Health Insurance Question

[RainMaker]

I know there are some experts with this stuff here so I'm asking for help. Here's the situation I'm in with my Mother.

She's been disabled since last year. She didn't want to stop working but they would cause horrible flare-ups that would require heavy steroids to bring down (she suffers psoriatic arthritis). The issue ended up being that the doctors couldn't keep giving her the steroids as her body would stop doing things naturally. So she had to leave her job and she filed and gets disability checks every month.

On to health insurance. She was able to stay on Cobra for 18 months. It cost around $600/month but that's not the end of the world. She is able to get on Medicare at the 24 month mark of being disabled (which will be 6 months from now).

So the situation is that she's got this 6-month window of potentially no insurance. She can afford to pay a lot for insurance over that time and my brothers and I have all offered to pitch in for the cost if necessary. The problem is that every insurance company has rejected her for a private plan.

So the solution was supposed to be me putting her on my company's group plan for the next 6 months and calling her an employee. The problem is that I think that would fuck up her disability status (not 100% sure how that works).

Does anyone have any suggestions here? The biggest issue we run into is that she's on an expensive drug called Humira. She takes twice the normal dose so it can run around $28,000 for the year. I can get it in Canada for about half the price but I'd have to find a way to smuggle it in and I don't know if they'd let me take 6 months worth or if it expires (I believe it has to be refrigerated). I was thinking of contacting the drug company directly and seeing if they could help.

As for insurance, is there any options out there? Any new laws that have passed that would extend her COBRA since she's disabled? Seems some new stuff is out there but it's impossible to find clear information. I'd even settle for a major emergency insurance plan that would just cover major disasters. Outside of the cost of the drug, she really doesn't need to go to the doctor much. But still, with someone nearly 60, I just don't feel right with her having zero protection from major stuff.

Any help would be heavily appreciated . Hoping there is some law or thing out there to workaround these next 6 months.

[RainMaker]

And money isn't the biggest issue here. We can deal with a $10-$20k hit for these 6 months if need be. The bigger concern is something bad happens and she is stuck with a few hundred thousand in bills. She did have a horrible flare-up years ago that put her in the hospital for a month, so that's what I'm concerned about more than paying a real high premium or something.

[stevew]

Sucks that there is no generic available for that drug. I'd try to get as close to Abbot as possible. If they can't cut you a deal, maybe a wholesale pharmacy might? I would not smuggle it in though.

[ISiddiqui]

Generally, if a participant has to go on COBRA for disability, she gets 29 months of coverage rather than 18 - as long as the disability was known at the time COBRA began (or 60 days after starting COBRA):

http://www.dol.gov/elaws/ebsa/health/67.asp

However, if you or a family member becomes disabled at any time either before becoming eligible for COBRA continuation coverage or within the first 60 days of being covered by COBRA continuation coverage, you may be able to extend the maximum period of COBRA continuation coverage of 18 months, by up to an additional 11 months. This could result in a total of 29 months of COBRA continuation coverage. This disability extension will apply to the person disabled, as well as to all family members who are receiving COBRA continuation coverage due to the same qualifying event as the person disabled.

Originally Posted by Rainmaker

So the solution was supposed to be me putting her on my company's group plan for the next 6 months and calling her an employee. The problem is that I think that would fuck up her disability status (not 100% sure how that works).

The other problem is... well... that is illegal.

[Eaglesfan27]

Also, there is currently a bill before Congress that would extend the total length of Cobra eligibility and the Cobra subsidy extension for 6 months.

[RainMaker]

Originally Posted by ISiddiqui

Generally, if a participant has to go on COBRA for disability, she gets 29 months of coverage rather than 18 - as long as the disability was known at the time COBRA began (or 60 days after starting COBRA):

Employee Benefits Security Administration - Health Benefits Advisor

Thank you very much. Her employer knew she was leaving due to her disability and I assume knew about the SS.

The only issue is the 60 days from starting COBRA. I wonder if that's from when she sent in the application for SS benefits or the date it's approved. I know she got approved but didn't receive checks for a little while. I'll have to figure out that but there may be a chance that it was past the 60 days from receiving it from the SSA. I've also read conflicting data on whether she needed to show her employer the disability papers within a certain timeframe. I don't know if she actually did that and that seems like something they can get her on.

