Here's one of the problems with private health care insurance as I see it. You can have it your entire life and then lose it when you need it.

I have never been uninsured. My parents bought Blue Cross for me when I was born since that was the policy they had. When I got married, I either had insurance through my husband which he would pay for but at the lower group rate, or I had it through an employer as a benefit. I think that's important because I am not an example of someone who went without it until they needed it. I've been healthy and profitable.

Then last year, while about to have gall bladder surgery, there was my surprise divorce. No problem, I'll just go on COBRA, right? Not so easy. The COBRA law says that the covered person has to notify the company (the employer, not the insurance company) about the divorce, not the spouse.

I called, I sent copies of the divorce decree, I begged them to fill out the COBRA paperwork I was told by the third party company that my ex's employer had hired to handle this, that they didn't talk to spouses. They hung up on me. Unfortunately my ex told them the wrong day of the divorce, that it was three months before it actually was. He made a mistake. I found this out months later. They wouldn't talk to me. Despite seeing a copy of the decree, they believed that notification had come too late for COBRA coverage. I guess they thought I falsified the decree. My ex tried to fix the problem when my attorney told him what had happened, but he couldn't make himself understood! He has HD!

My attorney tells me that some spouses won't do the COBRA notification out of spite so their ex will be uninsured. And even if they do, the paperwork goes to the last known address so if they stayed in the house or apartment, they can just throw it out or forget to send it on. There's no remedy for this.

I called the company headquarters. HR told the third party company employed by them to do the paperwork. They refused (really!). The company reminds them who is employing whom. They say they'll do it. They don't.

I try getting private insurance. No one will insure me because I'm sick. The medical rep of one of them tells me I am uninsurable. The insurance company that was insuring me won't do it anymore because they aren't going to make a profit on me anymore and they don't have to continue coverage since I was part of a group and now I'm not.

I call our state's employment commissioner. I ask if my state has a program for displaced homemakers I can join. His helpful staff tells me to apply for Medicaid. I tell them, No, you don't understand, I can afford insurance, I just can't GET it. They explain that I should marry again immediately or get a job with a corporation that has medical benefits (no, I am not kidding). I tell them that I am sick and cannot work full time.

I call company headquarters again. They tell the third party company they'll fill out the paperwork. HR tells me to go ahead and get the medical care I need and once everything is straightened out, I'll be reimbursed. But the third party company tells me that if I represent myself as covered by that insurance, they will make sure I am prosecuted for fraud (no, I am not kidding).

I was without coverage for six months. I can't count the hours I spent on this before the COBRA paperwork was finally sent in. I had to pay for that six months even though I went without medical care. And it's important to realize that since my ex did NOT properly notify them of the divorce (the 'covered event'), HR did NOT have to help me get COBRA. It was perfectly legal for them not to fill out the paperwork.



Edited 2 time(s). Last edit at 08/03/2008 06:38AM by Marsha.

WOW! And you are a very competent person. Imagine and ordinary person trying to negotiate this crazy maze!

another example of why we need a major health care reform in this country....thanks for sharing!

Marsha,

There is a tangled web of Insurance. That's for sure. Nobody seems to want to pay anybody for services.

I'm surprised that Cobra could be extended that long.

Have you tried these people?
[www.delawareuninsured.org]

good grief! i sure hate that marsha. like paula said, imagine someone who doesn't have the knowledge or resourses to fight this.

I'm insured under COBRA for the next two years, Fred. The link you gave me is for Medicaid-based insurance. I am not poor and I don't qualify. I have an income and a house. I'm just uninsurable after COBRA because I have medical problems.

It's not a question of 'nobody wanting to pay for services.' I do, I want to have and pay for my health insurance. Again, this is NOT a case of someone going without when they were young and healthy and wanting to exploit the insurance company when they have health problems later in life. I had had health insurance for 54 years when the divorce occurred.



Edited 1 time(s). Last edit at 08/04/2008 10:02AM by Marsha.

Check the 3rd insurance provider. It's for the "uninsurable".

I know two people here that qualify for that, and they are their 50's with a house and a business. Cancer was the reason. (Different state I know.)

How much was the Cobra? $700 a month?

Good lord, Marsha! Advising you to get remarried right away, in this day and age!!!

My response to that would be - "Better yet, why don't you take me out into your back parking-lot and SHOOT me? You obviously have no respect for the rights of people in my position".

My COBRA is affordable. It's $356 a month. I can only get it for 36 months though - 24 left to go. I'll still be 8 years from Medicare at that point. Thank heavens I got through to someone at Joe's former company who went to bat for me or I wouldn't have the COBRA.

I called about program 3. It's only for those earning less than $20,800 a year.

My own experiences with crossing all of the Ts and dotting all of the Is, in regards to benefits has left me with a total sense of disgust. All of it is up to me, since I am single. All of it is up to Marsha, because she's recently single - and her husband of so many years is being a BUTT!!

I also believed that benefits I'd paid for for all of my adult life would be available to me when I needed them.

Health. Life. STD. LTD. I paid into them for nearly 40 years. I was HARDLY some "freeloader" who simply refused to pay into such benefit programs - and irresponsibly assumed that I could still cash in on them at the very last moment.

