6 ms·

People with health issues should still be able to purchase their existing insurance through COBRA, and, once that expires, through the public exchanges that are

by rcme 4y ago

People with health issues should still be able to purchase their existing insurance through COBRA, and, once that expires, through the public exchanges that are guaranteed to cover their existing condition. Thanks ACA.

chimeracoder 4y ago
> once that expires, through the public exchanges that are guaranteed to cover their existing condition. Thanks ACA. The ACA just states that insurers can't refuse a customer who wants to purchase a plan just because they have a preexisting condition. It doesn't actually require that the plan cover treatment for said condition. In many states - including wealthier deep blue states - the marketplace plan options are actually quite terrible.
- rcme 4y ago
  The HHS disagrees with you: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co... > Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.
  - notch656c 4y ago
    Doesn't this create a huge incentive for people to buy rolling "temporary" insurance plans which can consider pre-existing conditions, and then switch to subsidizing off the healthy once they actually get a condition and buy the regular ACA plans?
    - rcme 4y ago
      You can only switch plans during the open enrollment window or in cases of specific life events. You can't arbitrarily change plans whenever you want.
      - notch656c 4y ago
        "Temporary" plans are 1-12 months so you can buy ones that last until the next open enrollment, and if you're healthy you buy another (12 month) temporary plan. If you develop a condition you buy the regular plan.
    - vikingerik 4y ago
      Yes, and that's one reason why costs have ballooned so much, the need to subsidize people who didn't pay while they didn't have a condition and now do. The temporary plans aren't even necessary, if you can wait until the next regular enrollment period. The ACA originally tried to hide that vulnerability by making insurance mandatory, then it appeared when that forcible mandate was repealed. Edit to reply to the reply: Right, it's not insurance. Insurance is pooling risk. If you wait until the risk event has already happened, it's not insurance, it's just paying your own costs with extra steps.
      - notch656c 4y ago
        ... so we have the worst of both worlds. Insurers are forced to take pre-existing conditions, but you can wait until you have a condition before buying it. I don't think that's even "insurance" at that point.... America may quite possible have the absolute dumbest system humanly possible.
        willcipriano 4y ago
        The best part? The US spends more per captia than any other OECD nation on socialized medicine. The United Kingdom's NHS costs around half, per capita and delivers universal coverage.
        notch656c 4y ago
        Yeah. As a a pretty hardcore ancap who hates socialized anything, I'll still take NHS over our current system. Anything is better than our current bastardized system.
  - chimeracoder 4y ago
    No, you are misreading it. They cannot limit benefits due to your condition, but that doesn't mean that they have to cover treatment for your condition. If you have a disease or syndrome, the treatments for that condition (whether pharmaceutical, outpatient, or inpatient) may simply not be on the list of benefits provided by the insurance plans offered. It's legally distinct from, but analogous to, a nodiscrimination clause. They can't refuse to cover your mammogram (which they cover for everyone else) just because your initial diagnosis for Vamipiric Brain Syndrome occurred before your plan went into effect. But they can choose to say they they don't cover Nosferatudone for anyone (when Nosferatudone happens to be the only effective treatment for Vamipiric Brain Syndrome). (There are, separately, certain treatments that all insurance plans must cover by law, although that's separate from the ACA, and it's a very limited set).
    - rcme 4y ago
