Cobra Policy Changed - I was not notified

Mar 28, 2019

  1. quarryherring
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    quarryherring New Member

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    I went to go to the doctor today and they told me I owed $200 for the visit. Typically I paid a $50 copay, so I asked why such a large amount, and they told me that I now had a $5000 deductible. My insurance plan never had a deductible as it was called a "copay" plan. But it seems they have switched things on me behind my back. I never agreed to such a deductible plan when I signed up for the health insurance. In fact I chose the copay plan instead of the deductible plan when I original elected coverage when I was employed.

    It looks like the plan must have changed at the beginning of this year for whatever reason. I was NEVER given any notification of this change or else I would have cancelled the cobra plan immediately. I have been paying for a plan I did not agree to for 3 months. This has to be illegal and neglectful behavior by both my previous employer and the insurance broker who provides the benefits right? Someone should have at least sent an email, letter, or phone call right? I just wasted $650 a month for the last 3 months if they dont refund these premiums. This is some crooked business if you ask me.

    Does anyone out there have any knowledge about such a matter?
    Thank you in advance for any info you share.
     
  2. Yagents
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    Yagents Guru

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    Your cobra plan mimics whatever current group plan current employees have. If choice was only high deductible, then that is what u get too. U should have received notification of it. You may be or probably are stuck for 2019
     
    Yagents, Mar 29, 2019
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  3. somarco
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    somarco GA Medicare Expert

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    You can cancel your COBRA at any time. No refunds. Open enrollment material would have been mailed by your former employers COBRA administrator during last years open enrollment.

    Voluntarily dropping COBRA does not create an SEP which would allow you to buy an Obamacare plan.
     
    somarco, Mar 29, 2019
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  4. LostDollar
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    LostDollar Guru

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    (caveat, not an insurance agent. Comments based on personal experience with Cobra through two open enrollments.)

    What Somarco said.

    Large employers are regulated pretty strictly on Cobra coverage. With payment of the required premium, they are required to give the terminated employees on Cobra the same coverage as active employees. The flip side of that is that they can give employees on Cobra coverage the same coverage as active employees. The employers can change coverage options for ALL employees each year during the company's open enrollment period.

    You would have received some type of notification from the company or the third party administrator for the company's Cobra plan. Two possible guesses (there could be other choices) as to what might have happened:

    1) In order to save the company money on insurance premiums, the company went to a higher deductible plan for all employees.

    2) They have two options, a high deductible plan and low deductible plan and the overall insurance plan is set up so that every employee's (active and Cobra) coverage defaults to the high deductible plan every open enrollment unless the employee specifically opts into the lower deductible plan each open enrollment.

    An employer offering a higher deductible plan MIGHT offer their employees a reimbursement of some amount of the deductible upon submission of receipts. For example, a company with a $5,000 deductible plan might give employees back the first 1500 of the deductible if they turn in receipts.

    Notice I said MIGHT, not will. You could check with the company or the Cobra plan's administrator to see if there is any option like that in the plan you are on now.

    If you have the money to work with, you could also check and see if the plan meets the specific requirements of a High Deductible Health Plan (HDHP) which allows you to establish a Health Savings Account (HSA). Those are a very useful savings option.
     
  5. scagnt83
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    scagnt83 Worldwide Expert of Everything

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    You would have been sent some type of info in the mail informing you of the change. If not, and if you can prove it, then you might have a case to complain.

    You say that you would not have continued Cobra had you known. And I do understand your frustration. However, have you looked at the deductibles on individual plans? The ones with deductibles under $5k are astronomically expensive. (yes, I am well aware of how much you are paying for cobra)

    Now, if you are young, and especially if your income qualifies for premium subsidies, then you could certainly save money by being in an ACA (obamacare) plan on the exchange.

    But since you chose COBRA, my guess is you are over age 35 and earn an average yearly income too high for ACA subsidies. Or you would have gone on ACA after leaving your job...

    And proving you did not receive correspondence is not easy to do. Most COBRA administrators document the sending of documents. In my experience, most can tell you the exact date the letter was sent out on. Often people mistake it for just another benefits statement. I have seen many instances of employees "not receiving correspondence" when in actuality, it was sent. Have you moved recently? Are you receiving the benefit notices after going to the doctor for care? This is the kind of stuff the carrier is going to ask if you complain.

    Other than complaining to the carrier and employer, there is nothing you can do. Ride out COBRA and then you will have eligibility to enroll in whatever individual plan you want, or find a new job. Those are your only two options.
     
  6. scagnt83
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    scagnt83 Worldwide Expert of Everything

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    Assistance with employee deductibles (in the form of HRAs/HSAs/cash bonuses/reibursements) are considered a part of compensation.

    Someone on COBRA is no longer an employee. Therefore they no longer receive any compensation (the whole reason they must pay the entire premium on COBRA & no longer pay just a small portion). And that includes help with deductibles.

    An employer could just choose to help severed employees with deductibles... but why would they??
     
    Last edited: Apr 5, 2019
  7. LostDollar
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    LostDollar Guru

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    Thanks for the comments/education there. Something I did not understand.
     
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