To COBRA or not to COBRA, this is a frequent question.

First, COBRA is not health insurance. COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that governs how and when a qualified beneficiary can continue terminated group health insurance coverage for a specified period of time by self-paying the premium.  In short and in general, it’s a law that allows an ex-employee and /or their dependents to remain on the employer-sponsored group health plan for a period of time. When you leave employment you are mailed a COBRA Election Notice that includes all of the dates, deadlines, and rules for making an election. To learn more about COBRA, visit:

Prior to healthcare reform, private Individual and Family Plan (IFP) health insurance was a popular alternative to electing COBRA primarily due to the premium savings. Group plans being typically richer in benefits were often much higher in premium. Receiving the COBRA notice from the employer was often a shock to the ex-employee, but premium relief could be found in the IFP market. As an active employee, this is camouflaged by the fact the employer is paying a good portion of the premium if not all of it. With COBRA, the ex-employee pays 100% of the premium plus 2% administrative cost.  So saving $500 a month or more in the IFP market was not unusual. Now, post-ACA, the COBRA notice is still a shock, but unless one qualifies for premium subsidies (found through CoveredCA, the public exchange), generally speaking, the individual/family market isn’t the bastion of savings it once was. Here are just some of the reasons for this: fewer options in the higher deductible/lower premium plan offerings, guarantee issue (no pre-existing condition restrictions), and mandated essential benefits that all plans must cover.

With premium savings being diminished there are advantages in maintaining group coverage under COBRA. PPO-style plans in the group market often have larger provider networks …even within the same carrier. For example, Blue Shield uses a smaller provider network for their IFP PPO plans than they do in their group plans. A doctor could be In-Network in a Blue Shield group plan, but out-of-network in a Blue Shield individual plan.

Also, because COBRA is a continuation of the same coverage you had as an employee, your coverage will stay the same*. That includes full credit for any deductibles that have been satisfied, out-of-pocket maximums, etc. for that calendar year.  Remember, in most cases plan deductibles and out-of-pockets run on a calendar year basis.  Starting an individual plan would mean starting a deductible and out-of-pocket maximum over again during a plan year. For example, if you left a job June 30, you could continue coverage under COBRA July 1. If you decide not to elect COBRA but enroll in an individual plan July 1, you would start over with a new set of calendar year benefits as well as deductibles and your out-of-pocket with just half the year remaining. And, it all starts over again January 1 of the next year. Staying on COBRA could save you money in out-of-pocket costs.

For an employee leaving a company with employer-sponsored group insurance, there are certain times when they can enroll in individual coverage: when their group plan ends, when COBRA benefits are exhausted, or during open enrollment (Nov. 1 through January 31). They would have 60 days from when your group plan terminates or when COBRA is exhausted to enroll in individual insurance.

If you have left a job and are considering COBRA, or are planning on leaving employment, contact your benefits department or insurance carrier to learn more about your specific COBRA options and costs. To learn more about individual plan options and costs, give us a call!

*While under COBRA, if premiums for your plan change, or if the employer sponsoring the plan makes a plan change or carrier change, you will be treated the same as an active employee and any changes will affect you as well.

Phil Dougherty

Travel Insurance provides peace of mind.

Many travelers are under the wrong impression their domestic health insurance plan or the US government will provide assistance in the event of a medical emergency while traveling abroad. With international travel at an all-time high, more travelers are realizing the benefit of knowing they are covered by travel medical insurance should they become ill or injured while traveling out of the country.

Take some of the stress out of traveling by following these recommendations.

Before you leave:

  • Review your domestic health insurance plan to know what it does or does not cover while traveling abroad.
  • Purchase travel insurance and become familiar with your plan’s benefits and limitations. If coverage for a pre-existing condition is important, be sure it’s included in the policy you purchase.
  • If you’re planning high-risk activities (such as surfing, skiing, or climbing), be sure and add the appropriate riders.

While traveling abroad:

  • Bring along a record of your medical health history, including your primary doctors’ names and phone numbers, health conditions, as well as your prescription names and dosages.
  • Keep a copy of your travel insurance identification card with you, which will include the insurance company’s 24-hour hotline phone number.
  • Keep all receipts should you need to file a claim when you return.

For information and quotes on travel insurance, please visit OnlyHealthInsurance.

Phil Dougherty

Special Enrollment Period

The ACA reform has brought with it restrictions on when individual health insurance plans can be purchased. Every year there is an open enrollment period during which time those who are uninsured can enroll in a plan or those with a plan can make a plan change. The open enrollment period this year is November 1, 2016 through January 31, 2017. Outside of this open enrollment period, you’d need to experience a “qualifying life event” to enroll in coverage.

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Keeping your health plan current.

A belated Happy New Year!

Now that your health insurance is in place for another year, I hope it provides you the peace of mind you were looking for and that you’ll have little need of it.

What’s important now is to keep your plan active. A plan termination due to an unintended non-payment can be costly, and not just for the potential exposure to high health care costs. If your plan is canceled, you could be unable to restart coverage until next January. In addition to lack of insurance, you could be fined for not having ACA-compliant coverage. Continue reading

Best ways to check if your providers participate in the network for “off-exchange”, non-CoveredCA plans.

Ensuring your “must have” providers are in your health plan’s network is not as easy as it should be. Some PPO carriers have gone to narrower networks (namely Anthem Blue Cross, Blue Shield and CIGNA) so it’s important to check provider participation. Although carriers each have a provider search tool on their website, search tools are not always easy to use or up-to-date.

Before finalizing your health insurance carrier and plan decision, you’ll want to take several steps to make sure your providers take your plan. Although the following suggestions are not fail proof, they can provide some peace of mind that your providers are likely “ in-network”. Continue reading

Open Enrollment starts November 1!

The annual health insurance open enrollment period is fast approaching! This is the time when individuals and families already enrolled in ACA-compliant coverage can review their health insurance and make a plan change, and when those without coverage can enroll as well.  This year, more than ever, it is important to be informed of the changes coming to your specific plan and California’s health insurance marketplace in general.  Read your carrier renewal packets thoroughly!

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Dental Insurance – Is it worth it?

If you are like the millions of Americans who don’t have dental insurance provided by an employer, you may wonder why there aren’t more “reasonable” insurance products available in the individual market.  There is no shortage of individual dental plans; all medical insurance companies offer them.  But after looking more closely many people conclude correctly that it just doesn’t add up.  So how come? The devil is in the details. Continue reading