ACA/Cobra; do I have this correct?

[jim584672]

For those going on Medicaid it is retroactive up to 3 months prior to the month of application - in some circumstances.

13ADM-03 -Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010

All MAGI eligible individuals will receive fee-for-service coverage retroactive to the first day of month for which the individual is determined Medicaid eligible. For applicants, coverage will be retroactive to the first day of the month of application. Individuals may also qualify for Medicaid coverage of and/or reimbursement of medical bills incurred in the three-month period prior to the month of application.

 

[easysurfer]

Nov 15th isn't that far away

 

[GTFan]

Since my former employer's coverage ends January 31 I was thinking of using the 60 day Cobra grace period then sign up for an ACA plan to start in April thus saving 2 months of Cobra premiums and if we get sick we'll then pay the premium. I still have few months to decide whether or not to take advantage of this....

Same here, my coverage will end 12/31/14 I think. So given that, can I sign up on the exchange during open enrollment but delay ACA policy start until 3/1/15? That way I'll get the COBRA free ride for a couple months. I think this is very doable given that ACA open enrollment won't end until mid-Feb.

Reason why I'm interested is that it will essentially save me a couple of months' ACA Bronze 2015 premiums (assuming no health issues), and I won't get subsidies until 2016 so I'm paying full boat.

I don't think I would elect COBRA to get the extra 45 days then not pay the bill, that seems like stretching it a bit much. Can't they come after you for back payments since you elected coverage?

 

[pb4uski]

....Can't they come after you for back payments since you elected coverage?

I think there only recourse would be to deny claims from insured events occurring during the coverage period where the premiums was not paid.

 

[explanade]

ACA Open Enrollment is November?

I haven't gotten my COBRA packet yet, so don't know what the price will be.

My final date is in 2 weeks. I had looked at getting coverage for October through December but I guess I'd have little chance of meeting the deductible barring anything catastrophic.

So if the COBRA isn't too bad, use it through the end of the year should be the strategy?

 

[pb4uski]

It depends. How much deductible have you used so far this year and how much is left? How much is the difference in premium? If you are using the same insurer, oftentimes the deductible will carry over (mine did).

If you have used very little and there is a substantial premium difference, then go with the lower premium. If you have used a lot of the deductible and/or the premium difference is slight, then stay with the COBRA.

 

[Options]

Same here, my coverage will end 12/31/14 I think. So given that, can I sign up on the exchange during open enrollment but delay ACA policy start until 3/1/15? That way I'll get the COBRA free ride for a couple months. I think this is very doable given that ACA open enrollment won't end until mid-Feb.

Reason why I'm interested is that it will essentially save me a couple of months' ACA Bronze 2015 premiums (assuming no health issues), and I won't get subsidies until 2016 so I'm paying full boat.

I don't think I would elect COBRA to get the extra 45 days then not pay the bill, that seems like stretching it a bit much. Can't they come after you for back payments since you elected coverage?

Careful here! There is no such thing as a "free ride". With COBRA, the following is true:

1) You have 60 days from the date of loss of coverage to elect COBRA. If you fail to elect within that window of time, you have no coverage and can no longer sign up under COBRA;

2) It's true, you have up to 45 days after electing COBRA to make the first payment. So in theory you could wait 60 days to sign up, then wait another 45 days to pay. However, you must make payment for the entire 105 days (60 days + 45 days), amounting to a hefty payment due. If you fail to make payment, all medical care during that 105 days--including appointments, prescriptions, etc.--will not be covered. You will be on the hook for the full amount of all cost of care during that period. OTOH, if you wait the entire 105 days but still make payment, your coverage will be retroactive back to your very first day of loss of coverage (when your employer's medical insurance ended for you).

3) Yes, if you don't take any prescriptions and believe you won't need medical attention during that 105 days, you could choose to elect, delay payment by 105 days, and if you should have an unfortunate accident during the 105 days, make the payment then, with medical care retroactively covered. Downside is getting medical care without coverage during that emergency: you'll end up calling your old HR department who will have to coordinate between your medical care provider and the insurance problem. It will be anything but fun and the last thing you'll need during a medical emergency.

