Health insurance and the job interview. Cancer edition
July 8, 2019 11:24 AM Subscribe
When an employer offers it, health insurance is part of a compensation package. If I was to change jobs and want to ask for more detailed insurance info after getting a job offer--because cancer, and existing care team--how do I navigate that? I'm in the US. Additional related questions inside.
US healthcare is such bullshit. Cancer is in our house and we've had a care team in place for about nine months at two different hospitals. If I need to change jobs (and I may) this could have terrible ramifications if the new insurance plan does not cover care at these locations. I imagine going through the interview process and getting an offer, and then how do I proceed gracefully with questions about how much the new insurance will cost for me and my spouse, and whether or not care at our existing hospitals is covered? I would want to avoid at all costs sharing that my spouse has cancer. Will such questions set off alarms and jeopardize the hire?
I'll also at this stage need to tell them something along the lines of "every other week I take most of a day to support a loved one during a medical procedure." I don't imagine this being a big problem, as I'm not regularly client facing. I do remote work and currently make up missed time elsewhere in the week, often that same evening (in my current job it's just about getting the work done, not when I do it, and likely true for the next one). But I'd owe it to any new employer to tell them that I need to be away for that period. Would using that line be enough, how might it be received, and is there anything else I should consider?
More, if you care to comment on any:
-my current employer covers the full cost of my insurance and half of my spouse's, and I know this is probably more than I can expect from most employers (the place I worked before this offered the ability to add a spouse, but it was so expensive, nobody did it). What is typical?;
-if my company goes under, we'll have to resort to COBRA and I think this means our coverage stays the same at some exorbitant cost that we must bear.
-I asked questions about second opinions in my last post, and we have that scheduled (at a third hospital, that is also currently in our insurance network). I'm imagining given the unstable work question, that--even if the second opinion merits it--we would not want to change care teams based on the second opinion until we're even sure we could go to that hospital.
US healthcare is such bullshit. Cancer is in our house and we've had a care team in place for about nine months at two different hospitals. If I need to change jobs (and I may) this could have terrible ramifications if the new insurance plan does not cover care at these locations. I imagine going through the interview process and getting an offer, and then how do I proceed gracefully with questions about how much the new insurance will cost for me and my spouse, and whether or not care at our existing hospitals is covered? I would want to avoid at all costs sharing that my spouse has cancer. Will such questions set off alarms and jeopardize the hire?
I'll also at this stage need to tell them something along the lines of "every other week I take most of a day to support a loved one during a medical procedure." I don't imagine this being a big problem, as I'm not regularly client facing. I do remote work and currently make up missed time elsewhere in the week, often that same evening (in my current job it's just about getting the work done, not when I do it, and likely true for the next one). But I'd owe it to any new employer to tell them that I need to be away for that period. Would using that line be enough, how might it be received, and is there anything else I should consider?
More, if you care to comment on any:
-my current employer covers the full cost of my insurance and half of my spouse's, and I know this is probably more than I can expect from most employers (the place I worked before this offered the ability to add a spouse, but it was so expensive, nobody did it). What is typical?;
-if my company goes under, we'll have to resort to COBRA and I think this means our coverage stays the same at some exorbitant cost that we must bear.
-I asked questions about second opinions in my last post, and we have that scheduled (at a third hospital, that is also currently in our insurance network). I'm imagining given the unstable work question, that--even if the second opinion merits it--we would not want to change care teams based on the second opinion until we're even sure we could go to that hospital.
All of this discussion happens between them extending an offer and you accepting. The details about benefits, the asking for time off, etc. etc.
I did some of this because I was job searching while pregnant so I had questions about health coverage & maternity leave. What I said to the hiring manager/recruiter who extended the offer was "I have some specific questions about benefits. Is there someone in HR I could speak to about those?" and then I had the conversation with HR. As far as I know, the details of that conversation did not make it back to the hiring managers. You can also ask directly for detailed information about healthcare if that isn't provided (in my experience, detailed info has been provided with the offer occasionally, but not always or even usually). Larger employers will often have options with several companies at several different levels.