      Yes, you're always able to buy a bad health insurance plan. But you're also able to buy a good health insurance plan, and your pre-existing condition won't impact the price of the good insurance plan.
      - chimeracoder 4y ago
        > Yes, you're always able to buy a bad health insurance plan. But you're also able to buy a good health insurance plan, If one exists, and as I stated in the original post, in many states, even the best plans available on the marketplace are quite terrible. And that's a problem that's actually gotten worse in recent years, not better, as plans have left the exchange (and providers have dropped marketplace plans from their networks). > and your pre-existing condition won't impact the price of the good insurance plan. Your "pre-existing condition" won't impact the price of the insurance plan relative to others who are purchasing that same plan, but you quite likely will be in a situation where the "good" (eg, gold) plans are the only ones which will provide the coverage that you need, and those are the most expensive ones. This satisfies the letter of the law, but in practice it still means that often people with chronic health condition either are are forced to pay more for coverage or are literally unable to get coverage for their conditions at all (because none of the marketplace plans will cover it). The protections provided by the ACA are much more narrow than you're portraying them as, which is understandable because it's a common misconception about how the ACA operates, but it's unfortunately a very important distinction.
Karunamon 4y ago
Entirely serious question: is COBRA actually of any use to anyone? From where I sit it's always been pretty aspirational since it requires you to also pay the employer side of the insurance which is colossally more expensive than the employee side, and you are expected to do this while being out of work?
- swozey 4y ago
  You can opt out of it (or not opt in) up until, I believe (and correct me if I'm wrong) for up to a year after leaving the job meaning that you can deny coverage UNLESS something major comes up then you pay from that point on. So it's useful for that event, some emergency coming up. I've never paid for it, the one time I had it come up it was something like $800/mo for me as a single 20s laid off person. Not top priority.
- coredog64 4y ago
  There’s a hack for COBRA if you’re immediately switching jobs: Sign up for COBRA but don’t make the payments. If something really bad happens before coverage at your new employer kicks in, make the payments and the claims. TL;DR: Treat COBRA as an options contract.
  - mcast 4y ago
    I thought COBRA benefits were retroactive? I was told you can sign up once you're at the hospital.
- galdosdi 4y ago
  It's useful for 60 days, since for 60 days (or maybe it's 90 or 30, I forget -- look it up yourself if you need it, don't listen to me) you can elect it retroactively. So you can go without insurance, and as long as you haven't hit the 60 days, you can retroactively pay for it if a devastating emergency happens. Actually dealing with this would be a huge logistical hassle, and god help you if you're hospitalized, unconscious, and can't file the paperwork or get someone else to, but at least you probably wouldn't go bankrupt. Hopefully that buys you some more time to find a new job or line up an ACA plan if you're in a state with decent ACA plans, because actually paying for COBRA out of pocket for months at a time is indeed very expensive. (It also would be totally worth it if you had existing expensive health care needs in your family)
Arainach 4y ago
When I left Microsoft I believe the cost I was quoted for COBRA was thousands a month - not quite as much as my salary when I was working there but enough that it would have rapidly depleted my savings if I didn't find another job immediately.
nblgbg 4y ago
When you enroll in COBRA, you are responsible for paying both the employer's contribution and your own contribution. This can amount to thousands of dollars per month. It may be more cost-effective to consider state insurance options or those available on healthcare.gov. I took COBRA in the past and I know about this.