Something to think about.

In California, you can get COBRA for 18 months, and get another 18 months under CAL-COBRA, for a total of 36 months medical coverage. If these turn out to be less than coverage under the ACA, as is my case, it's a good deal.

 

[ziggy29]

I don't think I would elect COBRA to get the extra 45 days then not pay the bill, that seems like stretching it a bit much. Can't they come after you for back payments since you elected coverage?

They might not pay the claims while you were in arrears, but they can not cancel you until the 61st day and you are still not paid. If you don't pay after (say) 45 days and then you have a major expense, just make sure you retroactively pay all the premiums past due in addition to the current month and you will be covered. But yes, if you never paid it you'd be responsible for the large bill.

This is why there's not much risk with the strategy at certain times of year IF you do it right, but it could be risky if it's not done right or your retroactive payment isn't paid or credited timely enough.

 

[ERhoosier]

They might not pay the claims while you were in arrears, but they can not cancel you until the 61st day and you are still not paid. If you don't pay after (say) 45 days and then you have a major expense, just make sure you retroactively pay all the premiums past due in addition to the current month and you will be covered. But yes, if you never paid it you'd be responsible for the large bill.

This is why there's not much risk with the strategy at certain times of year IF you do it right, but it could be risky if it's not done right or your retroactive payment isn't paid or credited timely enough.

Agreed. IIRC there are no grace periods beyond the '60 + 45' days discussed. So you could be in DEEP dudu if that COBRA office were to somehow loose/misplace/ignore your 1st payment

 

[Theseus]

How much deductible have you used so far this year and how much is left? How much is the difference in premium? If you are using the same insurer, oftentimes the deductible will carry over (mine did).

1+

That's why I'm going with COBRA, premiums are high, yes, but being a "continuation of coverage" makes it worthwhile to retain what has already been shelled out for deductibles & out of pocket expenses. Knowing we will have more medical expenses yet this year makes that an easy choice.

FWIW, employer did have a "retiree insurance" available, but the premiums, deductible, etc were all higher than the COBRA/group plan; 2014 income will be too high to benefit from going with ACA coverage.

One caveat I learned after taking ER though, is that 18 month COBRA coverage is not guaranteed. Because it is a continuation of your employer's group health coverage, if the employer jettisons that plan, you might be shopping for new coverage anyway. Found that out due to prior employer being a target in a merger, new owners may keep the existing plan in force, but are not obligated to do so. I am thinking they may keep the existing plan active until year's end, otherwise they will certainly have several thousand 'new' employees mighty unhappy if their deductibles all get set back to zero - and I am assuming retirees on COBRA should be able to tag along on that. States may have other additional protections, my state does but it too has loopholes big enough to lose coverage for up to 60 days. Some other tidbits in there too, about requirements to notify employees, and retirees, if plan is being tossed - and failure to comply makes employer liable for any expenses incurred.

When initiating COBRA the other day I was advised payment for coverage is being requested in advance, so on the first of the September when my COBRA coverage begins, I'm told 2 months premiums will be due. Double the ouch factor, but knowing our healthcare costs will easily exceed the premiums, I'll comply without complaint.

 

[rodi]

I was in cobra limbo recently.

They *can* deny coverage (especially for prescriptions) while it's being sorted out.
My last day of work was 6/19. Kaiser was notified I was no longer covered as of 6/20. I got the cobra paperwork - which was messed up...spent a few hours straightening it out and they got me new paperwork about 6/27. In the meantime, my husband was denied lab work by Kaiser, and his mail order prescriptions were "held".

Got my payment in... and the company hired by my former employer to manage cobra sends Kaiser the info... with mistakes. (Only coverage for me, even though I paid family coverage.)

I had a doctor appt - was covered. Discovered my son wasn't covered when I took him in for a staph infection he got during sailing camp. I signed paperwork agreeing to pay if it wasn't straightened out. Went to the pharmacy and found out the antibiotic was $168.

