Can I keep it? (My health insurance, that is.)
January 2, 2013 5:13 PM   Subscribe

Can I keep my excellent health insurance offered through my parents company or do I have to accept the insurance offered through my workplace?

In October, I started my first full-time, salaried professional job that offers health insurance and other benefits. I currently have United Healthcare Choice health insurance plan through a parents employer and am very happy with the doctors that I see- some of which I have been seeing for over 10 years. I see specialists 2x/year for checkups and my prescription refills and a mental health provider every 6 weeks. I really like that I don't need referrals for any doctors and when I have gone to the ER in the past (I actually don't have a primary care doc where I now live) it has never been a terribly expensive amount- no more than $500, including xrays.

I am confused as to whether I must accept the insurance through my new employer or if I can keep the insurance that I currently have. I have read that apparently the Affordable Care Act says that you can stay on a parents plan until the age of 26, unless insurance is offered through your workplace. In 2014, the law will change to allow you stay on the parents plan, but at present, you would have to go. I am curious though, how would anyone ever find out? It seems unlikely that I would be kicked off my parents plan- am I right or wrong? But I have also read that it is possible to have 2 different insurance plans-- for example, if you are married, you can have insurance through your plan and your spouse's plan. My friend who is the same age as me but is still in school and does not work (23) has dual insurance through both of her parents. So what is the real story? Can I have both? And if not, why are parent + work plans excluded while spouse +spouse and parent + parent are allowed?

Background Info Since I Am Anon: I asked a coworker what she thinks about our health insurance, and she told me that it sucks and it is likely because we work at a small company. There are less than 20 F/T employees that are based in our office, whereas my parent's company has nearly 100,000 employees worldwide.

The plan offered through my current employer is Oxford Freedom. There are 3 different plans available, Freedom Direct, Access, and Select which cost $153.75, $197.25, and $261.25 respectively. The coworker that I spoke to said that she pays $60!! for generic birth control on the Access plan. I currently pay $30/3 month for generic birth control on mail order and when I used to get generic at the pharmacy, it was only $15. Even when I got the name brand pill, it was only $30 copay!

So obviously, my employer's plan is not good compared to what I currently have and I do not want to change. It only costs an extra $70 2x/month for my parent to add me as a dependent... That $140/month is a better deal than the cheapest crappy plan which is $153.25/month. I know this might sound like a first-world problem, so before I get flamed, I would like to say that I am thankful that I have insurance period, but I really don't want to pay more for less if I don't have to.

I am 23 years old. I live and work in NYS and my parents do as well, although I do not live in their household. I would be writing the insured parent a check for $140 each month.

Bonus question: How would I evaluate whether a plan is good or not? I just compared prices for PCP visits/specialists/ER and the birth control copay above. Is there something I'm missing? I'm not really sure what the deductible is for UHC but we've never had any problem paying for doctors visits so I guess it isn't horribly high (or low... not sure which is best). All but one of my doctors take both UHC and Oxford.

tl, dr: As a 23 year old with excellent dependent insurance and crappy insurance offered through my own workplace, does the Affordable Care Act screw me over? Or am I worrying for nothing-- because I can be covered by both or because no one would ever find out?
posted by anonymous to Health & Fitness (13 answers total) 2 users marked this as a favorite
The thing about insurance companies is that they don't like to pay out money. They have to be careful about claims because companies don't make money by spending money. Will an insurance company care much about the cost of routine health care or birth control? No, not really. Will an insurance company care much about paying $300,000 for your care after you crash your car in the middle of the winter and require emergency surgery? Yep, and you can be sure that if there is any reason that they are not liable for the cost, they will find out and refuse to pay. If they're of the not-so-nice sort, they might even retroactively cancel your policy and force you to reimburse them for all health care costs they've paid for since you started your job.