The most common (but far, far from universal) coverage scheme in corporate America is that an employer will cover a good portion of your cost, and allow you to purchase but won't subsidize your spouse/family's cost. YMMV. For what it's worth, it's more common in the non-profit field (especially large non-profits) for health care to be more highly subsidized. But again this is not at all universal.
It's also worth reaching out to your hospital/care providers pre-emptively to get a list of who they work with so that you can compare that to the options from the company.
If you get laid off, you can resort to COBRA. If your company goes under, COBRA will not be an option. COBRA is the option of continuing to be on your company's group health care plan after you terminate employment with them (paying full, unsubsidized rates). If the company does not exist anymore and therefore no longer has a health plan, you don't have COBRA as an option. At that point, you go on the public health marketplace for your state (which you will be eligible for because losing your coverage is a qualifying life event), and/or you find a new job as quickly as humanly possible.
posted by brainmouse at 11:38 AM on July 8, 2019 [2 favorites]
I did some of this because I was job searching while pregnant so I had questions about health coverage & maternity leave. What I said to the hiring manager/recruiter who extended the offer was "I have some specific questions about benefits. Is there someone in HR I could speak to about those?" and then I had the conversation with HR. As far as I know, the details of that conversation did not make it back to the hiring managers. You can also ask directly for detailed information about healthcare if that isn't provided (in my experience, detailed info has been provided with the offer occasionally, but not always or even usually). Larger employers will often have options with several companies at several different levels.
The most common (but far, far from universal) coverage scheme in corporate America is that an employer will cover a good portion of your cost, and allow you to purchase but won't subsidize your spouse/family's cost. YMMV. For what it's worth, it's more common in the non-profit field (especially large non-profits) for health care to be more highly subsidized. But again this is not at all universal.
It's also worth reaching out to your hospital/care providers pre-emptively to get a list of who they work with so that you can compare that to the options from the company.
If you get laid off, you can resort to COBRA. If your company goes under, COBRA will not be an option. COBRA is the option of continuing to be on your company's group health care plan after you terminate employment with them (paying full, unsubsidized rates). If the company does not exist anymore and therefore no longer has a health plan, you don't have COBRA as an option. At that point, you go on the public health marketplace for your state (which you will be eligible for because losing your coverage is a qualifying life event), and/or you find a new job as quickly as humanly possible.
posted by brainmouse at 11:38 AM on July 8, 2019 [2 favorites]
Agree that you can totally ask to see all the healthcare details before accepting an offer. I don't have as serious of healthcare needs as you, but I would absolutely not move forward with a company if they didn't offer a decent plan.
My husband was briefly on my insurance and my monthly premium went up, but it was nowhere near half of the cost. I pay about $40/month for myself and he was an additional $80/month, and that's nowhere near half of the cost of what the company pays. So it's kinda all over the map as to what your company will pay."
posted by radioamy at 11:50 AM on July 8, 2019
My husband was briefly on my insurance and my monthly premium went up, but it was nowhere near half of the cost. I pay about $40/month for myself and he was an additional $80/month, and that's nowhere near half of the cost of what the company pays. So it's kinda all over the map as to what your company will pay."
posted by radioamy at 11:50 AM on July 8, 2019
IANYoncologist - so YMMV a lot, but in our area, we have had a lot of shifts in payors, so this has happened a lot. Typically what has happened is that patients are allowed to complete whatever therapies (if they are no longer in-network) they are on that have already been started, and then once complete, mandate a change in providers. I think that the most that you can do is to find out what your insurance benefits would be (if at all possible, before you change jobs), and let your clinic know that this is happening so that they can work with you. If you can buy some time before you accept the offer to help you investigate this, take that time.