Originally Posted by ISiddiqui

The other problem is... well... that is illegal.

Yeah, but options are limited here. I was looking into how hard it would be for her to go back to work and off disability, and then back on after 7 months when she's eligible for Medicare.

[RainMaker]

Originally Posted by Eaglesfan27

Also, there is currently a bill before Congress that would extend the total length of Cobra eligibility and the Cobra subsidy extension for 6 months.

Not going to hold my breath on that one.

[BYU 14]

She will be OK as long as the filing took place within that 60 days since there would be medical documentation of the disability at the time it was filed. I assume you have been in touch with her former employers HR rep, if not make sure they are looped in so the ball isn't dropped and they can assist with the administrative process.

[BYU 14]

Dola, I don't know where you live, but worst case scenario is that if she has no income and is disabled she may qualify for your state Medicaid program in the interim as well, something you should also check into.

[cschex]

Originally Posted by BYU 14

Dola, I don't know where you live, but worst case scenario is that if she has no income and is disabled she may qualify for your state Medicaid program in the interim as well, something you should also check into.

Unfortunately, most people who are on disability don't qualify for Medicaid because their disability income is considered too high for most current Medicaid guidelines. However, I agree with the previous points, as long as the disability was documented within the 60 day window, it shouldn't matter when she actually received the first check.

[RainMaker]

She should qualify for the COBRA extension after looking through the records. The issue is she never notified them within 60 days of being accepted. They knew she was on disability as that was the reason she could not longer work, but I guess you have to send them the notice in the mail.

Which makes another issue. They never sent her any materials on COBRA. She talked over the phone to them about being on it, but never received anything in the mail notifying her of what needed to be done. I would think that would give her some leeway.

As mentioned, my other option is putting her on my company health insurance. She's allowed to make up to $500 a month so I can just say she's a part time worker at minimum wage.

[ISiddiqui]

The issue is she never notified them within 60 days of being accepted.

That is an issue. You have 60 days from recieving your COBRA notice to accept COBRA and if she waited beyond that, they could say she waited too long.

If they never sent her a COBRA notice, then they can't say that (they are required to send a notice within 45 days of termination, IIRC).

[RainMaker]

Originally Posted by ISiddiqui

That is an issue. You have 60 days from recieving your COBRA notice to accept COBRA and if she waited beyond that, they could say she waited too long.

If they never sent her a COBRA notice, then they can't say that (they are required to send a notice within 45 days of termination, IIRC).

No, she is on COBRA. The notice is for extending her COBRA for 11 months because of a disability. From what I've read, she needed to send in her SS notice as soon as she was approved for disability. The problem is that she never knew to do that because she never received notice on COBRA stuff. She was put on COBRA through a phone call in a rather informal setting (it's a restaurant, not a big company with thousands of employees).

[ISiddiqui]

Understandable, but regardless, no matter how large or small the company is, they are required to send a written COBRA notice to the terminated employee. Now, I'm guessing from the phone conversation method that they are a self-funded plan?

And yes, she needed to send in her SS disability notification within 60 days of recieving it in order to get the extra 11 months (at 150% of premium cost, not simply the 102% of regular COBRA), but that information WOULD have been on the original COBRA notice, so she would have known to do it.

Basically that's the leverage you can use. That information would have been on the COBRA notice (it is standard language on model COBRA notices). She didn't know about it, because she never got a notice.

[DaddyTorgo]

ISiddiqui FTW

[RainMaker]

Originally Posted by ISiddiqui

Understandable, but regardless, no matter how large or small the company is, they are required to send a written COBRA notice to the terminated employee. Now, I'm guessing from the phone conversation method that they are a self-funded plan?

And yes, she needed to send in her SS disability notification within 60 days of recieving it in order to get the extra 11 months (at 150% of premium cost, not simply the 102% of regular COBRA), but that information WOULD have been on the original COBRA notice, so she would have known to do it.