If your parents' policy does not allow you to be covered if you have a job that provides coverage, then you should not lie to your insurance company. Full stop. Insurance fraud is a bad thing, especially if it's just to get cheaper birth control pills. If you cannot afford your birth control, I suggest talking to Planned Parenthood; they tend to have free or sliding scale plans for people just like you.
posted by saeculorum at 5:19 PM on January 2, 2013 [1 favorite]

You evaluate the plan based on, first, does it cover your chronic medical needs (BC is in this category), second, are you satisfied with emergency coverage, third, balance your needs for low co-pays and other out-of-pocket, vs. your ability, in cause of an emergency, to copver the entire deductible. If your parents can float you a loan in times of emergency, go for medium to high deductible, I'd say. (Figure $2000-5000.) If you're on your savings alone, skew towards low deductible if possible-- you don't need a medical event to wipe you out. The Affordable Care Act hasn't proven yet to be affordable for many.

Don't cheat on the insurance; I don't know the law, but if it is as you say, and you knowingly stick with UHC despite the law, UHC might drop you at any minute. I'm not sure if this constitutes a life-altering event enough to enroll in Oxford outside of an open enrollment.
posted by Sunburnt at 5:37 PM on January 2, 2013

Did you check with United Healthcare to see if the plan is a grandfathered one or not?

Plans that provide coverage for dependents are required to extend the coverage of dependents (adult children) to age 26, regardless of their eligibility for other insurance coverage, effective Sept. 23, 2010. Plans must provide coverage to all eligible dependents, including those who are not enrolled in school, not dependents on their parents' tax returns, and those who are married.

Grandfathered plans (group health plans and group health insurance coverage only) are not required to cover adult children to the age of 26 if the adult child is eligible to enroll in another employer-sponsored health plan. This is in effect until the first plan renewal date on or after Jan. 1, 2014.

If they are grandfathered you are probably out of luck, although my NYS healthplan does allow fulltime working adult children to be covered. So make sure you have checked with the plan.
posted by SyraCarol at 5:39 PM on January 2, 2013

Everything that saeculorum said. Also, it's not that UHC is better than Oxford, per se (Oxford is actually owned by UHC, fwiw). Bigger employers (like your parent's) tend to pay their own claims. They use the insurance carrier (UHC, Oxford, Aetna, Cigna, etc.) as an administrator, but it's the employer's bank account that is paying the bills. So they've got a lot more flexibility in what they're able/willing to offer. Smaller companies (especially really small <5>
I know this doesn't answer your question so much about which plan to stay with and if you are allowed to based on your current employment status, but I thought it might be helpful background, so that you're not viewing it so much as 'this carrier sucks vs. that carrier is awesome'. You could have multiple companies offering the same carrier, with vastly different plans.

For the most accurate answer to your actual question, have your parent read through their Summary Plan Description (which they should be able to access online through their carrier) in the section regarding eligibility requirements, and if they can't find the answer there, they can always call HR with a hypothetical scenario (my kid is job hunting, if they get a job, can I still cover them until 26?).
posted by spinturtle at 5:40 PM on January 2, 2013 [1 favorite]

I wouldn't risk it because: in my experience you can't trust anything HR or the insurance company says. I went through some round-and-round with my parent's insurance company and HR when this to-26 thing first started. My mom's health insurance assured me I was covered, so did HR, right up until the insurance co. got the bill for my first doctor visit. Then guess what, I'm not covered after all. In my case it turned out the law applies to younger-than-26, not 26-going-on-27. Nobody told me this before it was too late. HR had no idea what they were talking about. The insurance co won't really cop to covering or not covering anything until they actually see the bill; that is when they make the actual decision. So if you decide to do it, just know you're taking an expensive risk.
posted by bleep at 5:48 PM on January 2, 2013 [2 favorites]

You will be asked if you are insured under multiple plans. One of the plans will be considered primary. If allowed the other plan will be considered secondary. You must submit first to the primary plan and only after the primary plan has paid can you submit to the secondary plan for any difference in coverage. At that point the secondary plan can reimburse the difference between the two plans.

