Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

Health Insurance; COBRA; OBRA; HIPAA; Medicare. Ifcoverage under your next job.
asked, could you state that you knew that all 5 ofPart of this decision should be whether or not you or
these topics had the same thing in common: medicala member of your family has what is called a
insurance coverage for you and, perhaps, your"pre-exisitng coverage" condition.
family? Would you know the qualifications for each?Here again, before automatically taking COBRA, it
Well, in this article, we will discuss them. For a timelinewould be wise to contact a Benefits Insurance
that depicts, graphically, the time relationshipBroker and give him/her all of your options, and get
between them, please see the timeline intheir input. I have worked extensively with a Benefits
HEALTH INSURANCE Coverage from WorkInsurance Broker, and he is absolutely fantastic!
If we are lucky, we, and/or our spouse, work for aOBRA
company that provides, as a benefit, health insuranceWhat, you ask, is OBRA? I've never heard of it, you
coverage for us and our family. If so, we are verysay, and no one I know has heard of it either! Well,
lucky. Even if that is true, there are some key thingsthat's because, 99% of Human Resource or Benefit
that you might want to look at to see if you havefolks that I know have never heard of it! OBRA is a
ENOUGH coverage.federal law that was passed that extends COBRA
1) From your Human Resources Department (orfor an additional 11 months FOR DISABILITY
wherever else you would go to get informationPURPOSES ONLY!! Why, you ask, is this important?
about your health insurance) get what is called aThanks for asking, let's see if I can explain.
"Summary Plan Description" (SPD). This documentIf you are as nieve (did I spell this wrong too? sorry!)
should be kept where you can always find it, as itas I was when I first started looking to bridge my
contains all the information you will need about whathealth insurance from working to Medicare, I
your insurance covers and what it doesn't.assumed that when I got through all of the hoops to
2) Look up "Coverage" and "non-coverage" in yourqualify for SSDI (Social Security Disabililty Insurance)
SPD.I'd IMMEDIATELY be eligible for Medicare, RIGHT???
These will tell you what your plan covers and doesn'tWRONG!!!!
cover. You need to see if, perhaps, you or one ofWhen you FINALLY qualify for SSDI, you have to
the covered members of your family has a conditionwait for 5 months before you get your first check.
or circumstance that might not be covered, whereAND, the rules state that, you are eligible for
you need additional coverage. For example, let's sayMedicare 2 years (24 months) FROM THE DATE OF
that your family has a history of cancer; perhapsYOUR FIRST SSDI PAYMENT. Well, if you add 24 +
your plan restricts the number of hospitalization days5 you get, 29 months between qualifying for SSDI,
for care; or, restricts the days per condition. In thisand Medicare coverage.
case, (like my children) you might want to getOK, I said earlier that COBRA is for 18 months of
additional "cancer insurance" (I think that AFLACcoverage. Well guess what 18 months of COBRA +
might provide this type of coverage).11 months of OBRA equal - 29 months!
It would be a good idea to contact a HealthBUT, there are two catches to OBRA; first of all,
Insurance benefit Broker and ask him/her to readyou have a small window of 30 - 60 days to apply (
your SPD and see if you have any gaps in coverage.this window opens the date of your SSDI approval);
They then can help you supplement coverageand, it can cost up to 150% of your plan coverage
BEFORE YOU NEED IT!amount. BUT, if you have a "previously existing
NO HEALTH INSURANCE COVERAGEcondition" this might be the best way for you to
You might be one of the growing members of ourproceed.
society that, through one circumstance or another,Again, it is important to contact a Health Insurance
does NOT have health insurance coverage for yourBroker to help you with the risk/cost ratio of all of
family. In this case, I strongly encourage you tothese situations.
contact a Health Insurance Broker and get immediateIt is also improtant to know all of these deadlines as
coverage of what is called "catestrophic" (not sure ifyou plan to ensure that you and your family have
I spelled this correctly) coverage. In this type ofimportant health insurance coverage.
coverage, you will generally have large deductibles,HIPAA
but will have coverage if, say, one of you has to goHIPAA is a federal law that is called, briefly, the
into the hospital."portability" law for health insurance. What that
CONTACTING A BENEFITS INSURANCE BROKERmeans is that when you leave a group (read
Whenever you call or email a Health Insurancecompany-paid plan), the carrier that provided that
Broker, it is very important to prepare ahead of time.plan, must offer to you, another plan, different from
WHAT, specifically are you looking for; how muchCOBRA, when you leave the group coverage.
can you afford to pay every month; whatGenerally this will be what is called a "bare bones"
circumstances do you want to make sure that yourplan. Again, the best thing for you to do is to call
family is covered for. In this way, you can make sureemail a Health Insurance/Benefits Broker with all of
to focus on your critical needs.your information: SPD, COBRA info, HIPAA info,
COBRAneeds, cost limits, and let him/her help you find the
COBRA is an acronym ( how can I spell acronymoptimum plan coverage for you.
correctly, yet not be sure that I spelled catestrophicMEDICARE
correctly?) that stands for: Consolidated OmnibusOK, now, finally, we've reached Medicare! BUT (you
Budget Reconciliation Act. Basically, it is a federal lawreally didn't think it would be that easy, did you?) if
that allows you to pay for your Company-paid healthyou have qualified for Medicare because of disability,
insurance, as an active member, if you no longerthere are RESTRICTIONS (of COURSE there are!).
work for that company for, generally 18 additionalFirst of all, if you are qualifying for Medicare because
months.of disability, you are probably under the age of 65 -
1) COBRA is "triggered" (that is, you, or a coverednormal retirement age.
member of your family, become eligible for COBRA)Medicare coverage does NOT cover prescription
by events such as the following: resignation from thedrugs, which, those of us with disabilities probably
company; termination (FOR ANY REASON) from theneed, and which cost lots.
company; divorce of a spouse; a covered chile'sBut, Congress prescribed that states (all but 11) offer
birthday makes them ineligible for coverage. Thesewhat is called "Medicare supplement" plans, some of
are the main "triggering" events for COBRA.which do offer prescription coverages.
2) Now, when eligible for COBRA, you will be askedBUT, these plans ARE NOT REQUIRED TO, and do
to pay for 100% to 105% of the company'snot, offer these medicare supplement plans that
employee/employee and family coverage amount.offer prescription coverages to folks who qualify
You should get a letter from your companyunder age 65! So, if you are qualifying because of
explaining what that amount will be. BEFORE YOUdisability, your medical insurance plan doesn't cover
DECIDE TO TAKE COBRA, there are someone of your primary cost expenditures!
important things for you to consider.Here again is where you need to contact a health
What will be your cost, and what will be theinsurance/benefit broker. Again, he/she can work
coverage for that cost? Sometimes the cost is toowith you, and your specific circumstances, to get you
much for the coverage. In these cases, you mightthe coverage you need.
want to select HIPAA coverage, instead (see HIPAAHope that this information was helpful to you. If you
below).have any questions, please feel to ask them by
Or, you might just want to get catestrophiccommenting on this blog, and I'll be happy to get you
coverage as was mentioned earlier, and wait for fullan answer.