Most oncology practices have financial counselors that can help with access to things like drug assistance - use them. I know that we offer a substantial discount to people without insurance (along the lines of 60-70%), but this does not cover copay assist and things of that nature.
posted by honeybee413 at 11:53 AM on July 8, 2019 [1 favorite]
Most oncology practices have financial counselors that can help with access to things like drug assistance - use them. I know that we offer a substantial discount to people without insurance (along the lines of 60-70%), but this does not cover copay assist and things of that nature.
posted by honeybee413 at 11:53 AM on July 8, 2019 [1 favorite]
US based, and my last couple interviews, the recruiters have sent me the benefits package before the interview was even scheduled. Asking for it way up front shouldn't raise any red flags - health insurance in this country is such a shit show that everyone is used to people wanting to do research.
posted by ersatzkat at 11:54 AM on July 8, 2019
posted by ersatzkat at 11:54 AM on July 8, 2019
You could even phrase it as wanting to look at the total compensation package before making a counter and/or accepting. Companies with good insurance often like to promote it when you talk to HR.
posted by typecloud at 11:57 AM on July 8, 2019 [4 favorites]
posted by typecloud at 11:57 AM on July 8, 2019 [4 favorites]
very, very few employers cover 100% of their employee's premium, let alone any % of a spouse or child. what is typical, in my experience, is that they will cover some % of your premium, and while spouse/child can be added to insurance (a godsend before obamacare) they do not cover any % of that additional premium. which is why spouses often have different insurance from each other.
FMLA doesn't kick in until you've worked X hours at that job in the last year, and only if there are x employees, etc. etc. so, unless you had a very chill employer who was okay with you taking a day off every two weeks you might have to find alternate care for the person who needs it, at least for the first year.
posted by misanthropicsarah at 2:27 PM on July 8, 2019
FMLA doesn't kick in until you've worked X hours at that job in the last year, and only if there are x employees, etc. etc. so, unless you had a very chill employer who was okay with you taking a day off every two weeks you might have to find alternate care for the person who needs it, at least for the first year.
posted by misanthropicsarah at 2:27 PM on July 8, 2019
It's 100% OK to ask about this stuff with potential employers. I would definitely recommend asking post-offer, so that no one accidentally lets this info influence their decision. Even after the offer stage it will seem like a red flag to some employers, but in general the employers to whom this is going to seem like a red flag are going to be the kind with shitty health insurance and inflexible scheduling and personal/medical time policies, i.e. employers you can't really afford to work for anyway.
On your first question, I have no idea what's typical and I'm sure it varies a lot regionally and by industry but what you have now sounds pretty normal to me. FWIW my employer pays 100% of our premiums (medical and dental) and reimburses 90% of our deductible for both me and my husband, and it would cover kids too if we had any, so, you know, dare to dream? But I know that's very generous even in my well-compensated (for-profit) industry. In previous jobs (mostly in higher ed) it was usually either like, "we pay X% of your total premium whether it's for you, you and your spouse, or your whole family" or "we pay up to $X towards your premium which will cover your personal premium but probably not your spouse or kids'."
brainmouse is correct about COBRA - if you get laid off during a dramatic reorganization, you can probably stay on COBRA but if the company ceases to exist that's not going to be an option. Either way if you lose your job you can go on the exchange, which might or might not be cheaper than COBRA. (This might be a state-by-state thing, but I receive a statement from my insurer once or twice a year explaining how much my employer is paying towards my premium and how much I'm paying. That will tell you the full number you would need to pay if you had to cover COBRA yourself. It's probably a lot. You should be able to get the number from the insurer or from your employer.)
I say go ahead with the second opinion and see what happens. Obviously it would suck to change care teams twice in a short period of time. But even if the second opinion is different and you can't or don't want to transfer care to the new center, you might still be able to work with your current care team (or a hypothetical new care team) to execute on the new plan.
