Multiple Sclerosis: Hold on to Your Health Insurance with COBRA - dummies

Multiple Sclerosis: Hold on to Your Health Insurance with COBRA

By Rosalind Kalb, Barbara Giesser, Kathleen Costello

When you have multiple sclerosis (MS), hanging onto your health insurance can be difficult due to increased expenses, loss of income or employment benefits, and other problems. Fortunately, Congress and many states have already passed laws to protect your eligibility when you have MS.

In fact, these laws protect all Americans through life’s most common life — such as getting too old to be covered by your parents’ insurance policy, getting divorced, getting laid off from your job, or retiring.

One of the most important major laws you should know about is the Consolidated Omnibus Reconciliation Act (COBRA), which was passed into law by Congress in 1986. It protects your right to continued eligibility under your group health plan for a certain number of months after coverage would otherwise end.

This protection is important because lapses of 63 days or more in health insurance coverage make it difficult for a person to enroll in a new plan. COBRA guarantees continued eligibility for all qualified beneficiaries (covered employees and their covered spouses and dependents) for a limited time period after employment ends.

COBRA protection is triggered by several different kinds of events:

  • For employees:

    • Your employment is terminated voluntarily or involuntarily for any reason except gross misconduct.

    • You change your work status to part-time and become ineligible for your employer’s health plan.

  • For spouses of covered employees (domestic partners aren’t covered):

    • Your husband or wife (the covered employee) is terminated voluntarily or involuntarily for any reason except gross misconduct.

    • Your husband or wife changes his or her work status to part-time, resulting in ineligibility for the employer’s health plan.

    • Your husband or wife becomes entitled to Medicare.

    • You get a divorce or legal separation.

    • Your husband or wife dies.

  • For dependent children:

    • The qualifying events for dependent children are the same as for spouses (see the previous bullet).

    • An adult child turns 27 and ages out of a parent’s coverage.

When you make use of your COBRA privileges, you must agree to pay the former employer (or a designated third party) the full premium plus a 2 percent surcharge. After you pay this amount, your employer no longer pays any part of the cost of your coverage.

The law requires your employer to notify you about your COBRA rights when you join the group health plan and then again when you’re about to leave the plan. As a qualified COBRA beneficiary, you have 60 days from the date of the COBRA offer to tell your employer whether you plan to elect or reject the continued coverage. COBRA coverage begins the same day that the other coverage ends — without any gap in protection.

You can elect COBRA for yourself and any family member who’s covered under the same plan. If your spouse is the covered employee, he or she can elect it for you if you’re covered under the same plan.

The length of time that you receive COBRA benefits depends on what triggered your COBRA eligibility. For example:

  • If your job is terminated or your work hours are reduced, the COBRA benefit period is 18 months.

  • If the triggering event is loss of dependent status for an adult child at age 27, a divorce or legal separation from, or the death of, your insured spouse, the benefit period is extended to 36 months.

  • If any qualified beneficiary (employee, spouse, dependent child) becomes disabled during the first 60 days of COBRA coverage, he or she may extend coverage for an additional 11 months.

    To be eligible for this extension, you must give the insurance plan administrator a copy of the Social Security Administration’s disability determination within 60 days of receiving it. But bear in mind that the premium can legally be increased by 50 percent for months 19 through 29.