I did virtually all of the research I needed, into these programs - and how to apply and qualify - because the HR department at my former place of employment was a bunch of useless idiots.

I even tried to show them how to search the appropriate websites - and finally gave up in disgust.

WHAT??? I expected them to do their JOBS??? How silly of me!

I finally gave up and did all of the research myself and provided THEM with the application forms, and told them (in writing), "Unless you respond by such-and-such date, I'm going to procede as stated, in the understanding that you're in concurrence".

I did.

I eventually managed to get through the whole process with no support whatsoever. In fact, in spite of a WHOLE LOT of obstructionism!

I finally prevailed. But I'll tell you right now - I grew to agree with others on this post that the whole process is so arduous that one has to wonder how a "normal" person should be expected to survive it (much less someone who's ill)!

It's disgusting!

Marsha, I can't remember - did you try to get a signed statement from your physician stating that you're unemployable?

My physician was very helpful, in that regard.

I researched the COBRA option (heck, I VOTED for it, ages ago).

What many fail to understand is that COBRA itself is not at the basis of the often-exorbitant costs.

That's attributable to the underlying PRIVATE insurance.

COBRA merely allows you to extend the previous PRIVATE insurance - at the previous premium.

You merely take over the full payment of that premium since the employer will cease to contribute in any way.

And since the previous employer will also no-longer being deducting premiums from anyone's paycheck - COBRA will take over that administrative duty, for a certain period of time. For that, COBRA (a government program) charges a mere 2% of that premium.

My premiums were about $735. per month. COBRA would only add a 2% "administrative fee" ($15. per month).

So I have to respectfully submit that lumping all of that into one amount as to the "cost of COBRA" is misleading.

Especially in light of Fred's insistance (in spite of my having to explain this to him) - that government programs are a profligate waste of tax-payer money, for little or no benefit - and that one should rely instead on "private enterprise".

COBRA is a perfect example of something that disproves that theory in a big way.

Here's the REAL breakdown:

Of the total of $750. that COBRA would collect from me every month:

Only $15. per month would actually go to COBRA (the evil guvmint agency).

$735 of it would continue to go to the insurance company (private enterprise).

The insurance company (private interprise) was perfectly willing to continue to charge me the same exobitant premiums they'd been charging me for decades. Why not? My USAGE of those medical benefits had always been extremely paltry. I was an actuary's DREAM!

So Fred can continue to propose fanciful scenarios about the private sector being more beneficent than the private sector.

And to give you more return on your dollar.

It simply ain't true, Fred.

Check your facts.

Marsha-
I read in our local paper about 6 months ago where our County was going to have an insurance policy in which people who were not covered by another health insurance could become part of this "group" policy.
This would be offered to people who live in our county.
I do not know any of the other details. Is there something your county
might offer such as this?

Forgive me if this sounds stupid because I am a Canadian and don't know the US health care system. I know it may be expensive, but I guess that is a good reason for every person to carry individual insurance (if they can afford to) rather than purchase it thru their employer or their spouse's employer.
Sorry to hear about your trouble, Marsha. Bad things happen to good people.

Actually, Sally, it is better to get your insurance paid by your employer, if you can - and for as long as you can.

The tricky part comes when you leave your employment (like I did) - or if you leave your spouse, like Marsha did.

You then have to deal with paying the entire insurance premium with no contribution from your ex-employer or ex-spouse.

I've always had employment which provided health care for me. It's actually the same health plans that you get when you self-insure. Same private insurance companies. Same plans. Same exorbitant premiums. The only difference is who pays - and to what degree.

Your question makes perfect sense, when you read of the trials and tribulations suffered by those who have gone through really tough changes, in regards to "who pays and how?"

And even more scary - can you even still GET insurance.

Neither Marsha nor I can get "private" health insurance, at this point. In both cases, it's for health reasons.

Marsha's ex is being a total A--hole (if I may say this on the Message Board) - and is not being at all cooperative. He's being as obstructionary as he possibly can - and since he was the "beneficiary" on the insurance policy she relied on, she's largely at his mercy.

I'm uninsurable, because I have HD. Because of that, I have managed to qualify for Disability Retirement (not an easy task, may I tell you!) But, because of a "waiting period" clause in Social Security Disability (as it exists in the US) - I have to go for 2 years without medical benefits.

To make it clear, Cobra allows you to take over your employer paid benefits at the employer rate, once Cobra expires you have the option to turn it into a private policy which is usually a watered down version of the employer policy.

Marsha are you sure that you only get 36 months? I don't remember what the extension is and what hardships qualify?

And once the 36 months are up you should be able to purchase that policy, it might cost a fortune and give you little coverage but sometimes something is better than nothing specially if it gets you to retirement age. It is also a tax write off, back when I had it there was a limit to the write off, I think it is now 100%.

