I have been trying to help a family member research this question and have so far not been able to find a definitive answer. Suppose that someone is unemployed but has COBRA coverage for a health plan with very good benefits/coverage. The person gets a new job, which offers a group health plan, but the benefits are lousy. So far, I have been able to determine that one cannot continue on COBRA if he/she becomes covered in a group health plan that has no exclusion for pre-existing condition.
Can the person keep paying for the COBRA coverage and decline (not enroll in) the group plan at the new employer until the COBRA runs out? Does the answer change depending on whether or not the group plan at the new employer has an exclusion for pre-existing condition?
If it matters, the person has had continuous health insurance coverage for many years, either through an employer group health plan or COBRA. At this point, we are trying to work out the various hypothetical situations in advance, so there are no specific facts to be provided.
I am not sure the “limitations” qualifier is on receiving new insurance on cobra but my main concern would be how would you get insurance from the employer in the future when cobra runs out.
Unless they lucked out with timing they could be stuck with no insurance, waiting for the annual open enrollment period.
I think most plans include “change events” that allow you to change or enroll if something happens, and typically losing coverage from another source qualifies.
Thanks. We are aware of that. The exhaustion of COBRA benefits can trigger certain special enrollment opportunities. We are still looking for an answer to the OP.
Did you try calling the COBRA administrator? They should be able to tell you.
I believe that you can continue COBRA as long as you want to and pay for it, up to the maximum length or until you have (not just have the opptunity to get) other coverage. But I’m not authoritative.
It’s my understanding that according to HIPAA regulations a new group plan cannot exclude pre-existing conditions as long as you have had continuous coverage for 1 year or more. Am I wrong about this?
My understanding is that this is basically correct, as long as the coverage you had is “creditable coverage.” I’m not an expert, and I couldn’t say what coverage would not be creditable (although my understanding is that these circumstances are rare.) Also, I think the period can be 18 months if you are considered a “late enrollee” to the plan. Again, I am not an expert.
Yes, I called. Your understanding is the same as mine, but I’m not authoritative either. FWIW, we do plan to seek an additional professional opinion. I’m trying to become as educated about the issue(s) as I can before we take that step.
My employer told me absolutely not when they laid me off. I must inform them of the change in my employment service and they would stop my COBRA. I specifically asked about worse coverage at the new gig and they said it didn’t matter.
However, I don’t know whether they would have some vested interest in kicking me off their program, so I can’t say if that might bias what they told me, and whether this is some rule of law or merely their corporate policy.
At my company except in a few situations, COBRA is 102% of employer cost. So when you quit, you’re paying what the company paid plus a small admin fee as well to keep the benefit. So especially for our medical plan, it’s a LOT more expensive (our dental and vision are cheaper all around plans already) because the employer pays a large portion of the cost when the employee is working. Not sure if the 102% is standard or not.
No. It cost the same as what it did while you were employed. That might take more out of your pocket though, because you are paying both your own and the employer’s portions of the premium. Even at that, I had good coverage for $360 per month, which was waaaayyyy better than I could have done with private coverage.
There is, or was, a Federal program that covered 2/3rds of your COBRA payments for 15 months. So for 15 of 18 months, I was only paying $120/month for the same coverage.