Spent more hours on the phone with the corporation hired by my former employer, my former employer, and Kaiser member services. At one point had all 3 on a conference call. Was assured it would be fixed that day.

2 days later the company that Kaiser outsources mail order prescriptions calls to say they are cancelling my husbands order again. Back on the phone to all 3 parties....

In theory it's solved now.

My point is coverage can be denied if you don't pay promptly - or even if you do and they don't process the payment properly.

As to why I'm on cobra vs the exchange - I compared my group rates (cobra) of *total* costs (copays, deductibles, etc) and the equivalent coverage would be about $700/month more on the exchange. For me, the megacorp group discount made the cobra worth the hassle. We'll be changing to an HSA high deductible plan after the first of the year.

 

[explanade]

It depends. How much deductible have you used so far this year and how much is left? How much is the difference in premium? If you are using the same insurer, oftentimes the deductible will carry over (mine did).

If you have used very little and there is a substantial premium difference, then go with the lower premium. If you have used a lot of the deductible and/or the premium difference is slight, then stay with the COBRA.

Well my employer coverage doesn't have any deductibles, just copayments.


I was referring to getting an ACA plan for the final 3 months of this year. I would be paying for everything I suppose, though the prices may be lower if I was insured. Unlikely to hit the $5k deductible or whatever the Bronze plan is, unless there was a catastrophe.

 

[madbrain]

I was in cobra limbo recently.

They *can* deny coverage (especially for prescriptions) while it's being sorted out.

Actually, they cannot legally do so. All COBRA coverage is supposed to be retroactive. They have to cover for all services you during the 60 day COBRA election period if you tell them that you are electing COBRA.

My last day of work was 6/19. Kaiser was notified I was no longer covered as of 6/20. I got the cobra paperwork - which was messed up...spent a few hours straightening it out and they got me new paperwork about 6/27. In the meantime, my husband was denied lab work by Kaiser, and his mail order prescriptions were "held".

Got my payment in... and the company hired by my former employer to manage cobra sends Kaiser the info... with mistakes. (Only coverage for me, even though I paid family coverage.)

I had a doctor appt - was covered. Discovered my son wasn't covered when I took him in for a staph infection he got during sailing camp. I signed paperwork agreeing to pay if it wasn't straightened out. Went to the pharmacy and found out the antibiotic was $168.

Spent more hours on the phone with the corporation hired by my former employer, my former employer, and Kaiser member services. At one point had all 3 on a conference call. Was assured it would be fixed that day.

2 days later the company that Kaiser outsources mail order prescriptions calls to say they are cancelling my husbands order again. Back on the phone to all 3 parties....

In theory it's solved now.

My point is coverage can be denied if you don't pay promptly - or even if you do and they don't process the payment properly.

As to why I'm on cobra vs the exchange - I compared my group rates (cobra) of *total* costs (copays, deductibles, etc) and the equivalent coverage would be about $700/month more on the exchange. For me, the megacorp group discount made the cobra worth the hassle. We'll be changing to an HSA high deductible plan after the first of the year.

I had an issue a few years ago where I needed an emergency shot just a few days after my Kaiser work coverage ended. I was told I was not covered at the injection clinic.

This was before my former employer even had a chance to send me any COBRA paperwork.

I went downstairs to the Kaiser business office and they made me sign a letter that I was in my COBRA election period and would be electing COBRA, and that I would be responsible for all charges if COBRA premiums were not received in a timely manner.

I was then covered immediately. My employer plan had zero copay for injection, and I paid nothing out of pocket to get my injection.

It was only a minor inconvenience that wasted less than an hour of my time. I am glad it could easily be dealt with in person and not on the phone. I never received any bill subsequently.

Sorry that you were not treated the same way by Kaiser. I would not have accepted labwork or prescriptions being held during the COBRA period. In your situation, if Kaiser denied services. What would you have done if it was an emergency ? Even prescriptions can be an emergency - in case of my HIV meds for example, I cannot miss one day of them, without risking becoming resistant to them. But an ER still won't dispense these meds even though getting them is an actual emergency.

