Once on Medicare, is it worth keeping cobra coverage?

Michael_67

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Hi All,
This is a more specific version of a question I asked a while go, so bear with me. I will soon be leaving my job and plan to apply for SSDI and Medicare. My question is whether once I get on Medicare, is it worth keeping my cobra coverage health insurance through my work?
Some people on this forum mentioned retaining their cobra coverage as a form of secondary insurance. I have an Aetna policy through work which has been good at giving partial reimbursements for visits to my functional medicine doctor. However, cobra coverage is pricey (when I last checked about 5 years ago it was $600 /mo so I’m sure it’s more now). Now that I won’t be working, I could really use that money for basic expenses.
So how do I figure out if it is worth keeping? Who would be best to talk to? Any suggestions?
 

Nikki J

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There are SHIP counselors in every state. They are well versed in medicare and can advise you about particulars in your location Medicare alone won’t be enough. You need something to cover the 20 percent coinsurance and medications. That could be a medicare supplement plan plus a part d plan or medicare advantage. Medicare advantage is usually like an hmo with a limited network copays, deductible and oop max though I believe the oop max doesn’t always apply to drugs.

my experience is the medicare plus supplement was less than cobra but the drug costs were higher- a lot higher. Taking only riluzole medicare was a better deal. If I took other things like nuedexta it probably wouldn’t have been.
 

Ed340hp

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After the 5 month waiting period to qualify for SSDI & Medicare, you have a limited time to sign up for a supplement or advantage plan and prescription Part D plan. With ALS you want the best PPO coverage to make your potential future treatment portable, and that is usually a supplement plan. Many plans will allow a later switch to a reduction in coverage, from a supplement to a lower coverage copayment HMO advantage plan, but not a switch up in coverage. Part D plans can be switched every year. The costs are significantly less than COBRA. A Counselor can help a lot.
 

swalker

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This is a very complex area with many things to consider. Your circumstances will surely differ from mine, but I will share my experience so you have a few things to think about.

When I went on Medicare, I kept my former company's insurance using COBRA.

That COBRA policy was a very good policy and it provided insurance coverage for my wife. COBRA was very, very expensive (our largest expense). We live in a place were ACA (Obamacare) options are very limited, quite expensive, and generally pretty poor. So we decided COBRA was the right way to go so my wife would have high quality insurance.

The COBRA policy was considered secondary to Medicare in my case (an unusual case). Because COBRA was secondary, we had a pretty constant battle trying to get the insurance company to pay for things Medicare did not pay for. Though the insurance policy document said it covered those things, each time the COBRA insurance folks responded that they only cover what Medicare covers. Essentially, the COBRA policy, as secondary, covered deductibles and copays that medicare did not cover and not much else, in spite of what the policy document said.

Having both policies in this rather unusual configuration resulted in no real benefit to me and caused confusion and an endless stream of phone calls and letters for us. it was a headache.

But, it did provide excellent coverage for my wife.

After COBRA ran out, we obtained a Medigap policy for me and an ACA policy for my wife. Filing claims is so much simpler now!

Note that I was able to qualify for a Medigap policy when I discontinued COBRA, even though I did not sign up for Medigap during the normal eligibility window when starting Medicare. Apparently, having qualifying coverage from something like a COBRA policy while on Medicare allowed me to still qualify for a Medigap policy when COBRA eligibility expired. At least for me.

Was COBRA worth it? In hindsight, no. It cost way more to keep COBRA than it would have cost to get me a Medigap policy and my wife an ACA policy. But, that is only in hindsight. If my wife had had an expensive medical issue under COBRA, we would have been far better off going the direction that we did (because the ACA policies here are so poor). And that is the point of insurance. It is a pooled risk enterprise. It is always cheaper to not participate in the insurance pool if the risk is not realized for you. But, you will only know that after the fact.

If we had not needed COBRA to provide reasonable insurance for my wife, then it would have been far, far cheaper to opt out of COBRA and get me a Medigap policy when I went on Medicare. That is what I would have done.

Steve
 

Nikki J

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Since you are in New York you can enroll in Medigap later with no penalty. New York is very patient friendly. The primary/ secondary issue if you had work based insurance which cobra would be and medicare is determined by the size of your company. See a ship counselor. Do the math.
 

Tkthiede

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My COBRA stopped the day Medicare started. I did not realize this so I had a bunch of bills for that month. I would investigate further if I were you. Good luck.
Tammy
 

Michael_67

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Thank you Nikki! Deeply appreciate your help with this! Take care.
 

Michael_67

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Thank you Steve! I really appreciate you taking the time to explain the complexities of this. It's very helpful! I will definitely be talking to a SHIP counselor. All the best and take good care!
 

KimT

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You are lucky, you live in NY.

You will need supplemental insurance and the least expensive AND best insurance in NY is a Medicare Supplement. Medicare will pay for 80% of durable medical equipment and a supplement (Plan G) will pick up the balance. You will also need a Plan D, which covers drugs.

NY does it differently than Florida. Florida charges people under 65 three times the normal premium (most allowed by law.) NY averages the premiums for all so the rates are lower.

Don't be afraid to let an insurance broker do the work for you. Just make sure she/he knows you have ALS and will need medical equipment. The Blue Cross representative in Florida tried to get me into an Advantage Plan. Much cheaper but narrow selection of doctors.

For all interested: If you are in a state like Florida that gouges you for a supplement premium, you have a second open enrollment once you hit 65.....everyone does who had their first open enrollment before age 65.
 

Nikki J

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Ship counselor should be better than an agent with a financial interest. they are well trained if anything like Massachusetts. I have a friend who worked her whole career in patient services for an hmo and had extensive medicare experience with parents and a husband with ssdi. She still had several months of weekly training, had to study and pass a test and do a supervised period after qualifying. Isuspect your answer will be medicare plus a supplement that is the G category and whatever part d meets your needs ( there is a tool on the medicare dot gov site to see how much meds cost. ). You will get to pick part d every year but it is worth looking at things you think you might need. I search baclofen and nuedexta for example as things I might need besides the riluzole I do take.
 
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KimT

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Category F is no longer an option.
 

Nikki J

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Oops meant g correcting now
 

Michael_67

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Belatedly - Thank you so much Kim! I really appreciate you sharing this info with me! I have some more homework to do but you have given me hope there may be a somewhat more affordable way through this! Take care, M
 
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