gap in health insurance

[lizlemon19]

I am getting a new job at a school. I currently work at a school. I am contracted 195 days- 10 of which are the summer. Since I worked the entire year, I thought my health insurance would be covered until the new academic year. HR is telling me my insurance will end 7/31. They will pay me a lump sum payment of the rest of my paychecks. I elected to get my paychecks spread out into 26 biweekly payments.

New insurance will start 8/26. It would be for me, my husband, and 8 yo daughter. Paying for continued insurance would be $3300 which seems insane. Should I risk it? It’s a little over 3 weeks. Will I get penalized at tax time?

I live in MA if it matters. No major medical issues and have 90 supplies of medications. My older 2 sons have state insurance because of an adoption, and they have monthly medication and are more accident prone

[wanderingback]

You can retroactively enroll in cobra. You have 60 days.
So if you do have to use it you can enroll.

I currently am paying for cobra for my health insurance and the expense is similar, $3400/month, it’s depressing.

[puppylove64]

Yep. I would go with nothing and retroactively get cobra if you need it. I would reschedule appointments as needed to have none during the no coverage time period.

[imimahoney]

Jul 5, 2024 13:56:15 GMT -5 lizlemon19 said:

I am
I live in MA if it matters. No major medical issues and have 90 supplies of medications. My older 2 sons have state insurance because of an adoption, and they have monthly medication and are more accident prone

I may be wrong but I think you will get dinged.

Massachusetts requires everyone to carry health insurance and when you report it for taxes it clearly asks if you carried it for an entire year.

I would definitely double check w/the state before choosing to not carry insurance.

[statgirl]

From reading, it appears a gap of less than 63 days does not incur a penalty.

www.mahealthconnector.org/about/policy-center/rules-regulations/massachusetts-individual-mandate

[wanderingback]

Jul 6, 2024 7:25:16 GMT -5 imimahoney said:

Jul 5, 2024 13:56:15 GMT -5 lizlemon19 said:

I am
I live in MA if it matters. No major medical issues and have 90 supplies of medications. My older 2 sons have state insurance because of an adoption, and they have monthly medication and are more accident prone

I may be wrong but I think you will get dinged.

Massachusetts requires everyone to carry health insurance and when you report it for taxes it clearly asks if you carried it for an entire year.

I would definitely double check w/the state before choosing to not carry insurance.

Wow that’s horrible since for a lot of people insurance is employer dependent and people can get fired and/or change jobs. A lot of places insurance doesn’t start on day 1 of new employment and there might be a 90 day waiting period. But maybe in MA things are different. I certainly hope that people aren’t penalized for something outside of their control!

[imimahoney]

Jul 6, 2024 8:03:53 GMT -5 wanderingback said:

Jul 6, 2024 7:25:16 GMT -5 imimahoney said:

I may be wrong but I think you will get dinged.

Massachusetts requires everyone to carry health insurance and when you report it for taxes it clearly asks if you carried it for an entire year.

I would definitely double check w/the state before choosing to not carry insurance.

Wow that’s horrible since for a lot of people insurance is employer dependent and people can get fired and/or change jobs. A lot of places insurance doesn’t start on day 1 of new employment and there might be a 90 day waiting period. But maybe in MA things are different. I certainly hope that people aren’t penalized for something outside of their control!

Like I said, I could be wrong but with Mass Health there is an expectation that you carry insurance.

The penalty may be small compared to the cost of COBRA, though. Just something to double check, just in case.

[wanderingback]

Jul 6, 2024 8:11:59 GMT -5 imimahoney said:

Jul 6, 2024 8:03:53 GMT -5 wanderingback said:

Wow that’s horrible since for a lot of people insurance is employer dependent and people can get fired and/or change jobs. A lot of places insurance doesn’t start on day 1 of new employment and there might be a 90 day waiting period. But maybe in MA things are different. I certainly hope that people aren’t penalized for something outside of their control!

Like I said, I could be wrong but with Mass Health there is an expectation that you carry insurance.

The penalty may be small compared to the cost of COBRA, though. Just something to double check, just in case.

I’ll try to Google to find out more Info just for myself but my point is that is a horrible policy even if the penalty is $5. Most people don’t want to be without insurance. They go without insurance because it’s too expensive and/or they’re changing jobs.

I guess there are prob a few fringe people out there who don’t believe in health care and insurance but the vast majority of people who go without insurance aren’t doing it by choice, in my experience.

[whattheheck]

In my state what happens is that your health insurance terminates when your job terminates - health insurance is for employees and once your resign a you're no longer an employee and no longer eligible for health insurance (even if your payments would have covered your summer months had you remained employed). This causes teachers/staff to wait until two weeks (the typical contractual notice requirement) before the start of the school year to give notice and leaves schools/districts scrambling.

[Susie]

We had a similar situation a few years ago.  MH changed jobs, and the new one had an ~8 week waiting period to become eligible for health insurance.  Our DD was a toddler at the time.  We relied on the ability to retroactively elect cobra if we needed it, but tried not to.  We never ended up having to.  We went without health insurance for those 8 weeks and just paid privately for an appointment + Rx for one bout of pinkeye.  We didn't have a penalty because the period was short enough.  (ETA: this was NY)

[fn2187]

Jul 5, 2024 14:12:56 GMT -5 wanderingback said:

You can retroactively enroll in cobra. You have 60 days.
So if you do have to use it you can enroll.

I currently am paying for cobra for my health insurance and the expense is similar, $3400/month, it’s depressing.