If Kaiser had treated me the way they treated you, I would have gone to the state insurance commissioner, the media, etc.

 

[Theseus]

I was in cobra limbo recently. They *can* deny coverage (especially for prescriptions) while it's being sorted out.

Currently in limbo. Retired 8/1 (employer group plan covered us until 8/31), Cobra paperwork generated 8/5, on 8/19 initiated Cobra coverage to be effective 9/1 and was advised bill would come in "about" 1 week. Confirmation of Cobra enrollment paperwork generated 8/20, it also included reference to bill that would be coming and requirements for timely payment.

Actually, they cannot legally do so. All COBRA coverage is supposed to be retroactive. They have to cover for all services you during the 60 day COBRA election period if you tell them that you are electing COBRA.

DW was scheduled for surgery on 9/2. On the afternoon of 8/29 doctor's office advises BCBS IL was not approving procedure. Contacted BCBS IL and was told there was no record of prior non-surgical alternatives so they would not approve. Total BS, as BCBS had been paying for those very non-surgical alternative methods the entire calendar year. Customer rep, and their supervisor both said "there is nothing we can do". To me, that was a red flag indicating something else was amiss. On morning of 9/2 DW contacted doctor's office and insurance situation still not improving. I also contacted ex-employer's benefits department, requested expedited handling of billing, no sorry, can't do that either. Only option to go ahead with surgery was to sign off accepting full responsibility for payment, and then "if" and "when" Cobra insurance payments were acknowledged try to get the insurance company to credit/retroactively reimburse us.

But, I have not even yet received the stinking bill, which I fully intend to pay in a timely manner. Oh, but BCBS did manage to send us cancellation notices received on 9/2. So yes, Cobra provides legal rights to continuation of coverage, but it is obvious to me that the insurance company, in this case BCBS IL has so little concern for patient wellbeing that even though they know Cobra coverage has been elected they will deny approvals for procedures and stonewall the consumer. While I understand there would be legal protection, it hinges on premium payments being made, credited, and acknowledged it a timely manner. Do I trust that process would be as efficient as the mailing of cancellation notices? Absolutely not.

So the net result was to postpone the procedure and wait until things are "sorted out", as Rodi indicated above.

<rant>Thankfully, it is not a life threatening condition, but most certainly does affect quality of life, and what probably frustrates me the most about this is that I did the ER thing to get away from the bureaucratic quagmire. And here I am, still up to my armpits in that same nonsense, just from a different source. </rant>

 

[travelover]

...............
<rant>Thankfully, it is not a life threatening condition, but most certainly does affect quality of life, and what probably frustrates me the most about this is that I did the ER thing to get away from the bureaucratic quagmire. And here I am, still up to my armpits in that same nonsense, just from a different source. </rant>

True, but one advantage of being retired is that you have all the time in the world to pester, hound and harass them until they do right by you. Ask me how I know...

 

[LastOfTheBoomers]

Cobra from Megacorp was $1,058 for two of us and bronze was $735 a month. If you are healthy and not on any long term drug therapies - it makes sense. YMMV

 

[rodi]

Currently in limbo. Retired 8/1 (employer group plan covered us until 8/31), Cobra paperwork generated 8/5, on 8/19 initiated Cobra coverage to be effective 9/1 and was advised bill would come in "about" 1 week. Confirmation of Cobra enrollment paperwork generated 8/20, it also included reference to bill that would be coming and requirements for timely payment.



DW was scheduled for surgery on 9/2. On the afternoon of 8/29 doctor's office advises BCBS IL was not approving procedure. Contacted BCBS IL and was told there was no record of prior non-surgical alternatives so they would not approve. Total BS, as BCBS had been paying for those very non-surgical alternative methods the entire calendar year. Customer rep, and their supervisor both said "there is nothing we can do". To me, that was a red flag indicating something else was amiss. On morning of 9/2 DW contacted doctor's office and insurance situation still not improving. I also contacted ex-employer's benefits department, requested expedited handling of billing, no sorry, can't do that either. Only option to go ahead with surgery was to sign off accepting full responsibility for payment, and then "if" and "when" Cobra insurance payments were acknowledged try to get the insurance company to credit/retroactively reimburse us.