If you do this ask both plans about the arrangement. Do not try to hide anything. Do not find yourself without insurance for any period (gap in coverage) - that can be an expensive mistake.
posted by NoDef at 6:05 PM on January 2, 2013 [1 favorite]

I can't answer from a legal point of view, but I work for a company (in NYS) that offers insurance but has a LOT of under-26ers there, and most of them are still on their parents' insurance plan, just because it's cheaper for them, if nothing else. So there are a lot of people doing this, although they may all be putting themselves at risk by doing so.
posted by ch1x0r at 6:13 PM on January 2, 2013

Also, keep in mind that at some point soon you will be required to prove you have health insurance when you file your income tax return. I don't have any knowledge that this will somehow allow your parents' insurance company to verify that you have access to your own insurance, but putting together a W-4 showing your employer's name along with some kind of insurance verification leaves even smaller wiggle room. It's not too big of a step for your parents' insurance company to demand a copy of their income tax return to prove that you are still a dependent. Our bankers require a copy of our return every year due to our business loans, so it's within the realm of possibility, I think. My advice is to follow the law.
posted by raisingsand at 6:56 PM on January 2, 2013

Depending on when open enrollment is at your company your coworker's plan may not have had the provision of the Affordable Health Care act that requires women's preventative care (including birth control) to be fully covered (that means FREE!) kick in yet. Most plans are not grandfathered and you should be covered by them when you enroll for the first time. Here's a guide for figuring out whether those provisions will apply to your new plan or not:

I have pretty crappy health insurance but honestly as a reasonably healthy woman in my 20s the birth control copay was my major medical outlay, and even with our crappy coverage I get my NuvaRing for free.
posted by kelseyq at 7:45 PM on January 2, 2013

ch1x0r: "I can't answer from a legal point of view, but I work for a company (in NYS) that offers insurance but has a LOT of under-26ers there, and most of them are still on their parents' insurance plan, just because it's cheaper for them, if nothing else. So there are a lot of people doing this, although they may all be putting themselves at risk by doing so."

Your coworkers' parents' plans are probably not grandfathered.

If you didn't know, the website has a pretty succinct summary of how the Young Adult Coverage works. Basically, IANAL but it sounds like you should be fine as long as your parent's plan isn't a grandfathered group plan.
posted by yaymukund at 8:00 PM on January 2, 2013

I am curious though, how would anyone ever find out?

Because claims adjusters don't just get bills and write checks. They do the work of investigating claims in the attempt to minimize the liability to the insurer. So, when presented with a claim, your parents' insurer will ask you where you are employed. If you do not tell them, your claim will be denied for failure to comply with the conditions of the policy. Once you tell them, your parents' insurer will then call your employer's HR department and ask whether you are eligible for benefits.

So yes, they can find out, and it's actually pretty trivial for them to do so. This shouldn't affect your eligibility, as under the ACA you can be on your parents' plan through age 25 unless it's a "grandfathered" plan.

This is actually a possibility. The rules are that any plan in place before the ACA was passed can be grandfathered in, i.e., companies aren't generally forced to get new plans simply because the law was passed. But it's been a few years now, and many employers change insurers every few years as they shop around for better prices. This is something your parents should ask their employer's HR department about.
posted by valkyryn at 2:23 AM on January 3, 2013

To recap - your answer depends on 1) if your parent's plan is grandfathered and 2) if your parent's plan actually excludes dependent children that have their own coverage. I point this out because many carriers (and TPAs in the case of self-funded plans) may offer only the "non-grandfathered" platform and do not even contain the provision that would exclude you.

So, check your parent's plan for "we believe we are grandfathered" language and for the dependent eligibility provisions.

Also keep in mind that, assuming your plans are offered through a cafeteria plan (i.e. pretax, for the simplest definition), unless it is currently open enrollment, you can't just change plans mid-year. You have to have an IRS-and-plan-permitted reason to drop your current election (at your job) and enroll in your parent's plan.

Finally, while the plan/insurer may not find out (hence the reason that dependent eligibility audit vendors make a living), if you/your parent enroll and state that you have no workplace insurance, that's fraud and could cause your parent to get disenrolled (and/or worse).
posted by Pax at 6:05 AM on January 3, 2013

From the OP:
"I called UHC earlier this morning and the rep was able to confirm that I am able to stay on the plan even if I am offered insurance through my employer. I could also opt to use both insurances. I was worried about calling because I didn't want to be flagged in the system but it worked out. Also, birth control is not the only medication I take (my BC is used to treat a medical condition) I also take medication for asthma and as well as 2 meds prescribed by my psychiatrist, so it is important to me to retain the plan that I have. However, BC is the only medication that my coworker takes, so I had to use that for the price comparison.

I appreciate everyone weighing in!
posted by jessamyn at 7:18 AM on January 3, 2013 [1 favorite]

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