How can I find health coverage for my family?

November 10, 2005 9:21 PM

I was laid off. COBRA is running out. How do I best acquire new health care coverage for my family when my wife is in much needed therapy and taking expensive medication?

I was laid off from my previous job in September of 2004, and have continued my medical coverage by paying out of pocket using COBRA ($973/month rising to $1200 in January. .. ouch). It runs out in March of 2006, and I'm working to get new medical insurance in place. My real concern is that my wife is undergoing vital mental therapy and taking prescription medication while working through a diagnosed disorder. I am fearful that no new plan will cover this, as they will term it a "pre-existing condition," and we cannot afford the costs of the treatments out of pocket. I am currently working freelance and doing well enough to not want to get a corporate job unless I have to. Plus I'm hopefully getting into a Graduate School at UCLA, starting in September of 2006. I called my current provider today and they told me once COBRA runs out it's over, no extensions are possible with them as an individual. So I now know I have to go to another health plan provider. Does anyone know what my options are?

posted by jasonlatshaw to health & fitness (13 comments total)

Good luck. You might start over at eHealthInsurance.com. Insurance is regulated at the state level, so the next bit of research for you is what your state's rules regarding preexisting conditions and mental health coverage parity are.
posted by ilsa at 9:35 PM on November 10, 2005

My understanding is that you are probably going to have to join a group plan within 63 days of your COBRA running out. That pretty much means getting a job- unless you can get it through school, but you should call your state Dept of Labour right now and ask to speak to an expert- there may be a state program or individual plans may be required to honor the coverage in CA, I don't know.
posted by fshgrl at 9:38 PM on November 10, 2005

HIPAA helps here: if you get new health insurance, your new insurance cannot exclude pre-existing conditions unless you have a gap in coverage of 63 days or more.

However, you might find it hard to get new individual/family insurance. If you apply as an individual, the insurer can decline to cover you at all, can decide to cover you and not your wife, or can charge you rates much higher than their advertised rates.

If you have access to group insurance (whether through a new employer or some kind of professional association), I'm pretty sure the insurer cannot decline to cover you. This is your best bet.

Are you in California now? The state has a high-risk pool for people who run out of COBRA and can't get new coverage. Confusingly enough, I think it's also called HIPAA insurance.
posted by expialidocious at 9:44 PM on November 10, 2005

I'm in Maryland right now. I googled the Maryland laws per the earlier suggestion and found this here:

HMOs and Pre-existing Conditions: As a matter of a long standing Maryland Insurance Administration enforcement policy, HMO's may not impose a pre-existing condition exclusion period. However, there is no citation in statute or regulation.

I think I'm reading that right. . . if I apply for an HMO then they can't exclude her treatment, right?
posted by jasonlatshaw at 9:53 PM on November 10, 2005

Have you or your wife thought about taking a job, simply for the benefits? I've heard companies like the Container Store, REI and Starbucks offer decent healthcare plans to their employees, even to the part-time ones. Pre-existing conditions wouldn't matter in this case, as long as you kept continuous coverage.
posted by j at 10:29 PM on November 10, 2005

According to this bulletin, there is a 'high risk' and/or 'COBRA exhausted' pool, MHIP, for which you seem to qualify (might be more reasonable than what you're now paying for COBRA, albeit with high co-pay). Scroll down to p. 17.
posted by namret at 11:04 PM on November 10, 2005

Does the Unemployment Insurance program in MD offer health insurance, the way the one in MA does?
posted by Kirth Gerson at 5:11 AM on November 11, 2005

Check into joining professional associations. Also organizations for freelance/self-employed folks in your area. One of these groups may have set up a group insurance plan for their members.
posted by desuetude at 7:42 AM on November 11, 2005

I second j - if nothing else works out at least. Starbucks offers insurance to all of their employees who work more than twenty hours a week. I'm not sure if your wife would be covered if you worked (I have to confess I don't know insurance well), but is she well enough to manage 20 hours as barista bitch? At a low-traffic location, it'd probably be a lot of fun - I loved my barista job, and if it paid enough I'd still be doing it.
posted by kalimac at 7:52 AM on November 11, 2005

I think I'm reading that right. . . if I apply for an HMO then they can't exclude her treatment, right?

Yes, those rules sound like they say HMOs can't exclude pre-existing conditions. But they can choose not to cover you/her at all, and they might not cover her condition. Mental health coverage is a very sticky issue, partly because of certain mental hospitals that abused the rules (to say nothing of young people) in the 80s and early 90s.
posted by ilsa at 8:03 AM on November 11, 2005

Someone brought up a really good point about university COBRA plans. Can anyone wager a guess as to how little you could get by with (tuition and academic-wise) and still be eligible for the health insurance? It seems there is potential for getting a lot of the tuition back by withdrawing from classes.
posted by rolypolyman at 8:59 AM on November 11, 2005

You want the state high-risk pool. They are comparable in rates to COBRA, depending on age and family status, and you end up in an HMO that is widely accepted among providers within the state.
posted by Saucy Intruder at 9:11 AM on November 11, 2005

NY has a program offered to freelancers meeting certain criteria (industry, amount billed, etc) through The Freelancer's Union. Maybe your state has something like that?
posted by discokitty at 9:58 AM on November 11, 2005