by rcme 4y ago

chimeracoder 4y ago

> once that expires, through the public exchanges that are guaranteed to cover their existing condition. Thanks ACA. The ACA just states that insurers can't refuse a customer who wants to purchase a plan just because they have a preexisting condition. It doesn't actually require that the plan cover treatment for said condition. In many states - including wealthier deep blue states - the marketplace plan options are actually quite terrible.

rcme 4y ago
The HHS disagrees with you: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co... > Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.
- notch656c 4y ago
  Doesn't this create a huge incentive for people to buy rolling "temporary" insurance plans which can consider pre-existing conditions, and then switch to subsidizing off the healthy once they actually get a condition and buy the regular ACA plans?
  - rcme 4y ago
    You can only switch plans during the open enrollment window or in cases of specific life events. You can't arbitrarily change plans whenever you want.
    - notch656c 4y ago
      "Temporary" plans are 1-12 months so you can buy ones that last until the next open enrollment, and if you're healthy you buy another (12 month) temporary plan. If you develop a condition you buy the regular plan.
  - vikingerik 4y ago
    Yes, and that's one reason why costs have ballooned so much, the need to subsidize people who didn't pay while they didn't have a condition and now do. The temporary plans aren't even necessary, if you can wait until the next regular enrollment period. The ACA originally tried to hide that vulnerability by making insurance mandatory, then it appeared when that forcible mandate was repealed. Edit to reply to the reply: Right, it's not insurance. Insurance is pooling risk. If you wait until the risk event has already happened, it's not insurance, it's just paying your own costs with extra steps.
    - notch656c 4y ago
      ... so we have the worst of both worlds. Insurers are forced to take pre-existing conditions, but you can wait until you have a condition before buying it. I don't think that's even "insurance" at that point.... America may quite possible have the absolute dumbest system humanly possible.
      - willcipriano 4y ago
        The best part? The US spends more per captia than any other OECD nation on socialized medicine. The United Kingdom's NHS costs around half, per capita and delivers universal coverage.
        notch656c 4y ago
        Yeah. As a a pretty hardcore ancap who hates socialized anything, I'll still take NHS over our current system. Anything is better than our current bastardized system.
- chimeracoder 4y ago
  No, you are misreading it. They cannot limit benefits due to your condition, but that doesn't mean that they have to cover treatment for your condition. If you have a disease or syndrome, the treatments for that condition (whether pharmaceutical, outpatient, or inpatient) may simply not be on the list of benefits provided by the insurance plans offered. It's legally distinct from, but analogous to, a nodiscrimination clause. They can't refuse to cover your mammogram (which they cover for everyone else) just because your initial diagnosis for Vamipiric Brain Syndrome occurred before your plan went into effect. But they can choose to say they they don't cover Nosferatudone for anyone (when Nosferatudone happens to be the only effective treatment for Vamipiric Brain Syndrome). (There are, separately, certain treatments that all insurance plans must cover by law, although that's separate from the ACA, and it's a very limited set).
  - rcme 4y ago
    Yes, you're always able to buy a bad health insurance plan. But you're also able to buy a good health insurance plan, and your pre-existing condition won't impact the price of the good insurance plan.
    - chimeracoder 4y ago
      > Yes, you're always able to buy a bad health insurance plan. But you're also able to buy a good health insurance plan, If one exists, and as I stated in the original post, in many states, even the best plans available on the marketplace are quite terrible. And that's a problem that's actually gotten worse in recent years, not better, as plans have left the exchange (and providers have dropped marketplace plans from their networks). > and your pre-existing condition won't impact the price of the good insurance plan. Your "pre-existing condition" won't impact the price of the insurance plan relative to others who are purchasing that same plan, but you quite likely will be in a situation where the "good" (eg, gold) plans are the only ones which will provide the coverage that you need, and those are the most expensive ones. This satisfies the letter of the law, but in practice it still means that often people with chronic health condition either are are forced to pay more for coverage or are literally unable to get coverage for their conditions at all (because none of the marketplace plans will cover it). The protections provided by the ACA are much more narrow than you're portraying them as, which is understandable because it's a common misconception about how the ACA operates, but it's unfortunately a very important distinction.

Karunamon 4y ago

Entirely serious question: is COBRA actually of any use to anyone? From where I sit it's always been pretty aspirational since it requires you to also pay the employer side of the insurance which is colossally more expensive than the employee side, and you are expected to do this while being out of work?

swozey 4y ago
You can opt out of it (or not opt in) up until, I believe (and correct me if I'm wrong) for up to a year after leaving the job meaning that you can deny coverage UNLESS something major comes up then you pay from that point on. So it's useful for that event, some emergency coming up. I've never paid for it, the one time I had it come up it was something like $800/mo for me as a single 20s laid off person. Not top priority.
coredog64 4y ago
There’s a hack for COBRA if you’re immediately switching jobs: Sign up for COBRA but don’t make the payments. If something really bad happens before coverage at your new employer kicks in, make the payments and the claims. TL;DR: Treat COBRA as an options contract.
- mcast 4y ago
  I thought COBRA benefits were retroactive? I was told you can sign up once you're at the hospital.
galdosdi 4y ago
It's useful for 60 days, since for 60 days (or maybe it's 90 or 30, I forget -- look it up yourself if you need it, don't listen to me) you can elect it retroactively. So you can go without insurance, and as long as you haven't hit the 60 days, you can retroactively pay for it if a devastating emergency happens. Actually dealing with this would be a huge logistical hassle, and god help you if you're hospitalized, unconscious, and can't file the paperwork or get someone else to, but at least you probably wouldn't go bankrupt. Hopefully that buys you some more time to find a new job or line up an ACA plan if you're in a state with decent ACA plans, because actually paying for COBRA out of pocket for months at a time is indeed very expensive. (It also would be totally worth it if you had existing expensive health care needs in your family)

Arainach 4y ago

When I left Microsoft I believe the cost I was quoted for COBRA was thousands a month - not quite as much as my salary when I was working there but enough that it would have rapidly depleted my savings if I didn't find another job immediately.

nblgbg 4y ago

When you enroll in COBRA, you are responsible for paying both the employer's contribution and your own contribution. This can amount to thousands of dollars per month. It may be more cost-effective to consider state insurance options or those available on healthcare.gov. I took COBRA in the past and I know about this.