okalb 104 #1 April 29, 2014 I have a friend that is currently in a messy situation. Luckily, it happened after the January 2014 implementation of “Obamacare” so he won’t have a problem, but I am wondering what his options would have been prior to 2014 Here is the situation. He has a pretty substantial back injury. He underwent surgery for it and it was unsuccessful. He is scheduled for corrective procedures in a few months. He is currently covered by health insurance through his employer. There is a pretty good chance that his employer will have to “let him go” because he is unable to work for at least another few months. Once he is let go he will lose his insurance. The company that he works for has fewer than 20 employees, so my understanding is that he would not be eligible for COBRA. As far as I know, his only option would have been to get coverage through an individual plan, but that would most certainly have excluded the pre-existing condition that put him out of work in the first place. Does anyone know what other options he would have had or would he have just been screwed? I have supported the ACA all along, but please don’t take this as a fictitious argument in favor of it. This is a situation that a friend has just found himself in and he was worried about losing his insurance if he loses his job. I told him that it was not going to be an issue since Obamacare went into effect, but it got me thinking about what would have happened to him if this all occurred a year ago.Time flies like an arrow....fruit flies like a banana Quote Share this post Link to post Share on other sites
quade 4 #2 April 29, 2014 A couple of years ago he'd be totally fucked. Fortunately, losing employment now opens up a special enrollment case in ACA and he can sign up the day he's no longer covered by employment provided insurance.quade - The World's Most Boring Skydiver Quote Share this post Link to post Share on other sites
turtlespeed 226 #3 April 29, 2014 okalb I have a friend that is currently in a messy situation. Luckily, it happened after the January 2014 implementation of “Obamacare” so he won’t have a problem, but I am wondering what his options would have been prior to 2014 Here is the situation. He has a pretty substantial back injury. He underwent surgery for it and it was unsuccessful. He is scheduled for corrective procedures in a few months. He is currently covered by health insurance through his employer. There is a pretty good chance that his employer will have to “let him go” because he is unable to work for at least another few months. Once he is let go he will lose his insurance. The company that he works for has fewer than 20 employees, so my understanding is that he would not be eligible for COBRA. As far as I know, his only option would have been to get coverage through an individual plan, but that would most certainly have excluded the pre-existing condition that put him out of work in the first place. Does anyone know what other options he would have had or would he have just been screwed? I have supported the ACA all along, but please don’t take this as a fictitious argument in favor of it. This is a situation that a friend has just found himself in and he was worried about losing his insurance if he loses his job. I told him that it was not going to be an issue since Obamacare went into effect, but it got me thinking about what would have happened to him if this all occurred a year ago. You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
jclalor 12 #4 April 29, 2014 turtlespeed ***I have a friend that is currently in a messy situation. Luckily, it happened after the January 2014 implementation of “Obamacare” so he won’t have a problem, but I am wondering what his options would have been prior to 2014 Here is the situation. He has a pretty substantial back injury. He underwent surgery for it and it was unsuccessful. He is scheduled for corrective procedures in a few months. He is currently covered by health insurance through his employer. There is a pretty good chance that his employer will have to “let him go” because he is unable to work for at least another few months. Once he is let go he will lose his insurance. The company that he works for has fewer than 20 employees, so my understanding is that he would not be eligible for COBRA. As far as I know, his only option would have been to get coverage through an individual plan, but that would most certainly have excluded the pre-existing condition that put him out of work in the first place. Does anyone know what other options he would have had or would he have just been screwed? I have supported the ACA all along, but please don’t take this as a fictitious argument in favor of it. This is a situation that a friend has just found himself in and he was worried about losing his insurance if he loses his job. I told him that it was not going to be an issue since Obamacare went into effect, but it got me thinking about what would have happened to him if this all occurred a year ago. You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. I've tried find anything that's close to what you are suggesting, do you have more information on this? Quote Share this post Link to post Share on other sites
