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COBRA Subsidy Questions

Here are some answers:

  • What is the COBRA subsidy? The COBRA subsidy is designed to help you pay for health insurance during unemployment. It pays for 65% of the cost of your COBRA premiums.
  • Who is eligible for the COBRA subsidy? You can get subsidy if you were laid off between September 1, 2008 and May 31, 2010. The subsidy lasts for up to 15 months.
  • What happens after 15 months? You can stay covered under COBRA for another 3 months (more in some states), but you will have to pay 100% of the premiums. For example, if you are currently paying $350 per month under the subsidy, your premiums will increase to $1000 per month.
  • Where can I find less expensive health coverage? While the benefits from COBRA are great, the cost is often too high. Take a look at our article Health Coverage Help During Unemployment for ways to find great health coverage for as low as $39 per month.

An Update on the COBRA Subsidy

The COBRA subsidy was a component of American Recovery and Reinvestment Act passed in February 2009.  The key component of the program is that the government will pay 65% of the cost of your COBRA insurance premiums for nine months.  (Normally, workers who elect COBRA coverage pay 100% of the cost of premiums.)

In its current form, the COBRA subsidy will expire at the end of December 2009.

Two groups of people will be affected by this expiration:

  • Those who began receiving the subsidy when it first became available (i.e. March 2009)
  • Those who become unemployed during December 2009 or later

Unless the subsidy is extended, both groups will be required to pay the full cost of COBRA premiums, which average $400 per month for individuals and $1,200 per month for families.

New Legislation

Fortunately, there are currently two bills in Congress that would extend the current COBRA subsidy.

HR 3930 – Proposed by Representative Joe Sestak in the House of Representatives, this bill would provide the following:

  • An additional six months of COBRA subsidies for current recipients
  • 15 months of COBRA premium subsidies for workers laid off between January 1, 2010 and June 30, 2010

S 2730 – Sponsored by Senators Robert Casey and Sherrod Brown, this bill from the Senate offers the same features as the House bill, plus:

  • The COBRA subsidy would be increased to 75% of the cost of premiums
  • People who lose their health insurance because of a reduction in hours would also be eligible for the subsidy

What To Do?

If your COBRA subsidy is about to expire:

  • Think about extending your COBRA coverage.  You may have to pay the unsubsidized premium for a month (or until the new legislation passes), but this will ensure that you maintain your health insurance.
  • Evaluate your options for individual health insurance.

If you lose your job during December 2009

  • Most companies will continue health coverage through the last day of the month of your departure.  If you are covered by your company insurance plan through the end of December, you will not be eligible for the COBRA subsidy in January.  Talk with the Human Resources department at your employer and see if you can begin your COBRA coverage immediately.  This way, you will lock in the subsidy at least the next nine months.

Also see March 2010 Unemployment Extension for further updates on the COBRA subsidy.

Health Insurance Terminology: Financial Phrases

Why take the time to understand the financial language associated with your health insurance?  Simply put – understanding the language will save you money.

Here’s how: Your health insurance costs are comprised of a variety of variables, which you have the ability to control.  Ultimately, these variables determine the amount of your monthly premium.  Viewed from another angle, the monthly premium you pay will directly impact the other cost components.

Invest a few minutes to learn the financial language of healthcare, and you may end up saving yourself hundreds of dollars per year.

  • Claim: A request for payment from an insurance company or managed care plan. A claim may be filed either by you as the patient or by your healthcare provider (e.g. doctor’s office or hospital) after service has been provided.
  • Co-insurance: The portion of a medical bill that you have to pay (i.e. the amount not covered by the insurance company). Co-insurance is stated as a percentage. For example, if your co-insurance is 30%, you will pay 30% of the medical bill, and your insurance company will be responsible for remaining 70%. With a fee for service plan co-insurance works as described in the previous example for all healthcare costs. In managed care plans, co-insurance generally refers to the percentage that you are responsible for when visiting out-of-network doctors or when receiving specialized medical procedures.
  • Co-payment: The fee you pay when visiting a doctor. Generally ranges from $10 to $50. Depending on your plan, co-payments may apply toward your deductible. Co-payment is also referred to as “co-pay.”
  • Deductible: Costs you will have to cover on your own before your insurance begins paying. For example, if you have a $500 deductible and are undergoing surgery that will cost $10,000, when the bill for the surgery arrives, you will pay $500, and your insurance company will pay $9,500. The deductible will reset annually. Depending on your insurance plan, the deductible will only apply to certain types of procedures.
  • Lifetime Limit: The maximum amount that the insurance company will pay over the course of your life. The lifetime limit is relevant when considering potential chronic conditions, long-term medications, prolonged hospitalization, or other situations that require ongoing medical costs.
  • Out of Pocket Maximum: The maximum amount that the health plan will require you to contribute during any one year. After you have met the deductible amount, your co-payments will count toward the out of pocket maximum. As an example, if your out of pocket maximum is $3,000, after you have paid this much in a given year, the insurance company will cover 100% of the costs beyond $3,000. In practice, some insurance plans structure out of pocket maximums for specific services (e.g. hospital stays or surgeries).
  • Premium: The monthly price you pay for your healthcare coverage. Nearly all other variables discussed impact the amount of your premium. Think of your premium as the answer that you get when solving a long, complicated math problem. This is also the amount that you see on your receipt or voucher. It is advisable that you keep all your vouchers with the voucher code on them to easily trace your payment and other concerns in case of emergency.

See our Health Insurance Glossary for a comprehensive list of even more healthcare vocabulary.

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