Good luck! Job searching on top of everything else sounds insanely hard. I hope you can find a supportive job with insurance that's at least adequate, maybe even awesome. There are good employers out there.
posted by mskyle at 2:34 PM on July 8, 2019
On your first question, I have no idea what's typical and I'm sure it varies a lot regionally and by industry but what you have now sounds pretty normal to me. FWIW my employer pays 100% of our premiums (medical and dental) and reimburses 90% of our deductible for both me and my husband, and it would cover kids too if we had any, so, you know, dare to dream? But I know that's very generous even in my well-compensated (for-profit) industry. In previous jobs (mostly in higher ed) it was usually either like, "we pay X% of your total premium whether it's for you, you and your spouse, or your whole family" or "we pay up to $X towards your premium which will cover your personal premium but probably not your spouse or kids'."
brainmouse is correct about COBRA - if you get laid off during a dramatic reorganization, you can probably stay on COBRA but if the company ceases to exist that's not going to be an option. Either way if you lose your job you can go on the exchange, which might or might not be cheaper than COBRA. (This might be a state-by-state thing, but I receive a statement from my insurer once or twice a year explaining how much my employer is paying towards my premium and how much I'm paying. That will tell you the full number you would need to pay if you had to cover COBRA yourself. It's probably a lot. You should be able to get the number from the insurer or from your employer.)
I say go ahead with the second opinion and see what happens. Obviously it would suck to change care teams twice in a short period of time. But even if the second opinion is different and you can't or don't want to transfer care to the new center, you might still be able to work with your current care team (or a hypothetical new care team) to execute on the new plan.
Good luck! Job searching on top of everything else sounds insanely hard. I hope you can find a supportive job with insurance that's at least adequate, maybe even awesome. There are good employers out there.
posted by mskyle at 2:34 PM on July 8, 2019
Generally speaking, once you have an offer of employment, everything is on the table. Is it possible that an employer might try to find a reason to rescind the offer if they're in line to take a hit on benefit costs? Yes. Would that be legal? Don't know.
posted by SemiSalt at 3:46 PM on July 8, 2019
posted by SemiSalt at 3:46 PM on July 8, 2019
After I got my offer, I said I had some questions about other benefits and got scheduled for a call with an HR person. Nobody seemed at all surprised by the question.
I would ask about the flex time in the same period, after the offer and before accepting. Get the answer in writing.
I have heard one story from a person with ongoing medical care where she demanded to see some sort of very official description of the insurance plan, literally the document that defined what the company had contracted with the insurance carrier to provide. I forget the name. The company offered her various more pre-digested formats, but then relented and just made her sign an NDA. I have no idea how common this scenario is: my sense is that she had unusual needs and also the company was a bit odd. But it worked out.
posted by meaty shoe puppet at 6:41 PM on July 8, 2019
I would ask about the flex time in the same period, after the offer and before accepting. Get the answer in writing.
I have heard one story from a person with ongoing medical care where she demanded to see some sort of very official description of the insurance plan, literally the document that defined what the company had contracted with the insurance carrier to provide. I forget the name. The company offered her various more pre-digested formats, but then relented and just made her sign an NDA. I have no idea how common this scenario is: my sense is that she had unusual needs and also the company was a bit odd. But it worked out.
posted by meaty shoe puppet at 6:41 PM on July 8, 2019
-my current employer covers the full cost of my insurance and half of my spouse's, and I know this is probably more than I can expect from most employers (the place I worked before this offered the ability to add a spouse, but it was so expensive, nobody did it). What is typical?;
This, as well as how much of a red flag asking for detailed insurance info would be, depends SO MUCH on industry, size of company, and location. For example, my personal experience is all in nonprofits. It is much more common in certain kinds of nonprofits to pay a high percentage of premiums, even 100%.
