COBRA insurance or an Ohio private health insurance plan. If you are currently insured under a group medical plan and you retire or leave your employer, you have a decision to make. Should you accept the offer (assuming it is available) or purchase a personal healthcare policy. Generally, COBRA medical rates will be high, unless the employer is paying a portion of the premium.
Before determining which option is best, it’s important to understand exactly what COBRA is. The “Consolidated Omnibus Budget Reconciliation Act” allows an employee, spouses and dependents, the right to continue their medical benefits after they have left their employer (subject to guidelines).
Previously, a stimulus package was available to help defray costs, although it is no longer offered. Typically, this period of time is 18 months, although with some circumstances, a spouse and dependents can keep benefits for 36 months. A total disability may allow an employee to reatin COBRA for 29 months.
Before the 18 months expires, a policy that guarantees coverage and pays for pre-existing conditions is likely to be available through the Ohio Marketplace. You should receive notification in writing, and the letter will inform you about specific options. The plan administrator of your employer should have a copy of the letter, and may be able to provide additional details regarding dental and vision options. A federal subsidy may be offered, depending upon household income, to reduce premiums.
The Female Spouse Role
It's also important to understand that women's participation in the work force is significant, and often they are the decision-maker regarding many of the topics we discuss in this article. Prior to age 50, females tend to utilize benefits more, and are often the care giver (if needed). With increased diversity, many additional preventative benefits are now covered, along with much more comprehensive maternity benefits. Qualified plans have also eliminated a separate deductible for maternity benefits, and cesarean section coverage is more comprehensive.
The United State Department Of Labor publishes a small guide about women and job-based health that can be very helpful. This fact sheet highlights some of the common roles and issues facing women when they leave an employer and must compare benefit options. Also, many more families now obtain their benefits through the wife's employer. Therefore, when she retires, a private Marketplace plan or Group coverage through the spouse may have to be selected. In these situations, multiple policies can be issued for different family members.
COBRA Or Exchange Plan
You may be eligible to buy an Exchange policy through Open Enrollment, which may be much less costly than the transitional benefits you are offered. You don't have to pass (or take) a physical and you will not be turned down because of medical issues you are being treated for (past or present). There also will be no surcharges or waiting periods for any services.
Just as importantly, if you have not completed the full 18 months of COBRA benefits, you can still enroll for Marketplace coverage. For example, if you became eligible in July, although only six months have been utilized by the end of the year, you may still compare, and ultimately enroll in Exchange policies. Of course, we'll help you research and understand which option is best for your situation.
If you qualify for a government subsidy, it's highly probable the Exchange plan will be the best solution. The criteria is having a household income between 100% and 400% of the Federal Poverty Level. The resulting premium tax credits will allow you to purchase affordable coverage or possibly become Medicaid-eligible.
The rate you pay is 102% of the cost charges to the employer by the insurer. Of course, this can present a problem since Ohio group rates can be very expensive…often, much more than a private plan will cost. Thus, it’s not unusual for an individual rate to cost as much as $600 per month and a family rate double (or more). Dental and vision rates, however, are usually not expensive.
One of the reasons for these high premiums is the richness of benefits you often receive with an employer-purchased plan. Often, the catastrophic deductible is very low, perhaps $500 or less. Sometimes, there is no deductible on major claims which will drive premiums up. Maternity is often included in group plans which can easily add $200-$400 per month of premiums. Most private Ohio health insurance policies do not include maternity benefits, unless there are complications.
There may be other benefits that your work plan had that may not be available (or may be limited) under a personal policy. Mental illness may be one condition that your group plan at work covered, but your private policy doesn't. But generally, the most important features will be provided under a policy you purchase yourself.
Group Policies Through Work
Traditionally, the makeup of a group medical plan consists of a higher proportion of either unhealthy insureds or persons with very serious health problems. Since almost everyone is accepted into the plan, unlike a personal policy, very few applicants are denied coverage. Thus, your rate that you are offered may be quite high.
Thus, when presented with choosing to accept your offer or a private Ohio health insurance plan, perhaps the biggest variable is the rate that you will pay. If you have no existing conditions and other members of your family (if applicable) are also in great health, more than likely, electing to buy your own coverage may be the best option, since the rate difference could be substantial.
However, it is critical that if/when you apply for an individual or family plan, that you don’t overlook the deadline that you have to formally accept the COBRA offer. This is important in the event that the offer you receive on your new health insurance policy is either unacceptable or will not be available before the deadline.
You also should allocate at least 3-5 days to review the offer and discuss the details with us or an experienced licensed broker in Ohio. Insurance laws can also be reviewed. Remember that although Open Enrollment occurs every year, there is only one chance to enroll in COBRA, so it's important not to miss the deadline.
Combination Of Different Plans
Sometimes, it may be worth considering a combination of COBRA and a private medical plan. This works best when the individual eligible for benefits has an extremely serious medical condition and is uninsurable. However, all other members of the family have relatively no issues (or very minor conditions).
In these types of situations, the combination of a single plan on the individual and a private plan on the remaining members of the family could save thousands of dollars per year. One of the best plans can be found here. COBRA will cover pre-existing conditions on the insured that badly needs that coverage. Meanwhile, other more healthy family members can pay a much lower rate on a completely separate policy.
They also can choose a completely different type of coverage (if they choose that option). Thus, one spouse may have catastrophic coverage while the spouse and children have a more comprehensive plan. Or perhaps the worker that leaves the employer keeps "Cadillac" benefits while other dependents select a much cheaper option that keeps prices low.
Perhaps the most important thing to understand about COBRA health insurance in Ohio is that you have many affordable choices. Since pre-existing conditions are not factored into private plan rates, if you qualify for the federal tax subsidy, you should be able to find a much more economical option by purchasing your own coverage through our website.
Additional Information: - If your Ohio COBRA benefits are ending after the last day of Exchange Open Enrollment, you can still purchase a subsidized plan. When your coverage ends, it is considered a "special event," which entitles you to buy a healthcare plan that is ACA-compliant. Therefore, your policy would not be medically underwritten, and all of the new Metal options would be available.