Employer based health insurance provides coverage for tens of millions of Americans. Unfortunately, many employees will be without coverage if they lose their job, quit, retire or if their company goes out of business. In most cases, an employee can elect COBRA upon losing employment. The Consolidated Omnibus Budget Reconciliation Act will provide 18 months of additional coverage so long as the group consisted of 20 or more employees. In Ohio, if the group is under 20 employees COBRA allows for up to six months of coverage. This law is sometimes referred to as “Baby COBRA.”
There are certain rules regarding who is eligible to elect COBRA and what the cost will be, but in all cases COBRA is temporary insurance for the insured. In addition, the expense to the former employee can be significant. Ultimately, the cost will be determined by the premiums for the former plan plus a 2% administrative fee. Former employees are often surprised to discover how much it will cost to elect their company insurance through COBRA.
Individual Health Policies for Healthy Consumers
Once their COBRA benefits have run out, individuals and families will need to search the individual health market. If you are in good health, usually there are few problems obtaining an individual or family policy. However, if the former insured is in poor health – finding a comprehensive policy can be very difficult. There are providers who will insure high risk individuals, but typically the benefits to the insured are far less than their employer sponsored plan. When possible, an individual in poor health may only be able to find adequate coverage in another employer sponsored plan. The state of Ohio does offer an HMO plan providing open enrollment with select companies. The coverage offered will vary by county and the enrollment window will differ from company to company. However, you can expect these plans to be very expensive.
Purchasing Permanent Coverage
Thus, it is advisable to explore your options as soon as you lose your employer sponsored coverage. COBRA can be helpful, but because it is not permanent, new coverage will usually be needed at some point. One potentially difficult scenario can be easily avoided by shopping for insurance early. Electing COBRA while in good health and waiting to apply for permanent coverage until the allotted 18 months expires is a risky proposition. What if your health changed for the worse during that period of time? You may have difficulty finding coverage in the individual market. However, you would have been insurable had you applied for a plan immediately after becoming unemployed. In many cases, the permanent individual coverage would be less expensive as well.
In summary it is always advisable to obtain permanent health insurance coverage while you are in good health. Once accepted, you can keep this coverage for as long as you need it. If you rejoin a group plan later, you may elect to drop the coverage or maintain it if you feel that you have a superior plan.
By: Adam Hyers
Posts Tagged ‘Individual Health Policies’
Health Insurance For Someone With Pre-Existing Conditions
November 11th, 2009
If you have you been rated up or declined for health insurance it’s probably because you have a pre-existing condition.
Thousands of uninsured, underinsured and uninsurable individuals are facing serious health issues like heart disease, heart attack, diabetes, cancer, stroke, liver disease, AIDS, pregnancy, depression and kidney disease. Any of these pre existing conditions can cause them to be declined for health coverage. Today, you may even be declined if you are over-weight.
It’s a real challenge obtaining health insurance for someone with pre existing conditions. However, before we get ahead of ourselves, here are some questions we need to address.
What is a pre-existing condition?
A pre-existing condition is any injury or sickness for which diagnosis has been made, treatment has been recommended, treatment has been rendered, or expenses have been incurred within a set amount of months prior to the effective date of coverage (usually 3, 6 or 12 months and this can vary by state). It includes any condition manifesting itself in symptoms which would cause a prudent person to seek medical advice.
What is a pre-existing condition exclusion period?
Insurance companies try to discourage people from waiting until they get sick to purchase medical insurance. This is accomplished by imposing what is known as a preexisting condition exclusion period. This simply means, if you have a medical problem which exists at the time you purchase insurance, the insurer will deny the claims pertaining to that medical problem for a certain period of time.
The rules governing preexisting condition exclusion periods in individual health policies vary widely from state to state and are very much different from the rules of an employer-sponsored plan. If you have or recently have had health coverage, you may be able to apply this creditable coverage to offset a preexisting condition exclusion period.
Why all the hoopla over a pre-existing condition?
The biggest stumbling block with private individual medical insurance is the problem with preexisting conditions. Plain and simple… insurance companies don’t like preexisting conditions. They know in the long run… it will cost them more money to insure you. Frankly, insurers prefer to insure people who are not very likely to need the insurance.
But stop and think! Who doesn’t have some kind of health or medical issue? It may be something as simple as asthma or as complex as cancer. Some pre-existing conditions can be managed and these individuals can live a relatively healthy and normal life.
Yet, insurers can and do turn down “high risks” individuals for coverage because of an existing or previous illness. Even if coverage is found, the premiums charged are often unaffordable. Sometimes the individual may end up with a modified policy paying more because of their medical history or having to take a policy that excludes their pre existing conditions.
Are there things I can do to get healthcare coverage?
Here are some choices for obtaining health coverage. See if any apply to your situation.
(1). Employer-sponsored group health plan
(2). Join a professional organization (e.g. Chamber of Commerce)
(3). Individual health insurance
(4). State risk pool (if one exist in your state)
(5). Discount health cards
(6). Guaranteed Issue Health Insurance
Whether covered by insurance or by some other means, the total cost of health insurance for someone with pre existing conditions is high enough to dramatically impact that person’s lifestyle.
Today it is important for all of us to lead a healthy lifestyle. However, if you already have a preexisting condition that is keeping you from getting affordable health coverage, you should investigate the 6 options listed above to see which would work best for you.
By: Rudy Wilson
