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COBRA Insurance Benefits, Cost, Rules and How it Works

One of the worst parts of getting laid off is losing your health insurance. COBRA insurance softens that blow by allowing you to keep your employer-sponsored plan temporarily. It comes with a hefty price tag though.

COBRA is available for people who quit their job or are:

  • Laid off
  • Fired and it wasn’t for “gross misconduct”
  • Without insurance because an employer cuts your hours
  • Without coverage because of a divorce, a spouse’s death or other qualifying events.

    Your dependents can also get coverage if:

    • You die
    • Your child turns 26 and drops off a parent’s plan
    • A divorce or legal separation
    • You become eligible for Medicare

      COBRA is a vital safety net that protects you, but it’s costly and has limits. Let’s take a look at COBRA, see how it works, what it costs and other alternatives when you lose your job.

       

      What is COBRA insurance and how does it work?

      Congress passed COBRA, which stands for the Consolidated Omnibus Reconciliation Act, as a way to bridge the insurance gap for people who lose their jobs.

      If you sign up for COBRA coverage, you use your insurance the same as your employer-sponsored plan. It’s the same health insurer. You get the same care and benefits. The only difference (and it’s a significant one) is you don’t get help from your former employer. You pay for all the costs.

      Before 2014, COBRA was the only choice for millions of Americans who lost their employer-sponsored insurance.

      The Affordable Care Act (ACA) added other options for Americans. The ACA requires that health insurers cover all Americans regardless of health status and pre-existing conditions. Before the ACA, someone with pre-existing conditions would pay exorbitant premiums or might not find an insurer to cover them. The ACA ended that practice, which opened up individual plans to more people.

      Plus, the ACA created exchanges, which make it easier for people to find a plan on their own. The ACA also implemented subsidies for people who earn 400 percent of the federal poverty limit. So, you can get help with your premiums and out-of-pocket costs.

       

      COBRA benefits: Are they retroactive?

      COBRA provides you the same benefits as your employer-sponsored plan. COBRA limits you to 18 months of coverage though.

      You can request an 18-month extension if you or a dependent is disabled. You can also ask for one if you face another qualifying event, such as a death.

       

      COBRA coverage periods

      Qualifying event

      Beneficiary
 eligible for COBRA

      Maximum
 coverage
 time

      Voluntary or involuntary termination of job other than gross misconduct

      Reduced hours

      Employee

      Spouse


      Dependent child

      18 months

      Total disability

      Employee

      29 months

      Employee entitled to Medicare

      Divorce or legal separation

      Death of employee

      Spouse


      Dependent child

      36 months

      Loss of dependent-child status

      Dependent child

      36 months

       

      One important point: COBRA only applies to private-sector companies with at least 20 employees, as well as state and local governments. However, you may find your state has a similar COBRA law for smaller companies.

      Your employer should notify you or your dependents of the COBRA option within 30 days of your last day or if you become eligible for Medicare. Your employer may also tell your spouse about COBRA if you die.

      If you or a dependent become eligible for COBRA because of a divorce or if a child turns 26, you should notify your employer within 60 days.

      You have 60 days to decide whether to sign up for a COBRA plan. COBRA lets your dependents approve coverage even if you decline COBRA.

      If you reject COBRA, you can still get it later as long as it's within the 60-day window. Your coverage is retroactive to the qualifying event, such as your last day.

      One cost-effective option is to wait to get COBRA until the end of the 60-day window. That way you won’t pay premiums, but you can still get retroactive coverage back to the qualifying date if you find you need COBRA.

      You must pay the premiums for the entire period in which you’re eligible even if you sign up 60 days later. In other words, if you sign up on day 59, you still have to pay all the premiums from the 59 days.

      You can cancel the COBRA coverage at any time within 18 months. You’re not locked in. You will likely want to drop COBRA once you become eligible for a different health plan, such as if you get another job.

      If you stop paying premiums, COBRA coverage will end automatically. Make sure to pay your premiums promptly.

      A health plan may also terminate a COBRA plan if your former employer drops group health insurance coverage.

       

      COBRA insurance cost

      COBRA allows you to keep your employer’s insurance, but that’s not cheap. You have to pay the entire tab for the premiums plus up to 2 percent administrative costs. The employer will no longer help you with your costs. It’s all on you.

      You might be eligible for a federal income tax credit to help you with COBRA premiums. The U.S. Department of Labor said the Health Coverage Tax Credit (HCTC) is potentially open to people who lost their jobs because of the “negative effects of global trade.” You may also be eligible if you receive benefits under the Trade Adjustment Assistance Program or receive pension payments from the Pension Benefit Guaranty Corporation.

      The HCTC pays 72.5 percent of premiums. You fork over the remaining 27.5 percent. If you’re eligible, you might wind up paying similar premiums than you did when you were employed.

       

      Alternatives to COBRA insurance

      COBRA is a way to keep your current employer plan after losing your job temporarily. But it’s not the only health insurance option. You can:

      • Sign up with your new employer.
      • Go onto your spouse’s health insurance plan. Losing your job kicks in a special enrollment period. That period gives you time to go onto a health plan at your spouse’s employer.
      • Get a plan through the ACA exchanges or an individual health plan. If your income is below 400 percent of the federal poverty level, you can find subsidized ACA plans. You don’t get that benefit from individual plans that aren’t sold through the exchanges.
      • Sign up for a short-term plan. Most Americans can now sign up for a short-term plan that can last a year. You can also request two renewals. Short-term plans are low cost, but they also provide limited benefits. Many plans don’t offer pregnancy and infant care and you might struggle to find one that covers mental health and prescription drug coverage. Plus, they can have large out-of-pocket costs. Short-term plans can be a stop-gap until you can get another employer-sponsored health plan but understand short-term coverage’s limitations.
      • See if you qualify for Medicaid. Nearly three dozen states expanded Medicaid eligibility. The expansion makes people with incomes at 138 percent of the federal poverty level or below eligible for a Medicaid plan. Medicaid usually costs much less than any of the other options.

         

        No matter what option you choose, make sure that your doctors accept that insurance. Also, check to see how much your medications will cost and that the plans cover your prescriptions.

        Once you compare costs, including premiums and out-of-pocket money, you can figure out whether COBRA insurance is the best option for you.

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