Curious- wouldn’t it be a lot cheaper to buy insurance through your state than pay $3400 cobra? Or does your state not offer it?

[wanderingback]

Jul 9, 2024 14:29:37 GMT -5 fn2187 said:

Jul 5, 2024 14:12:56 GMT -5 wanderingback said:

You can retroactively enroll in cobra. You have 60 days.
So if you do have to use it you can enroll.

I currently am paying for cobra for my health insurance and the expense is similar, $3400/month, it’s depressing.

Curious- wouldn’t it be a lot cheaper to buy insurance through your state than pay $3400 cobra? Or does your state not offer it?

If I want something that essentially doesn’t cover anything then yes I could pay a little less, but not much. The "high tier" plans that my state offers still aren’t great coverage and for a family it’s just about the same price, $3300/month.

If it were just myself who has no known medical problems I might risk it. But I have a child and a partner who had a cancerous tumor removed last year and has 6 month procedural follow ups, so not going to risk it.

[egishere]

Jul 9, 2024 14:29:37 GMT -5 fn2187 said:

Jul 5, 2024 14:12:56 GMT -5 wanderingback said:

You can retroactively enroll in cobra. You have 60 days.
So if you do have to use it you can enroll.

I currently am paying for cobra for my health insurance and the expense is similar, $3400/month, it’s depressing.

Curious- wouldn’t it be a lot cheaper to buy insurance through your state than pay $3400 cobra? Or does your state not offer it?

I know when I looked into that when my DH was laid off, the state insurance cost as much as Cobra for a crappy plan.  It's income based (like your previous years taxes) so they don't even take into account if you are laid off currently and your current income etc. 

[fn2187]

Jul 9, 2024 15:53:42 GMT -5 wanderingback said:

Jul 9, 2024 14:29:37 GMT -5 fn2187 said:

Curious- wouldn’t it be a lot cheaper to buy insurance through your state than pay $3400 cobra? Or does your state not offer it?

If I want something that essentially doesn’t cover anything then yes I could pay a little less, but not much. The "high tier" plans that my state offers still aren’t great coverage and for a family it’s just about the same price, $3300/month.

If it were just myself who has no known medical problems I might risk it. But I have a child and a partner who had a cancerous tumor removed last year and has 6 month procedural follow ups, so not going to risk it.

Not sure if this is something you would know but if a child has state coverage that is extremely limited on providers, is it ok to not utilize the coverage and just pay out of pocket (full cost) for better providers? I see no reason this is an issue but there seems to be lots of rules I’m not aware of.

[ellipses84]

I’d plan to retroactively use Cobra and only if something catastrophic happened. Anything less than $3k you could pay for OOP and still save $. Make sure your spouse knows what to do in case you become incapacitated.

Try to stock up on any prescriptions you may need before hand. This may not be possible due to type of medicine or insurance billing but may work for things you don’t use as regularly. For example, I have an albuterol inhaler I only use occasionally for exercise but I don’t run out of one often so I don’t have the prescription automatically refilled, and it’s very expensive to buy OOP. Things like antibiotics that you make need in an urgent care situation are usually really cheap OOP. I just had to do that because my Dr sent a prescription to a pharmacy near me on vacation and they weren’t a preferred provider so I asked for the cash price, they added mfr / pharmacy discounts and it was $16 for 2 prescriptions.

Even though it’s still legally required to have health insurance, I think the federal tax penalty no longer exists. Not sure about state. Any penalty for a partial month should be pretty minimal and way less than the monthly cobra fee.

Sounds like the state ACA exchanges vary drastically in cost and options. Mine gives pretty large subsidies based on income. You could get the cheapest plan for catastrophic issues, which might mean a $10k+ deductible before they start paying for anything, if that made you more comfortable than a Cobra gamble.

[mich1]

Jul 9, 2024 17:21:04 GMT -5 fn2187 said:

Jul 9, 2024 15:53:42 GMT -5 wanderingback said:

If I want something that essentially doesn’t cover anything then yes I could pay a little less, but not much. The "high tier" plans that my state offers still aren’t great coverage and for a family it’s just about the same price, $3300/month.

If it were just myself who has no known medical problems I might risk it. But I have a child and a partner who had a cancerous tumor removed last year and has 6 month procedural follow ups, so not going to risk it.

Not sure if this is something you would know but if a child has state coverage that is extremely limited on providers, is it ok to not utilize the coverage and just pay out of pocket (full cost) for better providers? I see no reason this is an issue but there seems to be lots of rules I’m not aware of.

This very much depends upon what your previous insurance is that you are getting under COBRA and whether or not you get any subsidies.  We had phenomenal COBRA for about half the cost of what it would have cost to put both DH and myself on the ACA.  We would receive no subsidies and it would cost us $1300pp/mo, so $2600 total for something that we'd need to outlay $5000 before it covered anything.  Our COBRA was $1100/mo for BOTH of us, the insurance was excellent and deductibles were only $500pp.  As both DH and I had already met our deductibles, anything we would need would be covered.  Had we gone with the ACA, we'd be starting all over with the deductible.

It really does pay to look at all your options, not just assume that COBRA would be out of your price range.  

[Wallflower]

I'm on the bandwagon to do nothing and only retroactively trigger COBRA if you need it. There is no risk there - you're covered if you need it up to the point your new insurance takes effect, but if you don't need it you've saved yourself the $$.

I did this once. My insurance ended 11/1 and the COBRA window was 60 days, ending on 12/30. I didn't sign up but knew I could if I needed it. My new insurance was effective 1/1, so I had one day with a risk of being totally uncovered. You can bet I was careful that day!!