turtlespeed 226 #5 April 29, 2014 jclalor ******I have a friend that is currently in a messy situation. Luckily, it happened after the January 2014 implementation of “Obamacare” so he won’t have a problem, but I am wondering what his options would have been prior to 2014 Here is the situation. He has a pretty substantial back injury. He underwent surgery for it and it was unsuccessful. He is scheduled for corrective procedures in a few months. He is currently covered by health insurance through his employer. There is a pretty good chance that his employer will have to “let him go” because he is unable to work for at least another few months. Once he is let go he will lose his insurance. The company that he works for has fewer than 20 employees, so my understanding is that he would not be eligible for COBRA. As far as I know, his only option would have been to get coverage through an individual plan, but that would most certainly have excluded the pre-existing condition that put him out of work in the first place. Does anyone know what other options he would have had or would he have just been screwed? I have supported the ACA all along, but please don’t take this as a fictitious argument in favor of it. This is a situation that a friend has just found himself in and he was worried about losing his insurance if he loses his job. I told him that it was not going to be an issue since Obamacare went into effect, but it got me thinking about what would have happened to him if this all occurred a year ago. You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. I've tried find anything that's close to what you are suggesting, do you have more information on this? I threw out all my pre-Obamacare insurance literature when I lost the plan I was told I could keep. BUT . . just after ONE search try . . . I found this.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
okalb 104 #6 April 29, 2014 turtlespeed You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. My understanding is that is only applicable if the new policy is also through an employer not an individual policy. He would not be moving to a new job until he recovers from his injuries, so I don't think that is applicable here.Time flies like an arrow....fruit flies like a banana Quote Share this post Link to post Share on other sites
airdvr 210 #7 April 29, 2014 quade A couple of years ago he'd be totally fucked. Fortunately, losing employment now opens up a special enrollment case in ACA and he can sign up the day he's no longer covered by employment provided insurance. Losing your job has always been a qualifying event.Please don't dent the planet. Destinations by Roxanne Quote Share this post Link to post Share on other sites
jclalor 12 #8 April 29, 2014 turtlespeed *********I have a friend that is currently in a messy situation. Luckily, it happened after the January 2014 implementation of “Obamacare” so he won’t have a problem, but I am wondering what his options would have been prior to 2014 Here is the situation. He has a pretty substantial back injury. He underwent surgery for it and it was unsuccessful. He is scheduled for corrective procedures in a few months. He is currently covered by health insurance through his employer. There is a pretty good chance that his employer will have to “let him go” because he is unable to work for at least another few months. Once he is let go he will lose his insurance. The company that he works for has fewer than 20 employees, so my understanding is that he would not be eligible for COBRA. As far as I know, his only option would have been to get coverage through an individual plan, but that would most certainly have excluded the pre-existing condition that put him out of work in the first place. Does anyone know what other options he would have had or would he have just been screwed? I have supported the ACA all along, but please don’t take this as a fictitious argument in favor of it. This is a situation that a friend has just found himself in and he was worried about losing his insurance if he loses his job. I told him that it was not going to be an issue since Obamacare went into effect, but it got me thinking about what would have happened to him if this all occurred a year ago. You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. I've tried find anything that's close to what you are suggesting, do you have more information on this? I threw out all my pre-Obamacare insurance literature when I lost the plan I was told I could keep. BUT . . just after ONE search try . . . I found this.*** If you loose your job, you loose your insurance unless you enroll in COBRA. The link you provided is old news, if you leave an employer and their group plan, and then join another health plan from a new employer, they can't require a waiting period for pre-existing conditions. This issue has 0 (zero) bearing on the OP. If this situation had happend to him Pre-Obamacare, he would be fucked. Perhaps you should have read the OP more than ONCE. Quote Share this post Link to post Share on other sites
kelpdiver 2 #9 April 30, 2014 turtlespeed You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. But you would have to disclose the condition in the application, and that would have considerable impact on the policy rate. Odds are, he would have had to endure a rough year (or whatever period of time) until ACA policies were available, or until he could get hired by an employer with a suitable group policy. But if the condition untreated made it impossible for him to work reasonably, it would be hard to get hired. (Or marry into a plan?) These problems were a strong impetus behind the reform push. The general issue of cost controls was a driver, but ACA hasn't done much to solve that. Quote Share this post Link to post Share on other sites
turtlespeed 226 #10 April 30, 2014 kelpdiver *** You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. But you would have to disclose the condition in the application, and that would have considerable impact on the policy rate. Odds are, he would have had to endure a rough year (or whatever period of time) until ACA policies were available, or until he could get hired by an employer with a suitable group policy. But if the condition untreated made it impossible for him to work reasonably, it would be hard to get hired. (Or marry into a plan?) These problems were a strong impetus behind the reform push. The general issue of cost controls was a driver, but ACA hasn't done much to solve that. The series of events was: 1) Employed 2) Found out about the cancer 3) Went to treatment, and that took too much time away from work, and was let go. 4) He purchased a plan individually, continued his treatment, 5) He found another job, and because there was no lapse in coverage, he was able to continue his coverage even after 5 months of unemployment.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
