Help me help - U.S. healthcare woes
October 9, 2014 2:58 PM   Subscribe

My dear friend is resigning from her job in the near future. She will move to another state in 2-3 months and plans to go without health insurance until she can find a job there. Is this as bad an idea as I think? How can I help?

She is under 30 and in good health. She says she can’t afford interim coverage. I can afford, and would happily pay, the catastrophic insurance rates I’m seeing on (if that’s an option). I just don’t want her to risk getting trapped under a mountain of debt. How can I tactfully offer to help her out? Should I?
posted by ista to Human Relations (15 answers total)
When my husband was 21, he had a four month gap between graduating college and finding and starting his first job. Young and healthy, he came down with appendicitis on our honeymoon - in Canada. (the great Canadian health care system does not cover foreign tourists) Surgery plus a five day hospital stay - whooping bill. Just saying, the unexpected can and does happen.
posted by metahawk at 3:06 PM on October 9, 2014 [1 favorite]

As a datapoint, I just went about 3 decades without any health insurance. It didn't kill me.

If it was my friend, I'd let her make her own decision.
posted by humboldt32 at 3:06 PM on October 9, 2014 [7 favorites]

Also, there used to be rules about waiting periods to cover preexisting conditions if you didn't have continuous credible health care. If that is still true, and it could easily take more time than expected to find a new job then anything that flares up during the gap, even if she can wait to get her new job to take care of it, may not be covered. Not sure if this still true with ACA but if it is, it is another major risk of going without for a little while.
posted by metahawk at 3:08 PM on October 9, 2014

If your friend is eligible for COBRA, she should have 60 days to decide if she wants to continue coverage. She has to pay the premiums from the last day of her current coverage, but if something catastrophic happened, it would still probably be cheaper. She even gets 45 days after that to pay the back premiums. So, tell her to make sure she gives a good forwarding address to her employer so she gets the paperwork.

The other tactic that could work is if she gets paid monthly, she could resign effective early next month and her coverage would likely be paid for that whole month from her last paycheck. It would give her a few more weeks in addition to the 60 days.
posted by cabingirl at 3:23 PM on October 9, 2014 [3 favorites]

Friend of mine's dad quit his job without notice because he was pissy. He didn't take Cobra or anything and it took several months for him to find a new job and then he had 90 days before his new healthcare kicked in. His daughter got diagnosed with crone's disease and had to have part of her intestine removed. He's new insurance wouldn't cover it because it was a preexisting condition. She racked up $250k in bills. This was in the '90's, so I can't imagine what this would cost now.

I'd take the insurance, but then I've had two major medical incidents in my life.
posted by cjorgensen at 3:33 PM on October 9, 2014 [4 favorites]

Is she currently in a state with Medicaid expansion? She may qualify for that, if she has no other income coming in.
posted by spinifex23 at 3:50 PM on October 9, 2014

I was laid off from a job and figured I'd skip the health insurance. Exactly six weeks later, I ended up in the hospital. My brief stay was well over $20K. And BAM, pre-existing condition that a new policy wouldn't have covered. (My layoff had been cancelled in the meantime, and I still thank my lucky stars I had coverage, because I told myself I couldn't afford it.)

In America, you can't afford NOT to have health insurance.
posted by mochapickle at 4:01 PM on October 9, 2014 [1 favorite]

She should find out about COBRA from her current insurance. COBRA is generally retroactive.

But unfortunately you can't make her do anything since you don't control her.
posted by radioamy at 4:18 PM on October 9, 2014 [1 favorite]

No, don't buy her insurance. Yes this is a terrible idea. Healthy people get into accidents every day.

Why quit before moving, especially if you'll be so strapped for cash you can't afford insurance?

Your friend has problems, and this is the least of them.
posted by Ruthless Bunny at 4:36 PM on October 9, 2014 [1 favorite]

FYI, insurers can no longer refuse to cover preexisting conditions, per the ACA, continuous coverage or no. So that shouldn't be a concern.
posted by MadamM at 5:18 PM on October 9, 2014 [4 favorites]

I've received temporary health insurance through my college as an alumna. It wasn't very comprehensive but was reasonably priced.
posted by girlmightlive at 5:40 PM on October 9, 2014

The best options are probably COBRA or her state's health insurance exchange (or the federal exchange, if her state doesn't have one). Enrollment for Medicaid is always open, and enrollment for private plans opens on Nov. 15 (for plans starting Jan. 1, 2015) -- but since job loss is a life event, she should be able to enroll anytime after she's no longer eligible for her work's coverage.

