Postponing the Health Insurance Purchase

"I don't need health insurance since I am healthy". No matter how often I hear that it never makes sense.

The guy in the casket at the front of the church probably could use some life insurance but unfortunately it is too late to do anything about it.

Same for health insurance.

You can't buy it once you get sick.

Almost 2 months ago I was referred to a lady who would be needing health insurance when her COBRA expired at the end of September. I called and was told she was busy with other things but she would get around to it soon.

Over the next few weeks we had sporadic contact and then about 3 weeks ago she finally got serious about it. After going back & forth on options she finally agreed to complete an application for coverage. Even then it was a challenge to keep her on task.

Last week she faxed the application to me for review. The next day she emailed to say she had an exam including a colonoscopy scheduled for a few days later. We went through several questions, including questions about any symptoms or family history that might have prompted the colonoscopy.

She assured me there was nothing in her history but her doctor thought it would be a good idea.

By now the only thing we could do was submit the application and hope for the best. During the phone interview with the underwriter they noted she had filled a prescription for Movi-Prep . . . a medication to purge the bowels in advance of the exam.

The carrier opted to postpone taking any action until AFTER the colonoscopy. They were well within their right to do so.

Fast forward to today.

I got a call from her ex, telling me the results of the exam. They found 6 polyps and have sent them off to pathology and are awaiting the results.

Hopefully she will have a good prognosis, but this does put a kink in any plans for applying for health insurance. Now she will have to wait 12 months at a minimum, have a follow up colonoscopy and hope it is clear. Even then, there is no guarantee she can get coverage then.

And about that expiring COBRA . . .

Her only option now is to apply for coverage through the state risk pool.

Sometimes when an agent suggests moving forward it is best to listen to them rather than putting off a decision that limits your options.

COBRA, What is it? How does it work?

A short video from the folks at Humana. Learn about COBRA in  3 minutes, 28 seconds.

For more information on COBRA, check out COBRA insurance.

You may able to qualify for major medical that is more affordable than COBRA.

COBRA, ARRA . . . Gotcha!

Just when you thought it was safe . . . the land shark is at your door.

So you thought the Porkulus Bill and the ARRA (American Recovery and Redundancy Act) was a good deal for those who opt for COBRA, right? After all, your employer is required to pay 65% of your COBRA premium for up to 9 months so life should be good.

Not so fast Sparky.

By any chance did you have a Flex (FSA) plan in place for your group health insurance? If so, there may be a gotcha.

According to the folks at Conexis, this little goody is buried in the law according to a recent release from your friends at the U.S. Treasury.

COBRA premium reduction is available for any group health plan EXCEPT . . . vision only, dental only, mini-med plans, and . . . those administered under Section 106(c) as part of a flex spending plan. (See the bottom of page 3 and top of page 4 of the linked document).

Having fun?

I knew you were.

A Stimulating Conundrum

Washington’s idea of a stimulus package seems to be springing leaks. They want to spend taxpayer money to create jobs and stimulate the economy.

So why are they buying condoms from China?

the U.S. Agency for International Development, which has distributed an estimated 10 billion U.S.-made AIDS-preventing condoms in poor countries around the world.

But not anymore.

They will still be handing out condoms, just not ones made in the United States.

In a move expected to cost 300 American jobs, the government is switching to cheaper off-shore condoms, including some made in China.

Outsourcing condoms. What is the world coming to?

“Of course, we considered how many U.S. jobs would be affected by this move,” said a USAID official who spoke on the condition that he would not be named. But he said the reasons for the change included lower prices (2 cents versus more than 5 cents for U.S.-made condoms) and the fact that Congress dropped “buy American language” in a recent appropriations bill.

Makes you wonder how effective is a 2 cent condom?

Or a nickel one for that matter.

Besides, he said, the sole U.S. supplier — an Alabama company called Alatech — had previous delivery problems under the program.

Delivery problems. Probably a joke in there somewhere but this is serious business.

It’s clear that Alatech’s problems over the years, which apparently have been resolved, may have driven U.S. officials to seek much less expensive foreign-made condoms in the first place.

But that’s cold comfort to Fannie Thomas, who has been making AIDS-preventing condoms in southeastern Alabama for nearly 40 years in the small town of Eufaula.

When the company loses this contract the plant will have no choice but to shut down, putting some 300 people, including Fannie Thomas, out of work.

Many residents in Georgia are losing their job and their health insurance. Sometimes COBRA is an option, sometimes not. There are many low cost alternatives available including short term medical, high deductible catastrophic health insurance as well as traditional health insurance plans.

Options for the Unemployed

Insurance giant Aetna released a report which is a poor reflection on our ability as agents to get the word out about Georgia health insurance plans.

With unemployment exceeding 8%, thousands are finding themselves out of work and (apparently) no clue about their health insurance options.

The survey found that 69 percent of consumers had never heard of individual health insurance plans or did not know much about them. While general awareness of COBRA plans was higher, 38 percent of respondents said they expected to pay the same premiums as when they were employed.

Some of the blame can lie at the feet of employers who rarely do enough to educate their workforce on the value of health insurance benefits. But I find it almost incredulous that 69% have never heard of individual insurance plans. [Read more…]

Pig Farts and COBRA

LBJ conceived the Great Society to eliminate poverty and racial injustice.

George H. W. Bush created the No Child Left Behind to provide quality basic education to all children.

