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Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

Health Insurance; COBRA; OBRA; HIPAA;is called a "pre-exisitng coverage"
Medicare. If asked, could you state thatcondition.Here again, before
you knew that all 5 of these topics hadautomatically taking COBRA, it would be
the same thing in common: medicalwise to contact a Benefits Insurance
insurance coverage for you and, perhaps,Broker and give him/her all of your
your family? Would you know theoptions, and get their input. I have
qualifications for each? Well, in thisworked extensively with a Benefits
article, we will discuss them. For aInsurance Broker, and he is absolutely
timeline that depicts, graphically, thefantastic!OBRAWhat, you ask, is OBRA?
time relationship between them, pleaseI've never heard of it, you say, and no
see the timeline in INSURANCE Coverageone I know has heard of it either! Well,
from WorkIf we are lucky, we, and/or ourthat's because, 99% of Human Resource or
spouse, work for a company thatBenefit folks that I know have never
provides, as a benefit, health insuranceheard of it! OBRA is a federal law that
coverage for us and our family. If so,was passed that extends COBRA for an
we are very lucky. Even if that is true,additional 11 months FOR DISABILITY
there are some key things that you mightPURPOSES ONLY!! Why, you ask, is this
want to look at to see if you haveimportant? Thanks for asking, let's see
ENOUGH coverage.1) From your Humanif I can explain.If you are as nieve
Resources Department (or wherever else(did I spell this wrong too? sorry!) as
you would go to get information aboutI was when I first started looking to
your health insurance) get what isbridge my health insurance from working
called a "Summary Plan Description"to Medicare, I assumed that when I got
(SPD). This document should be keptthrough all of the hoops to qualify for
where you can always find it, as itSSDI (Social Security Disabililty
contains all the information you willInsurance) I'd IMMEDIATELY be eligible
need about what your insurance coversfor Medicare, RIGHT??? WRONG!!!!When you
and what it doesn't.2) Look upFINALLY qualify for SSDI, you have to
"Coverage" and "non-coverage" in yourwait for 5 months before you get your
SPD.These will tell you what your planfirst check. AND, the rules state that,
covers and doesn't cover. You need toyou are eligible for Medicare 2 years
see if, perhaps, you or one of the(24 months) FROM THE DATE OF YOUR FIRST
covered members of your family has aSSDI PAYMENT. Well, if you add 24 + 5
condition or circumstance that might notyou get, 29 months between qualifying
be covered, where you need additionalfor SSDI, and Medicare coverage.OK, I
coverage. For example, let's say thatsaid earlier that COBRA is for 18 months
your family has a history of cancer;of coverage. Well guess what 18 months
perhaps your plan restricts the numberof COBRA + 11 months of OBRA equal - 29
of hospitalization days for care; or,months!BUT, there are two catches to
restricts the days per condition. InOBRA; first of all, you have a small
this case, (like my children) you mightwindow of 30 - 60 days to apply ( this
want to get additional "cancerwindow opens the date of your SSDI
insurance" (I think that AFLAC mightapproval); and, it can cost up to 150%
provide this type of coverage).It wouldof your plan coverage amount. BUT, if
be a good idea to contact a Healthyou have a "previously existing
Insurance benefit Broker and ask him/hercondition" this might be the best way
to read your SPD and see if you have anyfor you to proceed.Again, it is
gaps in coverage. They then can help youimportant to contact a Health Insurance
supplement coverage BEFORE YOU NEEDBroker to help you with the risk/cost
IT!NO HEALTH INSURANCE COVERAGEYou mightratio of all of these situations.It is
be one of the growing members of ouralso improtant to know all of these
society that, through one circumstancedeadlines as you plan to ensure that you
or another, does NOT have healthand your family have important health
insurance coverage for your family. Ininsurance coverage.HIPAAHIPAA is a
this case, I strongly encourage you tofederal law that is called, briefly, the
contact a Health Insurance Broker and"portability" law for health insurance.
get immediate coverage of what is calledWhat that means is that when you leave a
"catestrophic" (not sure if I spelledgroup (read company-paid plan), the
this correctly) coverage. In this typecarrier that provided that plan, must
of coverage, you will generally haveoffer to you, another plan, different
large deductibles, but will havefrom COBRA, when you leave the group
coverage if, say, one of you has to gocoverage. Generally this will be what is
into the hospital.CONTACTING A BENEFITScalled a "bare bones" plan. Again, the
INSURANCE BROKERWhenever you call orbest thing for you to do is to call
email a Health Insurance Broker, it isemail a Health Insurance/Benefits Broker
very important to prepare ahead of time.with all of your information: SPD, COBRA
WHAT, specifically are you looking for;info, HIPAA info, needs, cost limits,
how much can you afford to pay everyand let him/her help you find the
month; what circumstances do you want tooptimum plan coverage for
make sure that your family is coveredyou.MEDICAREOK, now, finally, we've
for. In this way, you can make sure toreached Medicare! BUT (you really didn't
focus on your critical needs.COBRACOBRAthink it would be that easy, did you?)
is an acronym ( how can I spell acronymif you have qualified for Medicare
correctly, yet not be sure that Ibecause of disability, there are
spelled catestrophic correctly?) thatRESTRICTIONS (of COURSE there
stands for: Consolidated Omnibus Budgetare!).First of all, if you are
Reconciliation Act. Basically, it is aqualifying for Medicare because of
federal law that allows you to pay fordisability, you are probably under the
your Company-paid health insurance, asage of 65 - normal retirement
an active member, if you no longer workage.Medicare coverage does NOT cover
for that company for, generally 18prescription drugs, which, those of us
additional months.1) COBRA iswith disabilities probably need, and
"triggered" (that is, you, or a coveredwhich cost lots.But, Congress prescribed
member of your family, become eligiblethat states (all but 11) offer what is
for COBRA) by events such as thecalled "Medicare supplement" plans, some
following: resignation from the company;of which do offer prescription
termination (FOR ANY REASON) from thecoverages.
company; divorce of a spouse; a coveredBUT, these plans ARE NOT REQUIRED TO,
chile's birthday makes them ineligibleand do not, offer these medicare
for coverage. These are the mainsupplement plans that offer prescription
"triggering" events for COBRA.2) Now,coverages to folks who qualify under age
when eligible for COBRA, you will be65! So, if you are qualifying because of
asked to pay for 100% to 105% of thedisability, your medical insurance plan
company's employee/employee and familydoesn't cover one of your primary cost
coverage amount. You should get a letterexpenditures!Here again is where you
from your company explaining what thatneed to contact a health insurance
amount will be. BEFORE YOU DECIDE TObenefit broker. Again, he/she can work
TAKE COBRA, there are some importantwith you, and your specific
things for you to consider.What will becircumstances, to get you the coverage
your cost, and what will be the coverageyou need.Hope that this information was
for that cost?helpful to you. If you have any
Sometimes the cost is too much for thequestions, please feel to ask them by
coverage. In these cases, you might wantcommenting on this blog, and I'll be
to select HIPAA coverage, instead (seehappy to get you an answer.About &
HIPAA below).Or, you might just want toCarolyn is a website designed to assist
get catestrophic coverage as waseach person in his/her own unique quest
mentioned earlier, and wait for fullto navigate through the difficult and
coverage under your next job.Part ofoften conflicting and misleading
this decision should be whether or notinformation about coping with
you or a member of your family has whatdisabilities.



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