Retiree Dependant coverage after age 65

[Katsmeow]

I am trying to figure out what health coverage is available to me as the spouse of my husband and for our children if he retires and then turns 65.

DH is 62 and would like to retire sometime next year. I am currently covered through his plan as are our children. We could be covered on my employer's plan but have chosen not to since the coverage through his plan is better.

If DH retires he has subsidized retire medical and dental coverage and can continue to cover dependents who were covered at the time he retired. That seems to clearly mean the family coverage continues. This is important because I would prefer to also retire before 65 and my employer does not provide any retiree coverage. Therefore I have to either be covered through DH's plan, buy individual coverage on the open marktet and see if I can obtain coverage under the Texas High Risk pool.

What is unclear to me is whether the dependent coverage ends when DH turns 65. The retiree handbook is less than clear. There is a chart that shows that for pre-65 medical DH is entitled to subsideized medical. The hart then has a heading for post-65 medical and says that "Part D coverage paid by Megacorp if...[lists conditions that do apply to DH."

The handbook also says "Your dependent(s) for whom you provided medical or dental coverage at the time of your retirement will continue to be eligible for coverage as long as:

They meet the definition of an eligible dependent....

You continue to be eligible for retiree medical and/or dental plans."

The question I have is whether DH is considered to still be eligible for the retiree medical plan once he turns 65 and is only eligible for the Post-65 retiree prescription drug plan. The handbook says that if DH turns 65 he "will automatically be enrolled in the Post-65 retiree prescription drug plan..."

Anyone have any idea what that means? Does that mean that when he turns 65 that the kids and I lose coverage?

If we do, are we eligible for COBRA? If we do, will we be eligible for the Texas High Risk plan? If so, that might be an option.

I look thoroughly at all the plan documents at the Megacorp benefits website and could find nothing directly on point. One document says that if a participant becomes eligible fore Mecare that the plan administrator "will permit the Participant to make an election to cancel coverage of the Participant, spouse or Dependent..." This document though is not really talking about retiree coverage.

Another SPD says that if "you are the spouse of a Participant who is eligible for COBRA coverage" then you can get continuation coverage if you lose coverage for any of several listed reasons. One reason given is "Your spouse becomes entitled to Medicare benefits...." What is not clear to me is if that is something that is required by law to be in there. That is, can I read into this statement that I (and our kids) would lose coverage when he becomes entitled to Medicare?

I do realize DH can probably ask the benefits people at his company. He has always been reluctant to do that because he didn't want people to know he was thinking of retiring.

Obviously this is a big issue. If I lose coverage in 3 years then that concerns me. My great fear is not so much the cost of coverage but what if I get turned down (also 2 of our children have non-serious medical conditions that will nonetheless likely make it difficult for them to get coverage)?

On the other hand I hate the idea of having to stay employed for the next 10 years just to get health insurance.

One option might be the Texas High Risk pool. Does anyone have any experience with it? I read the eligibility and it looks like it is fairly easy to meet the requirements although it is fairly expensive.

Eligibilty Requirements for Obtaining Coverage from the Texas Health Insurance Risk Pool.

 

[Moemg]

All I know is the federal government allows the retiree to keep the family & dependents same coverage even after the retiree turns 65 as long as they were on the policy before he retired . So the 65 year old goes on medicare and the policy is his supplement while the family and dependents coverage stays the same .

 

[Martha]

I think that you have no choice but to ask and then have them confirm what they say by showing your husband the provisions in their plan which apply. Your husband might be able to present his questions as relating to concerns about the fact that he has a young wife and minor children so he needs to know what may happen with them when he eventually retires or dies.

We just don't have enough information and some of the info you quoted seems inconsistent.

Keep in mind that there is a good chance the employer can change the rules down the road, so nothing is guaranteed.

If it turns out that you are not eligible for coverage at some point, such as when he starts Medicare, then you would be entitle to COBRA benefits. The Texas risk pool is easy to get in if you are HIPAA eligible. You should be HIPAA eligible provided that you use up COBRA first. Of course, with health insurance reform who knows what the landscape will look like a few years from now.

 

[Katsmeow]

I think that you have no choice but to ask and then have them confirm what they say by showing your husband the provisions in their plan which apply. Your husband might be able to present his questions as relating to concerns about the fact that he has a young wife and minor children so he needs to know what may happen with them when he eventually retires or dies.

We just don't have enough information and some of the info you quoted seems inconsistent.

Keep in mind that there is a good chance the employer can change the rules down the road, so nothing is guaranteed.

If it turns out that you are not eligible for coverage at some point, such as when he starts Medicare, then you would be entitle to COBRA benefits. The Texas risk pool is easy to get in if you are HIPAA eligible. You should be HIPAA eligible provided that you use up COBRA first. Of course, with health insurance reform who knows what the landscape will look like a few years from now.

Yes, I think you are right on all points. The wording seems somewhat inconsistent to me as well. And, I think that as attorneys we probably parse words more closely than most people and perhaps notice that kind of thing.

I did research the COBRA thing enough to find out that if I do lose eligibility when he turns 65 that the kids and I would have 36 months of COBRA. I believe that state continuation coverage is another 6 months beyond that. I will be 58 1/2 when he turns 65 so the COBRA and continuation would take me to 62.

So, the issue would be whether to continue working for the next 7 years just to have coverage then when there is no guarantee my current employer will still offer coverage (or even exist) 7 years from now.

It is, of course, the case that DH's employer could drop retiree coverage altogether. But again do I let that keep me from retiring?

The Texas High Risk pool looks expensive but decent so looks like an acceptable alternative. But, then, again I don't know if it will still be there in 7 years. And, of course, health reform be a factor that we really can't weigh at this point.

I'm not so much worried about the cost of future coverage (within reason) as I am about availability of something. I am very risk averse but, even so, I don't really want to continue working for 10 more years until medicare just to guard against the health insurance risks.