly enrolling in other more affordable health insurance options. In the time frame of 60 days, from the time of termination of employment with health insurance, you are in the so called “Special Enrollment Period”. In this Period you have the choice to obtain obtain health insurance via the state exchange, in California, Covered California the private Individual Health Insurance Market outside the exchange, and/or Group Health Insurance with your spouse’s group health plan, next to the option of the COBRA election. Outside the “Special Enrollment Period,” past the 60 days, the only other option left is a) Medical the State Welfare Program in California your income needs to be in the 139% of the poverty level, or b) short term health insurance, which are not Affordable Care Act compliant and may result in tax penalties.

Solid Health Insurance Services will assist you in making the determination in either to elect the COBRA continuation or the option to select an Individual Health insurance in or off the exchange (Covered California,) and /or other coverage options which best suit you and your family needs.

Individual Health insurance inside the exchange or outside the exchange:

Quite often the Individual Health Insurance Plans inside or outside the exchange are more competitive priced than your COBRA continuation health plan; however, you should always compare the benefits of Cobra versus Individual health plans and their networks. Keep in mind that you have to apply in the 60-day period for the Individual Health Plans, and follow the Election Period Time Frame when choosing the COBRA continuation.

If you foresee that your Modified Adjusted Gross Income (MAGI) is below 400 % of the poverty level, then the best option might be the state exchange in California (Covered California) as they offer subsidies towards paying your health premium. Solid Health Insurance Services may assist in this important selection choice. Covered California, California’s state exchange, offers “one-stop shopping” to find and compare private health insurance options. You could be eligible to a tax credit which instantly lowers your monthly premiums and cost-sharing reductions to help you calculate what your premium and deductibles are before you make your choice to enroll. On covered CA, you will also get to know whether you qualify for free or low-cost coverage from Medical

When can I enroll in Individual Health Insurance Off Exchange or On Exchange (Covered California?)

Individual Health Insurance coverage offers you 60 days to enroll from the day you lose your job-based coverage as a special enrollment period. The special enrollment period lasts for 60 days and once your special enrollment period ends, you will not be able to enroll. In addition to this, there is an open enrollment period in which anyone can enroll in Individual Health Insurance, from 11/1/2016 to 01/31/17, should you have decided to enroll in the Cobra continuation coverage.

Can I switch between the coverage plans after choosing one plan i.e. if I choose COBRA continuation coverage, can I switch to individual health insurance and vice-verse?

If you enroll in COBRA continuation coverage, you can switch to an individual health insurance plan during the “Open Enrollment Period” (November 1st -January 31st). In addition to this, you can also end COBRA continuation coverage early and switch to individual health insurance, if you have a qualifying life event, such as getting married, birth of a child, etc.- but, be careful, if you terminate your COBRA continuation coverage without a qualifying life event, you will end up without any health coverage, which may result to pay a tax penalty for not carrying health insurance. You will have to wait until the next Open Enrollment Period to enroll in an individual health insurance inside the exchange (Covered California in California) or outside the exchange.

Once you have exhausted your COBRA continuation coverage and the coverage expires, next, you will enter the Special Enrollment Period (60 days). During this time period you are eligible to sign up for individual health insurance coverage, even if we are outside the Open Enrollment Period.

If you decided to choose the Individual Health Insurance Plan instead of the COBRA continuation coverage, you cannot switch to COBRA continuation coverage under any circumstances.

Is there option to enroll in another group health plan

You may be eligible to enroll in another group health plan (like your spouse’s group health plan), if you request enrollment within 30 days of loss of coverage. The best practice is to check with the group coordinator of your spouse’s health plan.

If you select COBRA continuation coverage rather than enrolling in another group health plan for which you are eligible, you will receive an opportunity to sign up in other group health plans within 30 days of losing your COBRA continuation coverage.

What to look for while choosing a coverage option?

There are certain things which are most necessary to look for in a coverage plan:

  • Premiums: If you choose COBRA coverage under one of the plans, then you could be charged up to 102% of the plan’s cost to provide that same coverage to a similarly situated plan participant or beneficiary who is not receiving continuation coverage. On the other hand, coverage through spouse plans or through individual health insurance may cost lesser.
  • Provider network: If you are under care or treatment for a condition, then a change in your health care plan may affect your access to a particular healthcare provider. You might wish to check if your current health care provider participates in a network as you consider other health coverage options.
  • Drug Formularies: If you are under medication then health coverage change can affect your costs of medication. In some cases, your medication might not be covered by another plan. You might wish to check whether your medication is listed in drug formularies for other health coverage or not.
  • Severance payments: If you lost your job and got a severance package from your former employer may have offered to pay some or all of your COBRA payments for a particular span of time.
  • Service Areas: There are some plans that limit their benefits to specific service or coverage areas. So, if you move to another part of the country, you may not be able to take full advantages. You might wish to check if your plan has a service area or other such limitations or not.
  • Other cost sharing: Along with premiums, you probably pay copayments, deductibles or such other amounts to use your benefits. You might wish to check for cost sharing requirements for other health coverage options.

How can I sign up COBRA continuation coverage?

To select COBRA continuation coverage, you must complete the Election Form provided by the employer or insurance carrier, and submit it according to the information and guidelines on the form. Each qualified beneficiary has separate right to select continuation coverage. Each continuation coverage plan can be elected for only one, several, or for all dependent children that are qualified beneficiaries. As a parent, you can select to continue coverage on behalf of any dependent children.

If I elect COBRA continuation coverage, when and how long my coverage will last?

Once you have selected your coverage, coverage will begin retroactively following the month you lost your job and generally last 18 months; however, for exception and plan continuation, please read your plan specific Cobra election paperwork.

In some circumstances, such as failure to pay premiums, frauds, etc., COBRA continuation coverage may end before the above date.

Solid Health Insurance Services will assist you in making the determination if either the COBRA continuation or the option to select an Individual Health insurance inside or outside the exchange (Covered California) and /or other coverage options best suits your and your family needs.

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