Getting a new health insurer

[blake-watson]

My mother was able to keep her insurance when she retired and still keeps me on it. I’m not sure about the details but I could ask.

[alyssa-silva]

Interesting. I wonder if it has to do with the type of insurance she has. Or if it varies by states?

[deann-r]

Be prepared for longer wait times and fewer options. Do you qualify for Medicare? Medicare is my primary and Medicaid secondary. Between the two most everything gets covered. When I transitioned off my dad’s plan, funniest thing I no longer got cavities. I have a feeling it has something to do with reimbursement rates, but of course no one would ever admit to that.

[alyssa-silva]

Greatttt. I believe I do qualify for Medicare. Interesting to know that you have Medicaid as a backup because I’m being told that I’ll lose it when my dad starts collecting social security in a few years. I guess, by law, I’m required to get half my dad’s social security and drop SSI which means I’ll lose Medicaid. Apparently when I signed the paperwork to receive SSI, I automatically agreed to this when my dad retires. I don’t know! That’s just what I’m being told. It’s all very confusing to me.

My biggest concern though is that all my medical stuff is out of state because I need more specialized doctors. Every doctor I have is in Massachusetts, and I’m in RI. I don’t know if Medicare will cover that. Do you know if they do?

[deann-r]

Yes, it’s all confusing. I too receive part of my dad’s social security. My SSI transitioned to SSDI after having a taxable income over a certain period of time. There’s some formula the county uses to keep me on Medicaid. Why are they saying you’ll lose it? Is it because your income would be too high with your dad’s portion of social security? If at all possible try to keep Medicaid. They pay for caregivers where Medicare doesn’t plus a lot of other stuff Medicare doesn’t cover. Some states have a Medicaid buy-in. You could check into that. I think there’s some kind of medical spenddown you can do to qualify too. Each state varies though.

I’m no expert but I would think you could keep your current doctors. Medicare is nationwide so I don’t see why you couldn’t. Do they accept Medicare/Medicaid? I guess that would be the main thing.

[mike-huddleston]

Hey Alyssa!

Been a while, but I have a couple of thoughts.  Some of this may depend on your father’s age.  I retired in December and am not eligible age-wise for Medicare.  So, I obtained what is called retiree insurance which is through the same health insurer as other active employees, but I have to pay the full premiums, rather than just the portion not covered by my employer.  I can keep this as long as I want until the age of 65.  I’m 60, but could qualify for Medicare now, but am currently not pursuing this.

I could have opted for what’s called COBRA, but that is only for 18 months.  The premiums would have been pretty close to what I’m paying now, but I didn’t want to be forced to make a decision in that 18 month period.

That was all background.  My wife has been on my insurance since the beginning.  She is a few years older than me and already qualifies for Medicare.  So, before I retired, she went on basic (Part A), which she had to do within 3 months of turning 65.  Recently, we added Part B for her coverage for doctor’s visits, etc.  We still are navigating the muddy waters of prescription coverage and supplemental insurance vs. Medicare Advantage.

So, it may be worth a conversation with the HR Benefits department of your father’s company from which he is retiring.  They may – may – be able to provide some guidance as to your options.  If you can qualify for Medicare, that may be the most cost effective option, but you should have several options to consider.

The medicare.gov website is also fairly decent and may be worth looking into.  Sadly, none of this is clearly laid out, and from my experience, that is not by accident. No one seems to know – or if they do, is not willing to share.  It can be both daunting and frustrating, but the earlier you can start on this and determining your options, the better it will hopefully be.

I hope this goes well and gets resolved to your liking as quickly as possible.

[mike-huddleston]

Sorry, I failed to mention that, as a potential short term solution, you should be eligible for coverage under COBRA for up to 18 months if there are issues or delays while trying to get your more permanent insurance in place.  Pretty sure the option to offer that is required by law.

[alyssa-silva]

Thank you so much for this information, Mike. I haven’t heard of COBRA before and will mention it to my dad. He will be 61 when he retires, and I believe he said two years after his retirement would be when I go on Medicare. Your input has been super helpful. I appreciate any help I can get since, as you mentioned, it’s so difficult finding the right resources and people to help make this transition seamless. Do you know if the same rules apply across all states?

[mike-huddleston]

Hey Alyssa.  Pretty sure COBRA was mandated as part of a federal law, so should be pretty much the same guidelines as it pertains to availability, eligibility,  and duration of coverage (18 months).  There may be guidelines around the size of your father’s company, but if you have coverage through him, I’m pretty sure that COBRA must be offered.  It’s optional to insure through them, but if he’s offered health insurance as a retiree like I am (not 65 yet), he can obtain through his HR and it will be retiree coverage.  Every other person he has covered on his current policy cannot, at least as far as I’m aware, just be dropped.  They have to offer coverage either on his retiree plan or through a separate COBRA plan.

As an example, if his health insurance is through Blue Cross, when he retires, he would go on Retiree Blue Cross.   He would have the same coverage offered to him as to others who still work there, but he would have to pay the full premium, not the subsidized amount he does now.  everyone else on his policy would either go on that Retiree Blue Cross policy for whatever additional premium, or be offered their own policy through COBRA, meaning COBRA Blue Cross.  There are different eligibility rules that dictate if you can go on his retiree policy or COBRA.  Of note, he could also elect to go on COBRA, but that would only last a maximum for 18 months, and then after those 18 months are up, he would need to secure his own health insurance policy.  Retiree lasts until 65, COBRA is maxed at 18 moths.

Here’s a link to the department of labor’s site with related info:
Continuation of Health Coverage (COBRA) | U.S. Department of Labor (dol.gov)

He and everyone else on his current policy could also secure coverage through the healthcare.gov exchange, however that most certainly has different eligibility requirements by state.

My HR department was terrible in providing guidance, so I had to dig a LOT to find out some of this.  I hope it’s helpful to at least get you started.  But please let me know.  I found out way more than I can type on this and am willing to share what I found out.