Obama is promising there will be No Patients Left Behind as part of his master plan to save the USA from economic collapse.

We still have poverty, racial inequity and students in public schools are still failing. So will the Spendulus Bill with promises to end inequity in health care and provide universal coverage succeed? Will there be No Patients Left Behind?

Let's see what Cassandra Kelsey has to say about that.

Cassandra lost her job with Verizon in January.

Kelsey walks with a cane and lists a litany of ailments, including degenerative arthritis and hypertension. For her, going without health insurance is unthinkable.

COBRA became law in 1986 and provided, among other things, a way for employees to continue their group insurance plan for up to 18 months (in most cases), providing them a way to bridge over to their next job with benefits. For the last 22+ years employees have had an option to assure they would not be without health insurance after leaving their job. So how many have prepared for that situation?

Very few.

Outside a District of Columbia career center on a recent morning, Kelsey clutched copies of her COBRA invoice, clippings from a newspaper about the stimulus bill, and a form letter she received from the White House after writing to President Obama.

Kelsey knew about the reduced premium and said it would bring her COBRA costs below $200 a month. But when she called her benefits department, she was distressed to learn that she would not be able to get the reduced cost immediately, probably not until May.

"I can't take advantage of it now, which I think is totally unfair,"

Unfair? As much as I empathize with Ms. Kelsey I fail to see how this burdensome new program from the O.G.M. (Office of Government Meddling) is unfair.

As part of the Spendulus Bill, employers are now required to subsidize 65% of the COBRA premiums for severed employees for up to 9 months. Supposedly they will get a credit against future payroll taxes to offset this cost but the program has only been in the air for a few weeks and already some employers are considering dropping their group coverage as a way of avoiding the financial burden of paying for benefits for laid off employees.

A $25 billion provision in the stimulus plan aimed to cut COBRA's price tag, reducing its cost 65 percent for workers laid off as far back as Sept. 1.

That's $25 billion out of $787 billion to spendulate the economy. If Congress really wanted to help those out of work you would think they would allocate more to COBRA subsidies and find a way to make it less onerous for employers who are already struggling.

Instead, Congress deems it better to spend $1 million on Mormon Crickets in Utah, a total of $41.5 million to renovate libraries for 3 dead presidents, and another $1.8 million for Swine Odor and Manure management.

In the big scheme of things, when you are talking about spending billions of taxpayer money, allocating $300,000 for GoGirlGo is not a lot of money. But somehow I don't think Ms. Kelsey will agree that it is better to support mormon cricket research and pig farts is more noble than helping out people who are unemployed.

COBRA Subsidy? Maybe, Maybe Not . . .

Washington works in strange ways, if you can say it works at all. One part of the recent legislation, which no one read before voting on, provides subsidies for COBRA.

Or does it?

We found several resources that have their take on the subsidy. Of course, like anything else having to do with new rules, the devil is in the details.

Problem is, we don’t have any details yet.

But here goes.

The folks at Fox Rothchild, Attorney’s at law, offered this perspective.

the American Recovery and Reinvestment Act signed into law today. It is going to create some change to COBRA administration that require some attention very soon. It provides for a 65% employer paid subsidy for COBRA premiums for 9 months.

An employer paid subsidy. That’s an interesting wrinkle, especially since the ex-employee normally makes the election and is responsible for paying the premium.

The subsidy applies to those who suffered an involuntary loss of coverage between September 1, 2008, through December 31, 2009. But the Act does not specify what it will consider an involuntary loss, and it also provides that all qualified beneficiaries, regardless of the reason for their qualifying event, must get the notice. Employers and plan sponsors should go back to September 1, 2008, and review records to determine everyone (including dependents) who had a qualifying event and confirm that these individuals will get notice. This can be for voluntary or involuntary termination or reduction of hours, but it also applies to those made eligible as a result of divorce, death or aging out of coverage. They may not get the subsidy, but you must be prepared to send them the notice.

This is like watching sausage being made.

You not only don’t know what is going in, but what is coming out either.

The Act includes a retroactive provision that allows those who were eligible for COBRA and did not elect. It creates a window for them to now elect continuation coverage retroactive back to the first date of the qualifying event subsequent to September 1, 2008.

So what if someone bought coverage other than COBRA? Can they drop it and pick up COBRA going forward?

Or say they did nothing, but had a major claim in the interim. Can they elect COBRA retroactively and expect COBRA (and the taxpayer subsidy of course) to cover the claim?

Recognizing that now there is an added cost to reductions in force that equates to paying 65% of COBRA premiums, employers must consider this added expense when considering the cost benefit of a reduction in payroll. Not all eligible employees will elect COBRA because of the subsidy, but it can reasonably be anticipated that more will than would without the subsidy. If you are in the process of reducing the workforce, affected employees should be advised that the subsidy is available, but application of the subsidy will not be finalized until the close of the transition period.

OK, so the employer is laying off employees to save money. After the RIF, say half decide to opt for COBRA. Since this is an employer subsidy, the employer must pay their share, collect the balance from the ex-employee, and then ask the government for a refund of their share.

Or something like that.

Regardless of the mechanics, the RIF was to save money, but the COBRA SNAFU might create cash flow issues for the employer, leading to more lay offs, creating more COBRA elections, which creates more cash flow issues, leading to more . . . .

Confused?

I know I am.