Just as an example I paid $600 a month in 1998 for my Cobra policy, and $1350 when it went to private insurance. I think I only got 18 months, Under Cobra I was covered for invitro, with my private policy I was charged $250 a day in the hosiptal, so was my baby. All told I paid $1350 a month for insurance and another $2000 in hospital stays and then you had to add in all the little things the private insurance didn't cover. JL would be paying $735 for probably a $2000 policy. That is the real value of Cobra, getting company prices.

And are you sure the company is not liable for not sending a letter out in a timely manner? In NJ at least it was very regulated and fined. If you have lawyers on it they should know.

Sorry you have to go through this at all.



Edited 2 time(s). Last edit at 08/06/2008 06:54PM by MRO.

That's true, MRO, that taking the COBRA option requires you to take over the premium your employer has been paying - plus a 2% "administration fee".

But I don't think it's a "watered down" version of the insurance provided by your ex-employer, at all. I was told by the COBRA website - and the documentation that I requested - that the coverage and premiums would be exactly What you were receiving before.

With this possible exception. If your previous employer offered more than one plan - you could change from the plan you HAD been under for ANOTHER plan offered by the same employer.

My ex-employer had 3 basic plans they offered to their employees. I had the PPO plan, which allowed me to self-refer. They also offered a managed-care plan which had somewhat smaller premiums and copays - but required a lot more red-tape and delays in getting the coverage you need.

They had 2 different dental plans that were available.

I received exact quotes as to what each of these different plans charged for premiums - and I had a choice among them.

I could retain my medical and drop my dental, if I so wished.

I also could drop my medical coverage, if I chose to. Since there wasn't a very significant difference between those options - and they all seemed prohibitively expensive - I dropped them all. I did the calculations, and it simply made better sense to deposit my precious retirement benefits into a savings account, rather than to fork it over to the insurance company.

I've traditionally been a very low user of health care benefits. (Usually about $50. per month).

Taking the COBRA option would have cost me about $750. per month.

So! If I opted to spend $700. more in premiums than I would probably use - or to bank it - there simply was no choice.

The thing is that if you pay it on premiums, a great deal of it might possibly go to waste. Insurance premiums are in the "use it or lose it" category. What you do not use (which based on my historic usage would probably be $700/mo) - would go down the drain. Or more accurately, in the insurance company's pockets - not yours.

If in contrast, you choose to bank it - then it's there for your use.
If you DO suffer a medical loss - then it's there for you.

And if you don't suffer a medical loss - then it's there for other emergencies, as well.


You said: "Marsha are you sure that you only get 36 months? I don't remember what the extension is and what hardships qualify?'

The standard period over which COBRA is in effect is 18 months. I know that extentions are available, but like you, I'm unsure as to what it takes to qualify.

You additionally said: "And once the 36 months are up you should be able to purchase that policy, it might cost a fortune and give you little coverage but sometimes something is better than nothing specially if it gets you to retirement age."

Unfortunely, MRO, this is simply not an option. Once the COBRA protection has elapsed - it's then considered a whole new policy.

Which means that you can be refused. It's a given that a PHD will be refused.

And of course, you can be refused for other medical issues - as Marsha has.

It's not a matter of just forking over however much it takes to acquire coverage, Maria.

Sometimes one is NOT ABLE TO ACQUIRE COVERAGE. AT ALL!!!

JL I said that the private policy was a watered down version, not Cobra version.

Purchasing the medical policy at the end might be a state by state thing. In NJ if you have coverage with no lapse you could not be refused a policy and no pre-existing conditions could be refused. I know that for a fact since I purchased the policy. And the policy I purchase was the exact policy I had offered as a private policy. It had no bells and whistles since I don't have the buying power of thousands of employees.

As far as dental policies they are useless, a company would spend less money paying for actual costs rather than a dental plan. So I don't doubt that you received the same quotes for dental. We are talking about medical and it would be impossible for you to get an apples to apples policy at the same rate for a medical policy that your company, the government pays for in bulk. So that $750 policy would be the same as paying $2k a month if you could buy it. But you could never buy some of the items that the government covers.

If you can itemize your taxes than purchasing medical bennies does have a benefit in a refund at the end of the year. If you have only one major medical event in a year having health insurance could be the difference of being a greeter at walmart or without insurance living in one of its shopping carts.

The Cobra option was never intended for long term Insurance as far as I can tell.

It's an option mostly used by people that lose their job and have a baby on the way or are under some kind of long term treatment like chemo.

Medicare will provide JL some insurance when she qualifies for it. Marsha, now that's different.

If I were to quit my job, I wouldn't take a cobra option. I wouldn't have any health insurance. A break in service would cause a real problem. If I got another job that had a waiting period before insurance kicked in, that would be an issue. But if I went job to job they would have to cover me for a pre-existing condition as long as I was covered and stayed covered before that.

Fred said: "Medicare will provide JL some insurance when she qualifies for it. Marsha, now that's different. "

Unfortunately, this is not true.

I HAVE qualified for it. And there's still a 2-year wait before I will start RECEIVING it.

It's simply not acceptable for a PHD to be without medical insurance for 2 years.

This is why I'm fervently supporting measure HR 6259. It would waive that 2-year waiting period for HD-sufferers, just as it is ALREADY being waived for ALS sufferers.