jclalor 12 #11 April 30, 2014 turtlespeed ****** You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. But you would have to disclose the condition in the application, and that would have considerable impact on the policy rate. Odds are, he would have had to endure a rough year (or whatever period of time) until ACA policies were available, or until he could get hired by an employer with a suitable group policy. But if the condition untreated made it impossible for him to work reasonably, it would be hard to get hired. (Or marry into a plan?) These problems were a strong impetus behind the reform push. The general issue of cost controls was a driver, but ACA hasn't done much to solve that. The series of events was: 1) Employed 2) Found out about the cancer 3) Went to treatment, and that took too much time away from work, and was let go. 4) He purchased a plan individually, continued his treatment, 5) He found another job, and because there was no lapse in coverage, he was able to continue his coverage even after 5 months of unemployment. Do you have any other evidence? (outside of Yahoo answers) Quote Share this post Link to post Share on other sites
turtlespeed 226 #12 April 30, 2014 jclalor ********* You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. Similar thing happened to my brother in law - as long as there is not a lapse in coverage, he didn't lose insurance and wasn't disqualified for pre existing. He had cancer BTW. But you would have to disclose the condition in the application, and that would have considerable impact on the policy rate. Odds are, he would have had to endure a rough year (or whatever period of time) until ACA policies were available, or until he could get hired by an employer with a suitable group policy. But if the condition untreated made it impossible for him to work reasonably, it would be hard to get hired. (Or marry into a plan?) These problems were a strong impetus behind the reform push. The general issue of cost controls was a driver, but ACA hasn't done much to solve that. The series of events was: 1) Employed 2) Found out about the cancer 3) Went to treatment, and that took too much time away from work, and was let go. 4) He purchased a plan individually, continued his treatment, 5) He found another job, and because there was no lapse in coverage, he was able to continue his coverage even after 5 months of unemployment. Do you have any other evidence? (outside of Yahoo answers) That was 7 years ago. The records are not mine.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
Amazon 7 #13 April 30, 2014 Many millions of Americans found out that one illness or accident was a chance to hop into the fast lane to a bankruptcy when their insurance they thought they had, and had been paying for years was actually not going to cover them. This was the reality... http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/ Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say. "That was actually the predominant problem in patients in our study -- 78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services," says Woolhandler. "Other people had private insurance but got so sick that they lost their job and lost their insurance." Quote Share this post Link to post Share on other sites
jclalor 12 #14 April 30, 2014 Iago ******You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. My understanding is that is only applicable if the new policy is also through an employer not an individual policy. He would not be moving to a new job until he recovers from his injuries, so I don't think that is applicable here. Look, if this is a real situation your friend really needs to see an attorney. ACA is new and the provisions have not been tried out in court. IF he gets let go he can get a plan on the exchange (sure) but only if he has the $10k it will take to pay the 12 month premiums AND the $5k deductible. Plus of if it is any way work related there are disability issues to deal with. Plus if he can't do physical labor he may have a hard time getting work. Even an office worker would be tough as he would need really good guidance on how to handle the hiring process. No employer wants to hire a potential massive medical liability. This is a bad situation all around. With out knowing his age, income, or what states he's from it would be impossible to say how much his premiums would be. $10,000 a year would certainly be the absolute worst case scenario for someone older and did not qualify for a subsidy, I Quote Share this post Link to post Share on other sites
turtlespeed 226 #15 April 30, 2014 jclalor *********You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. My understanding is that is only applicable if the new policy is also through an employer not an individual policy. He would not be moving to a new job until he recovers from his injuries, so I don't think that is applicable here. Look, if this is a real situation your friend really needs to see an attorney. ACA is new and the provisions have not been tried out in court. IF he gets let go he can get a plan on the exchange (sure) but only if he has the $10k it will take to pay the 12 month premiums AND the $5k deductible. Plus of if it is any way work related there are disability issues to deal with. Plus if he can't do physical labor he may have a hard time getting work. Even an office worker would be tough as he would need really good guidance on how to handle the hiring process. No employer wants to hire a potential massive medical liability. This is a bad situation all around. With out knowing his age, income, or what states he's from it would be impossible to say how much his premiums would be. $10,000 a year would certainly be the absolute worst case scenario for someone older and did not qualify for a subsidy, I Not worst case - Add smoker (don't know if he is or not) and his pre existing condition - which is not even close to "free" just now mandatory coverage - he could be paying twice that per year.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
