Friday, April 24, 2009

COBRA Crunch

Finding affordable health insurance in Georgia is relatively easy for most folks. When you adopt a bare bones approach and only pay for coverage you actually need most people are surprised to see how much money they have wasted in the past and how much they can save going forward.

But when you are out of work and without a paycheck, even the employer subsidized COBRA premium can be beyond reach.

Danna Walker of Humble, Texas lost her job at DHL and along with it her health insurance. The bi-weekly unemployment check of $688 is not enough to cover the family's COBRA premium of $1360 ($467 after the COBRA subsidy).
Like many others, the Walkers live on a knife's edge of risk. Without insurance to cover her high blood pressure or his diabetes, they defer doctors' visits when possible and obtain their prescriptions - nine between the two of them - for $4 apiece at Wal-Mart.

But their primary concern has been finding insurance for Jake, who, after four operations, two stem cell transplants and round after grueling round of chemotherapy, has been cancer-free for a year.

He continues to face a significant threat of recurrence and requires regular monitoring for at least two years. His twice-a-year CT scans cost $3,000 each, and quarterly blood tests and X-rays run more than $1,000.
When you lose your job and COBRA is an option, each family member has COBRA rights independent of the other. It is rare that all family members would face insurability options, and when possible, the healthy ones should be separated from those who need coverage from the group insurance plan.

Other things, such as asking your doctor to change medication to something less expensive such as generics or older brand names is a good start. But the COBRA subsidy will run out in 9 months (some times sooner, depending on the size of the group) and COBRA will expire as an option after 18 months. Most states have risk pools and all have provisions for HIPAA eligible individuals to continue their coverage.
Late last month, in a race against the clock, the Walkers obtained a short-term policy for Jake through Oklahoma State University, where he is a junior studying animal science on a scholarship. Doing so could be crucial to his future insurability because federal law allows insurers to deny coverage for pre-existing conditions when there has been a gap in coverage of at least 63 days.
That may or may not have been the right thing to do. Some states do not recognize STM (short term medical insurance) plans as creditable coverage and not all STM plans meet the criteria of creditable coverage. Many of the plans offered through universities are little more than a mini-med health plan with limited benefits and will not preserve their HIPAA rights.

Our health care Resource (Patient Charity) page is a popular starting point for those who are unemployed or uninsured. People can find taxpayer subsidized health care programs along with a number of charitable organizations that provide assistance.

When Danna was employed at DHL she paid $426 per month for health insurance, DHL paid the rest. Their coverage with Cigna covered roughly $2,000,000 for the cost of Jake's cancer treatment.

Cancer is not just an old person's disease. Jake is only 21.

Roughly 35 states have a high risk pool for uninsurables. (Sadly, Georgia is not one of them). The Texas risk pool wants $414 for a $1,000 deductible plan to cover Jake but the Walker's say they can't afford it.

Even with help all around it is not enough when you cannot find work. The ripple effect of the housing meltdown created by government intervention in the free market is still claiming new victims. So where are those 6,000,000 jobs that would be saved or created with taxpayer "stimulus" money?

Apparently not in Humble, Texas.

Most folks who are out of work can find affordable health insurance. We get calls almost daily from people looking for solutions and most of the time we are able to find a solid plan at a price that fit's their budget.
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