Group Health Insurance Options
July 3, 2013 9:45 AM   Subscribe

I need group health insurance, but I don't know what my options are with the new potential changes in the law. I am in the East Bay, in California. Help?

Kaiser has informed us that in September we will roll off of Cal COBRA (an extended version of the 18 month COBRA offered by the Feds). Now, we need to figure something out for the future, but don't know what that will be, and are looking for help in figuring out what our next step is or should be.

Complications: I am employed full time as an attorney, but there are only two of us full time, and my boss uses his wife's health care. He is not interested in starting a group with us. My wife works part time, and cannot work full time in her field due to illness-related fatigue.

My wife has MS, and my 2 kids have allergies which require prescriptions. As such, I am loathe to do anything BUT group coverage. We like Kaiser, but are not married to it. Our monthly prescription copays are currently reasonable (~100 per month); prescriptions without insurance would be prohibitive.

We currently are netting just over $4000 per month, of which $1700 is currently taken up with health insurance. Thereafter, we get by, but increasing the amount paid into coverage is tricky.

Are there advocacy groups (i.e., for MS) that offer group insurance or assist in getting group insurance? Other ways to get around this dilemma? You can email me at

Thank you very much.
posted by anonymous to Work & Money (6 answers total) 3 users marked this as a favorite
Starting in October you'll be able to enroll through the ACA exchange in california: you'll pay based on "community rating" based on age and number of kids and such, they're not allowed to refuse you or charge you extra for your wife's MS. You probably won't qualify for subsidies, but you'll be able to buy in at standard rates.
posted by Oktober at 10:13 AM on July 3, 2013

Its important to note that in October you'll be able to enroll in the exchange for a policy that will start January 1.

That leaves you with a gap from September to January. Its going to be tricky.

Obviously, group insurance is best. It doesn't sound like you're going to get that though your employers. Look to alumni associations and trade associations that might offer group insurance.

Otherwise, it looks like your best option is to buy a short-term individual plan and get on the exchanges in October. Many of the things that made individual coverage so shitty in the past should be fixed by plans offered in the new exchanges.

I've had good experiences dealing with insurance brokers when I was freelancing. They're not beholden to any particular insurer, and at least the guy I worked with was pretty personable.

Good luck!
posted by fontophilic at 10:26 AM on July 3, 2013

The ACA will provide you with two options in 2014. In both cases there no exclusions based pre-existing conditions or health status.

1. You will be able to buy individual health insurance for your family on the state insurance exchange.

2. Your company, if less than 50 employees, can buy a group policy on the small business insurance exchange called Small Business Health Options Program (SHOP).

The exchanges go on line on October 1 and policies go into effect in January. Check out for the California exchanges.

It should be fairly easy to get a group plan for just the two of you regardless of whether your boss joins. The main advantage of getting your insurance through the business is that it is paid using pre-tax money which means a savings of 30% or more. So even if you have to agree with your boss that you will take $X less in salary in exchange for your boss spending the $X on a group plan, you come out ahead by eliminating income tax.

In the mean time, you should get temporary coverage to bridge you from September to January. If you have had continuous coverage for the last 18 months, the temp plan cannot exclude you for pre-existing conditions (in California). You should go to an independent health insurance broker. Brokers are paid by the insurance company, not by you (at least not directly). A broker should be able to find the best temporary plan for your situation.
posted by JackFlash at 11:37 AM on July 3, 2013 [1 favorite]

I pay for Kaiser out of pocket and am also in the East Bay. It may be helpful to know (or maybe you already know) that they do not offer a "family plan". My daughter and I are each separate - I just happen to pay for both of us. For her I pay about $170/month including dental for a reasonable plan that covers all preventative free and $10 dollar prescriptions. Hospitalization obviously is more but there is some place where the co-pay for that maxes out that seemed reasonable when I was choosing it.

One option could be buying Kaiser out of pocket for the kids and maybe you, and then something different for your partner?

I know Alameda Alliance for Health, a local health insurance company which I believe is a non-profit, is fairly progressive and may accept your partner at a fairly reasonable rate even with the MS.
posted by latkes at 7:01 PM on July 3, 2013

Oh right, I forgot they can't exclude you for pre-existing if you were covered before! So Kaiser could be an option too.
posted by latkes at 7:02 PM on July 3, 2013

I am no expert but I reseached this when we thought my adult child would no longer be covered. I believe Kaiser is obligated to offer each of you an individual plan after the COBRA ends. In other words they can't turn you down. I think other plans CAN turn you down for pre-existing conditions, but they can't impose a waiting period of coverage if they do accept you. Good luck!!
posted by metahawk at 8:57 PM on July 3, 2013

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