jclalor 12 #16 April 30, 2014 turtlespeed ************You forget where if you are still insured you can transfer insurance before you lose your soon to be old insurance. My understanding is that is only applicable if the new policy is also through an employer not an individual policy. He would not be moving to a new job until he recovers from his injuries, so I don't think that is applicable here. Look, if this is a real situation your friend really needs to see an attorney. ACA is new and the provisions have not been tried out in court. IF he gets let go he can get a plan on the exchange (sure) but only if he has the $10k it will take to pay the 12 month premiums AND the $5k deductible. Plus of if it is any way work related there are disability issues to deal with. Plus if he can't do physical labor he may have a hard time getting work. Even an office worker would be tough as he would need really good guidance on how to handle the hiring process. No employer wants to hire a potential massive medical liability. This is a bad situation all around. With out knowing his age, income, or what states he's from it would be impossible to say how much his premiums would be. $10,000 a year would certainly be the absolute worst case scenario for someone older and did not qualify for a subsidy, I Not worst case - Add smoker (don't know if he is or not) and his pre existing condition - which is not even close to "free" just now mandatory coverage - he could be paying twice that per year. Pre-existing conditions are not a factor, you seriously did not know that? So your understanding of the ADA is that pre-existing conditions are a factor in the cost of your premium but 6 years ago they weren't ? Quote Share this post Link to post Share on other sites
jclalor 12 #17 April 30, 2014 I just checked Covered California, for a 60 year old on a silver plan with $6250 max yearly OOP, his monthly premium would be $822 a month. Remind us again how much better off an uninsured 60 year old with pre-existing conditions would be before the ADA? And try using facts as opposed to the shit you seem to just make up. Quote Share this post Link to post Share on other sites
turtlespeed 226 #18 April 30, 2014 jclalor I just checked Covered California, for a 60 year old on a silver plan with $6250 max yearly OOP, his monthly premium would be $822 a month. Remind us again how much better off an uninsured 60 year old with pre-existing conditions would be before the ADA? And try using facts as opposed to the shit you seem to just make up. That's like asking the ACA to actually be affordable.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
quade 4 #19 April 30, 2014 jclalor I just checked Covered California, for a 60 year old on a silver plan with $6250 max yearly OOP, his monthly premium would be $822 a month. Remind us again how much better off an uninsured 60 year old with pre-existing conditions would be before the ADA? And try using facts as opposed to the shit you seem to just make up. Because pre-ACA the 60-year-old with a pre-existing condition would probably not be able to get any insurance at all.quade - The World's Most Boring Skydiver Quote Share this post Link to post Share on other sites
billvon 3,085 #20 April 30, 2014 >Because pre-ACA the 60-year-old with a pre-existing condition would probably >not be able to get any insurance at all. And would die, saving him a tidy sum in insurance premiums in the long run. Quote Share this post Link to post Share on other sites
DrewEckhardt 0 #21 May 1, 2014 okalb Does anyone know what other options he would have had or would he have just been screwed? He could have taken advantage of a state or Federal Pre-Existing Condition Insurance Plan. Quote Share this post Link to post Share on other sites
DrewEckhardt 0 #22 May 1, 2014 jclalor I just checked Covered California, for a 60 year old on a silver plan with $6250 max yearly OOP, his monthly premium would be $822 a month. Only if he's making more than 400% of the federal poverty level which is $62,920 for a family of 2 and somewhat higher than the $51K median household income. At the $51K median income he'd only have been required to spend $4845 out of pocket for himself and his spouse, which is $201 each monthly. As a single person his cut-off would be $46,680 dictating a $4434 annual bill which is $369 a month. Quote Share this post Link to post Share on other sites
jclalor 12 #23 May 1, 2014 DrewEckhardt ***I just checked Covered California, for a 60 year old on a silver plan with $6250 max yearly OOP, his monthly premium would be $822 a month. Only if he's making more than 400% of the federal poverty level which is $62,920 for a family of 2 and somewhat higher than the $51K median household income. At the $51K median income he'd only have been required to spend $4845 out of pocket for himself and his spouse, which is $201 each monthly. As a single person his cut-off would be $46,680 dictating a $4434 annual bill which is $369 a month. The context of my answer was what would be the worst case scenario. Quote Share this post Link to post Share on other sites
jclalor 12 #24 May 1, 2014 DrewEckhardt *** Does anyone know what other options he would have had or would he have just been screwed? He could have taken advantage of a state or Federal Pre-Existing Condition Insurance Plan. While I'm not aware of every state regulation, what federal option are you speaking of? Quote Share this post Link to post Share on other sites