Gap in private health insurance

August 4, 2023 6:55 AM

If my employer won't back date coverage to the date of a qualifying life event, do I have any options besides COBRA to cover claims occurring during that month between plans?

Just what it says. Partner had health insurance through his employer and doesn't anymore. My employer won't add him to my plan until a month has passed from the date of the qualifying event. We had some pharmacy purchases that went through, which will eventually be bounced back and then we will owe full price on some very costly diabetic supplies. Trying to understand how to handle it.

posted by crunchy potato to Work & Money (7 answers total)

I would take this up directly with your carrier or administrator of benefits outside of your employer. The whole thing with QLEs is that they must be submitted within 30 days of the event happening, so waiting a month seems like maybe your employer is not adding your partner due to a QLE but rather some other means of enrollment. (Is it near open enrollment and they are just trying to avoid the QLE paperwork and add your partner via open enrollment instead?) It seems like someone is confused somewhere along the line and if you're still in the QLE window you might be able to get the insurance company to send you the forms directly to manage this. Even better would be dealing with your broker/administrator who supports your HR team, but it's sometimes difficult to ascertain who that is.

Barring the solution above, yes, it seems retroactively enrolling in COBRA for 1 month to cover the gap would work, but boy is it annoying!
posted by luzdeluna at 7:43 AM on August 4, 2023 [2 favorites]

If you haven't already, your might try Marketplace/Obamacare coverage for that gap. I don't know whether it can be backdated or what the prescription coverage will look like, but perhaps it's an option. It looks like access to COBRA doesn't disqualify you from Marketplace, if you are not actually enrolled in COBRA.

And, it's a long shot, but is there any chance the maker of the diabetic supplies will provide a partial reimbursement to your partner for that month? I know some drug companies provide sponsorship to patients for super expensive drugs, but I don't know if they will cover a one-month hardship or if it's more of an ongoing thing that has a lengthy medical onboarding process.
posted by happy_cat at 7:52 AM on August 4, 2023 [1 favorite]

My experience with Obamacare, which could be state specific, is that it starts from the month after the one you sign up in (eg, sign up July 2nd, get coverage Aug 1st). So even if you're entitled to sign up the gap will remain uncovered. Also, they're not vastly less expensive than my COBRA plan, and your yearly deductible starts from zero because it's a new plan.

I think COBRA is your way forward. Because it's the same plan, I believe your current deductible continues, which is probably helpful if you have already spent money this year (but yes, ask them).
posted by How much is that froggie in the window at 12:26 PM on August 4, 2023 [1 favorite]

Response by poster: I should clarify. The QLE was submitted within a month. We have 60 days from the date of the QLE to send in the info. But my employer won't let the change be effective until a month after the QLE so there's a few days where we have no coverage unless we get COBRA. It's employer discretion so idk why employers don't just back date this stuff, especially if the employee can pay catch up premiums or something. Sigh.
posted by crunchy potato at 3:33 PM on August 4, 2023

I've been here; I think the advice above is pretty much on point, but let me share, too. A one-month gap in health insurance is almost certainly best covered by COBRA if your goal is to have no insurance gap and cover a necessary expense that exceeds the one-month premium (which I'm 99% sure will be for the one-month premium for BOTH of you. I don't think you can extend insurance with COBRA for your partner but not you. Ask.)

The big difference between COBRA and ObamaCare these days is that you can extend your old insurance with COBRA and you have 60 days to finish arranging that with the insurer without a gap in coverage -- you can apply it retroactively if you have health care costs justifying that. So you can quit, be without health insurance for for a month or two as you are rehired and both of you regain health insurance from your new employer, and if something terribly expensive happens to you in that uninsured month or two months, you finish applying for COBRA retroactively and get the bills accrued during that period paid later on the exact terms of your old health insurance policy with your former employer (but without your former employer's contribution -- you two pay for the full cost of the policy).

ObamaCare is almost always adequate and much cheaper, but it can't cover the gap between the day you left you old employer and the first day of the month after you join your new employer. So if you're OK considering gambling on that gap, check that out. Note that if either of you incur unexpected huge health care bills during that gap when you're waiting for ObamaCare to kick in, you can just switch your strategy back to signing up with your former employer's insurance retroactively using COBRA, paying the higher expense for that, and using that instead,

ObamaCare is so, so much better that what we had before, but it's still a little bit of a mess in situations like this. So: COBRA right away if you know you'll need it for big bills right away, ObamaCare if you may be able to handle a gap, and back to COBRA if it turned out you didn't make it affordably through the gap and want to revert to your old employer's insurance to solve that.

So frustrating! And so embarrassing to share these details with folks from other countries that have real universal health insurance.

Good luck navigating all this -- much easier in some places, much harder in others. But I've done this game twice in the last four years (in California), and I think I'm sharing correct information.
posted by Scarf Joint at 7:03 PM on August 6, 2023

Oops, really messed up answering your question above after misreading it. You have existing health insurance with your employer and are adding your partner (who was insured with another employer with a different policy) after their coming gap of a month or less.

So, much more simply: Do nothing!

If your partner's diabetic supplies bills for that gap period exceed the full cost of a one-month COBRA extension, they apply and pay for it and use that old insurance for those costs. Otherwise, they order from your pharmacy on Day 1 of their coverage on your policy, all is well, and there's actually a net cost savings during a couple of scary, thrilling weeks of uninsured but retroactively fixable lack of coverage.

No ObamaCare to consider.

Your partner's COBRA people at their old job have all the details, and they have two full months to arrange retroactive COBRA with them if it makes financial sense.
posted by Scarf Joint at 7:43 PM on August 6, 2023

(And I don't think a responsible HR department would back-date; that's a potential lawsuit from the old insuror if your partner submits a $10 million claim during the backdated period and they sniff it out.)
posted by Scarf Joint at 7:51 PM on August 6, 2023