LOSING HEALTH CARE COVERAGE: Understanding the Options.

Author:Cheng, Tony

People who lose health insurance coverage through an employer or multiemployer plan have several alternatives to choose from to gain coverage. This article offers a look at the pros and cons of the available options.

Most workers obtain health insurance through their employer or multiemployer plan, but what happens if they or one or more of their dependents don't qualify for coverage or lose coverage for a variety of reasons?

Perhaps they don't work enough hours to qualify for coverage from their employer or multiemployer plan. Or perhaps they are ineligible to enroll in their spouse/partner's plan. Or they have a dependent who was previously on their plan but turned 26. Or they lost their job or retired before they were eligible for Medicare.

Everyone needs medical care, and health insurance plays a critical role in protecting people from expensive bills and unexpected costs. A variety of options are available to those looking for coverage. This article will explain those options and outline the benefits and disadvantages of each.

Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985

This legislation was enacted to give those who lose health benefits following loss of employment the right to choose to temporarily continue their existing employer-sponsored group health coverage. COBRA allows workers to retain their health insurance for either 18 or 36 months, depending on the type of event that caused the loss of insurance.

Pros: With COBRA, an individual's health insurance coverage is unchanged. Enrollees can keep seeing the same doctors, and they already know their copays and deductibles for medical services and medications.

Cons: Workers may be required to pay the entire premium for coverage, plus administrative expenses up to 102% of the plan's cost to the employer. In many cases, people will likely save money by shopping on the health insurance marketplace.

Coverage Through a Spouse

Many people can obtain health insurance through their spouse/partner's employer-sponsored health insurance plan. They should check whether the plan covers spouses and investigate the costs associated with joining the plan. Some plans have a family deductible, meaning the deductible for the entire family must be met before an individual family member will get full coverage of health care costs.

Pros: A spouse/partner is already familiar with the plan, and a couple can jointly manage one plan rather than handling multiple plans.

Cons: It may be cheaper to enroll in an individual plan through the health insurance marketplace. However, enrollees may not be eligible for financial assistance in the marketplace if a spouse/partner's plan offers coverage.

Health Insurance Marketplace

Coverage options may be...

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