But, I have not even yet received the stinking bill, which I fully intend to pay in a timely manner. Oh, but BCBS did manage to send us cancellation notices received on 9/2. So yes, Cobra provides legal rights to continuation of coverage, but it is obvious to me that the insurance company, in this case BCBS IL has so little concern for patient wellbeing that even though they know Cobra coverage has been elected they will deny approvals for procedures and stonewall the consumer. While I understand there would be legal protection, it hinges on premium payments being made, credited, and acknowledged it a timely manner. Do I trust that process would be as efficient as the mailing of cancellation notices? Absolutely not.

So the net result was to postpone the procedure and wait until things are "sorted out", as Rodi indicated above.

<rant>Thankfully, it is not a life threatening condition, but most certainly does affect quality of life, and what probably frustrates me the most about this is that I did the ER thing to get away from the bureaucratic quagmire. And here I am, still up to my armpits in that same nonsense, just from a different source. </rant>

Interesting that it was BCBS IL. Even though I have Kaiser Permanente - the corporate preferred plans are through BCBS IL - and cobra is handled by HCSC, which is partners/owner/subsidiary of BCBS IL (and BCBS TX and a few others.) So my COBRA paperwork is generated by HCSC, but half of the documenation states BCBS IL. I am not, unfortunately, surprised that they denied the surgery.

As far as my son's prescription. I signed paperwork for the doctors appt saying I would be responsible if the COBRA didn't come through. The pharmacy didn't offer the same thing - after talking to a supervisor I was advised to pay in full, then submit a claim for reimbursement. I did that - and am still waiting for the check. It's been a few weeks, so I should probably follow up. I was not offered the opportunity to sign a form promising payment if cobra didn't come through. The business offices are about 15 miles from the satellite office & pharmacy I was at so there was no one onsite to go talk to.

 

[madbrain]

True, but one advantage of being retired is that you have all the time in the world to pester, hound and harass them until they do right by you. Ask me how I know...

I think that's the case for pretty much anyone who wants to elect COBRA, retired or not.

But it's not right for the insurers to act the way they do. They know you probably aren't going to complain to your former employer HR, so you lose a lot of the leverage of being in a group when you go on COBRA.

 

[madbrain]

DW was scheduled for surgery on 9/2. On the afternoon of 8/29 doctor's office advises BCBS IL was not approving procedure. Contacted BCBS IL and was told there was no record of prior non-surgical alternatives so they would not approve. Total BS, as BCBS had been paying for those very non-surgical alternative methods the entire calendar year. Customer rep, and their supervisor both said "there is nothing we can do". To me, that was a red flag indicating something else was amiss. On morning of 9/2 DW contacted doctor's office and insurance situation still not improving. I also contacted ex-employer's benefits department, requested expedited handling of billing, no sorry, can't do that either. Only option to go ahead with surgery was to sign off accepting full responsibility for payment, and then "if" and "when" Cobra insurance payments were acknowledged try to get the insurance company to credit/retroactively reimburse us.

Sorry to hear about your ordeal.

Are you saying that the insurance company is requiring you to sign off accepting responsibility for payment, and also requiring payment in full upfront ? That is wrong and illegal.

But IMO, if they are merely requiring signing off and accepting responsibility, but not requiring immediate payment prior to the surgery, that should be fine, and you should proceed. They can bill you and then credit you once you receive the bill for the COBRA premium from your employer, and pay it.

 

[madbrain]

As far as my son's prescription. I signed paperwork for the doctors appt saying I would be responsible if the COBRA didn't come through. The pharmacy didn't offer the same thing - after talking to a supervisor I was advised to pay in full, then submit a claim for reimbursement. I did that - and am still waiting for the check. It's been a few weeks, so I should probably follow up. I was not offered the opportunity to sign a form promising payment if cobra didn't come through. The business offices are about 15 miles from the satellite office & pharmacy I was at so there was no one onsite to go talk to.