Basically that's the leverage you can use. That information would have been on the COBRA notice (it is standard language on model COBRA notices). She didn't know about it, because she never got a notice.

Thanks, that's what I'm hoping for. I'm hoping they don't even argue it, but that is some good leverage. I owe you guys a beer someday for the help.

[Eaglesfan27]

Originally Posted by RainMaker

Not going to hold my breath on that one.

Although it is unclear if the total length of Cobra eligibility was extended today or not, the subsidy for Cobra benefits was extended for 6 more months today. Good news to me as I'm paying my mother's Cobra costs.

[RainMaker]

Forgot to update this. She notified them that she was on disability and wanted the 11-month extension. They didn't even question it and said just give a copy of the letter from SSA and it would continue.

Thank you all for your help. This was a huge burden taken off everyone in the family. ISiddiqui, I especially owe you for pointing that out. If you're ever in Chicago, I owe you a beer and a game.

[Logan]

Originally Posted by RainMaker

Thank you all for your help. This was a huge burden taken off everyone in the family. ISiddiqui, I especially owe you for pointing that out. If you're ever in Chicago, I owe you a beer and a game.

Originally Posted by RainMaker

And money isn't the biggest issue here. We can deal with a $10-$20k hit for these 6 months if need be.

Sounds like you owe him a bit more than that!

[DanGarion]

Another save for the FOFC guys, great work!

[Flasch186]

love this board.

[ISiddiqui]

Awesome!!! Great to hear your mom got what she was entitled to, Rainmaker!

[DaddyTorgo]

I <3 FOFC!!!

[RainMaker]

Since I received so much help last time, I actually have a new family insurance problem.

My Dad was laid off from his job about 6 months ago. He went on their COBRA plan and has been on it without issue. Today he went to the drug store to pick up a prescription for a minor surgery he's supposed to have on Friday and was told that plan had been canceled.

So he called up the COBRA management company and his old company. They said they switched carriers but don't have any information on policy # or anything else till it's officially approved. One lady made it seem like this was common. They said all stuff would be covered retroactively to March 1. They had just cashed a COBRA check of his the other day.

Now the question is whether this sounds right or they are bullshitting him. He's worried they are broke and maybe got the boot from their old carrier. I would have thought you'd have another one lined up right away if you were planning on switching. He's got a surgery on Friday but wants to postpone it because he has no clue if he has insurance or not.

He never received notification they were switching carriers. And they can't give him any information now. Is that legal in any way? Does this make any sense to anyone? He's utterly confused as to what to do right now on the surgery scheduled for Friday.

[JonInMiddleGA]

Originally Posted by RainMaker

Now the question is whether this sounds right or they are bullshitting him. He's worried they are broke and maybe got the boot from their old carrier.

Sounds fishy to me, but then again I am a suspicious SOB.

Just for the heck of it, try Googling the name of his COBRA company, see what comes up. Odds are there'll be some negative publicity out there if they've hit financial hard times.

[RainMaker]

Originally Posted by JonInMiddleGA

Sounds fishy to me, but then again I am a suspicious SOB.

Just for the heck of it, try Googling the name of his COBRA company, see what comes up. Odds are there'll be some negative publicity out there if they've hit financial hard times.

He's not worried about the COBRA company, but the actual company he used to work for. I think the COBRA company just handles the paperwork. It sounds real fishy to me though how everything is playing out.

I just can't fathom there isn't a law out there that forces you to notify people when you switch or swap out plans. Honestly, if it wasn't for picking up a prescription today, he would have never known the old plan was gone.

[lynchjm24]

Many times when a company changes plans the COBRA lives stay with the PRIOR carrier....

[ISiddiqui]

He should contact his old company (that he used to work for) and talk to the Plan Administrator. Ask him what's the new insurance company (the COBRA company will be part of the regular insurance company that the Plan uses for its group health care). There really shouldn't be that much delay in the switch over.

If the Plan Administrator seems like he's giving you the run around, let me know what state you live in and I can give you the number of the regional EBSA office so you can get a Benefits Adviser to help you out (maybe calling up the company to get more facts, etc).