The bad news is that she can't pre-buy insurance from the exchange, she has to wait until she's not eligible for her employer's insurance plan (well, as long as her employer is offering "adequate" "affordable" coverage, but it sounds like they are).

Anyway, it's silly for her to take such a big risk and decide already that she won't have insurance while she's unemployed, before even checking to see if she's eligible for Medicaid or a subsidy. It's likely that she could have free or incredibly low cost premiums while she's out of work. In her case, signing up for insurance is likely to be cheaper than paying the penalty for being uninsured, let alone having the bad luck to rack up medical bills while she doesn't have coverage.

The pre-existing condition issue doesn't exist anymore because Obamacare outlawed denials based on health status and pre-existing condition exclusions. The threat of ending up in the hospital and racking up big bills while uninsured still exists, though. Hospitals might also have to be stingier with financial aid now because DSH funding, which used to fund a lot of that financial aid, is getting cut (since we were supposed to have universal coverage with Medicaid Expansion + Private Plan Subsidies, so there would have been no need for financial aid for uninsured patients anymore -- the Supreme Court upended that when they decided that states' acceptance of Medicaid expansion was voluntary).

If worst comes to worst and she doesn't end up getting insurance during her employment gap, as long as she's only uninsured for less than three months in the calendar year she shouldn't have to pay the penalty at least. IIrc, for an individual adult the penalty is $95 for 2014 and $300 for 2015 (and $695 for 2016).

I don't think that you (legally) can buy her insurance for her without her permission, but hopefully she's sensible enough that that won't be an issue and she'll just sign up for it of her own accord.
posted by rue72 at 6:15 PM on October 9, 2014

I would recommend against university plans, because they're exempt from (many? all? I can check if you're actually interested -- memail me) ACA regulations and don't have to abide by the minimum standards for comprehensive care/insurance. So in practice they usually end up being significantly more expensive than the insurance you'd get through the exchange but don't offer nearly as much coverage. For example, I actually think that my university's student plan still has lifetime payout caps, which is illegal for plans on the exchange to have now.
posted by rue72 at 6:19 PM on October 9, 2014 [1 favorite]

I think the best you can do is probably just to say "I'm really worried about your idea to go without health insurance. If you say you can't afford insurance premiums, you REALLY can't afford to go without insurance, because anything health-wise that happens to you is going to cost you more than that. You could get into serious trouble. I found a couple of options online that cost $x and $y - check these links out! All right, I'll stop nagging you now, just think about it. Love, your mom (aka ista)"

Don't offer to pay, that would be overstepping. You're absolutely right and she'd be taking a terrible gamble. I'm an emergency dept doc and I see people who lost this gamble almost every day. Just one emergency department visit is guaranteed to be more than what her premium for that time would be - but unfortunately, too many people think 'it won't happen to me' until it does.
posted by treehorn+bunny at 8:44 PM on October 9, 2014 [2 favorites]

One more reminder to look at COBRA. The way it was explained to me was that it was retroactive - i.e., after I left I didn't have to keep paying for my health insurance, but in the next XX days, if I decided I did want it after all, I could pay the premiums till that point and would qualify as having had uninterrupted coverage.

* I think XX was 60 days, but that may have changed.
* Many things have changed (for the better) with the ACA - pre-existing conditions are no longer excludable, so the need for continuous coverage is no longer as critical as it used to be.
* The catch with COBRA is that you're on the hook for the entire premium on your own, both your part (the paycheck deductions) and the part the employer used to pay. That's when you find out what really went in to your benefits package...

Finally, another vote to look at the post-ACA situation in the state she's moving to. She may be eligible for Medicaid if she's moving to one of the non-vindictive states.
posted by RedOrGreen at 9:09 AM on October 10, 2014

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