I hope it wasn't too large of an amount for the prescription.
The meds for myself and my husband add up to about $5,000 per month. I would never pay upfront if on COBRA. Fortunately, Kaiser gives me 100 day supply with one copay, so last time I went on COBRA, I didn't need refills until after the COBRA situation was sorted out.

 

[iac1003]

DH was hospitalized with several pulmonary emboli when we were in the 30 day grace period after I left Federal employment and before COBRA began. 3 years later all the bills aren't completely straightened out.


Sent from my iPhone using Early Retirement Forum

 

[MRG]

......snip......

But it's not right for the insurers to act the way they do. They know you probably aren't going to complain to your former employer HR, so you lose a lot of the leverage of being in a group when you go on COBRA.

My experience was very different. I never contacted benefits department about insurance until I was on COBRA. Megacorp didn't act any different to me as an ex employee. My experience may be the 1 in 1000000.

My COBRA got jacked up, suddenly didn't have coverage, one call to Mega and its fixed. My DW's Medicare refused to pay as they thought she was covered by my expired company benefits. One call to Megacorp benefits and that was fixed. The list goes on. Highly recommend involving your ex employer for issues.

 

[athena53]

<rant>Thankfully, it is not a life threatening condition, but most certainly does affect quality of life, and what probably frustrates me the most about this is that I did the ER thing to get away from the bureaucratic quagmire. And here I am, still up to my armpits in that same nonsense, just from a different source. </rant>

I hear ya. I left on May 9 and was scheduled for a sprint triathlon on May 17. When I didn't get anything on COBRA after a few days I called my previous employer and they told me that it would be handled by a third party company. That company didn't even have the material from them yet. They gave me the same song and dance others got here: just tell them you don't have any coverage but you WILL sign up for COBRA when you get the paperwork and they'll treat you. Don't worry, be happy.

I was paranoid as heck that I'd crash into another bicyclist and end up in the ER and have to hand over every credit card in my wallet to get treated. All went well, I got the paperwork after the triathlon and then we bought a private policy for me and got DH on Medicare. This whole insurance coverage process has been the most stressful part of retiring and I'm a retired actuary so I know the jargon better than the average consumer.

My DW's Medicare refused to pay as they thought she was covered by my expired company benefits.

Yeah, that happened to us with DH, too. I guess it's nice that Medicare is tracking the existence of other coverage since any other coverage is primary (so they're saving taxpayer dollars) but it would be even nicer if they also got prompt info when that coverage ended.

 

[Theseus]

Are you saying that the insurance company is requiring you to sign off accepting responsibility for payment, and also requiring payment in full upfront ? That is wrong and illegal.

Insurance company is saying coverage has expired. Which would technically be correct.

Cobra payment is to be made to 3rd party benefits department of ex-employer, but I have not yet received a bill with remittance instructions so that I can pay it (Cobra coverage was elected 8/19, paperwork confirming that was prepared 8/20). Meanwhile, the clock is ticking on deadlines for payment.

 

[rodi]

I hope it wasn't too large of an amount for the prescription.
The meds for myself and my husband add up to about $5,000 per month. I would never pay upfront if on COBRA. Fortunately, Kaiser gives me 100 day supply with one copay, so last time I went on COBRA, I didn't need refills until after the COBRA situation was sorted out.

Not budget breaking - but still significant. The antibiotics were $168, instead of a $20 copay. I can aborb that - but shouldn't have to.

As far as contacting former employer - that was one of the places I called. And they referred me to the COBRA company they outsource with - HCSC... who are the folks that jacked it up in the first place.

I *think* it's straightened out now. Kaiser sent me new cards (that are exactly like the old cards - same id's.) But I still don't know where my premiums went if they weren't being sent to Kaiser. Health Care Services Corporation was pretty prompt in cashing the payment checks.