For larger organizations (universities, major national associations, etc.) the HR folks have ZERO problem going over the details of health insurance with no explanation needed beyond a vague "sorry if this is a bother, but health insurance is important," to which they say "Of course it is! I will send you more detailed charts!" The organization officially doesn't need to care if you personally are going to be "using" more health insurance; it evens out in the big picture. Plan details are the sort of administrative function that HR handles separately from the hiring manager's assessment of you as a candidate for the job itself, and the hiring manager likely wouldn't even hear about it. In fact, if it came to you disclosing to HR that you have some specific family medical needs, HR would likely have some policies in place to ensure that it doesn't get back to the hiring manager.
For small nonprofits, it would be a whole different dynamic, as one person could throw the budget off-kilter. The administrative wall between HR and the decision-making leadership is more permeable, and they will either be awesome on principle, or awful on principle.
posted by desuetude at 11:02 PM on July 8, 2019 [1 favorite]
This, as well as how much of a red flag asking for detailed insurance info would be, depends SO MUCH on industry, size of company, and location. For example, my personal experience is all in nonprofits. It is much more common in certain kinds of nonprofits to pay a high percentage of premiums, even 100%.
For larger organizations (universities, major national associations, etc.) the HR folks have ZERO problem going over the details of health insurance with no explanation needed beyond a vague "sorry if this is a bother, but health insurance is important," to which they say "Of course it is! I will send you more detailed charts!" The organization officially doesn't need to care if you personally are going to be "using" more health insurance; it evens out in the big picture. Plan details are the sort of administrative function that HR handles separately from the hiring manager's assessment of you as a candidate for the job itself, and the hiring manager likely wouldn't even hear about it. In fact, if it came to you disclosing to HR that you have some specific family medical needs, HR would likely have some policies in place to ensure that it doesn't get back to the hiring manager.
For small nonprofits, it would be a whole different dynamic, as one person could throw the budget off-kilter. The administrative wall between HR and the decision-making leadership is more permeable, and they will either be awesome on principle, or awful on principle.
posted by desuetude at 11:02 PM on July 8, 2019 [1 favorite]
I feel you. I have made all of my job changes in the past 6 years based on screening employers by health insurance options either before or early in the application process. Are you applying places where you have friend/former colleague connections? Have them pull the health insurance info off their intranet for you. My current employer lists all of the benefits info (including networks, copay amounts, etc.) on the public internet. At other places I’ve also asked HR to share their benefits summary info following the HR screening interviews, and that has never been a problem.
It sucks to know that entire large organizations in my area are not options for me because they offer Blue Cross Blue Shield or UHG insurance, for example, and once I thought I did all my research but was blindsided by a hidden pharmacy benefit manager (PBM) contract that fucked up access to my child’s $37,000/month specialty medication for a while (get backup meds ready for any health insurance transition, or be prepared to pay out of pocket!). But “continuity of care” for serious medical treatment is a real thing that health insurers offer exceptions for, even though it involves stressful paperwork bullshit. Also pay attention to how long you have to be employed to be enrolled in benefits, and game your start date accordingly to avoid coverage gaps. Get that info in advance so you are not surprised by a mega COBRA cost.
posted by Maarika at 8:41 PM on July 9, 2019
It sucks to know that entire large organizations in my area are not options for me because they offer Blue Cross Blue Shield or UHG insurance, for example, and once I thought I did all my research but was blindsided by a hidden pharmacy benefit manager (PBM) contract that fucked up access to my child’s $37,000/month specialty medication for a while (get backup meds ready for any health insurance transition, or be prepared to pay out of pocket!). But “continuity of care” for serious medical treatment is a real thing that health insurers offer exceptions for, even though it involves stressful paperwork bullshit. Also pay attention to how long you have to be employed to be enrolled in benefits, and game your start date accordingly to avoid coverage gaps. Get that info in advance so you are not surprised by a mega COBRA cost.
posted by Maarika at 8:41 PM on July 9, 2019
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posted by nkknkk at 11:32 AM on July 8, 2019 [4 favorites]