COBRA Or Self-Insure

You can obtain a short term individual policy (30 days to 180 days.) Blue Cross sells it. High deductibles, but the premium is only $250 - $600 for a whole family. Good Luck!

We went with a high deductible plan for a year. For a family of 5 we paid less that $500. It was through Blue Shield of Ca. There also was no maternity coverage, which is what made it so inexpensive. Also, the premiums and copays would be tax deductible. Good luck.

I highly recommend Kaiser like someone did above, as an alternative. They have reasonable priced plans and it's a much better option than going bare. You can get a quote online too. I've had Kaiser for years, and we love it. The Peds are great and the system is perfect for needing a last minute appt for a sick baby/toddler.

Consumer Reports did a complete study on medical HMO plans, it may be on their website. They rated all the plans, and we found our COBRA plan (United Healthcare) rated at the bottom of the list. Why pay for poor quality? We changed from COBRA to Kaiser and the difference was HUGE. Out of pocket, our medications went from $750 a month to $15 a month. With Kaiser, we no longer have huge copays and unpredictible expenses. Before Kaiser, we spent $10,000-12,000 a year on medical copays. The new doctors are excellent and very responsive, we get an appt. within an hour. They have an excellent childrens program. Highly recommend it. When your husband moves to a new job, the Kaiser records will stay the same- the insurance "moves with you." You can see your test results, make appts and refill meds all online. No HMO paperwork to fill out, checks to write, or claims to file for reimbursement.

Also, please get private LIFE insurance. My friend's husband was laid off and died suddenly at age 45, no income and no life insurance. It helps to have life insurance that "moves with you." No matter where he works, when he works, or if he becomes 'uninsurable later' the insurance stays in place.

I can't weigh in on the COBRA or self-insure issue but I can put in my two cents on the developmental delays.

From birth to three, your child can and should be served by your local Regional center. They may provide the service or contract with someone who does -- but you should be able to get speech therapy and some other interventions through them.

From 3 to 22, your child's needs (including speech therapy)are served by the school system.

School systems are under-funded while the demand for their services is huge. To combat this, many of them deny services, cross their fingers and hope that you won't press it (Sorry if that's not accurate but that seems to be what I see here!). Your job as a mom is to ask for those services -- and then insist on them if the school system isn't forthcoming.

If you get a denial, you may need to pay for a private evaluation and then return to the school system with your demands AND the supporting documents.

This is why you pay taxes.

I would absolutely self-insure. Blue Cross offers a wide range of plans for an individual family that are much more cost effective that COBRA. I had a individual plan for my husband for awhile as it was much too expensive to add him on to my company's group plan and it worked out really well when we needed it.

When I quit working we did COBRA for a while, all the while researching more affordable options. I found that Kaiser had the best coverage for the price. I pay 368 for myself and my 2 kids (my husband has free coverage through his employer with no family benefit) per month.

My son was also early - 6 weeks. He didn't have a speech delay but had speech issues later on (the letter /r/ never really formed). He is 9 now and still gets speech therapy through the school district for this...it doesn't come from my insurance. I am not sure with a 2 year old how that works - you may want to wait until he's evaluated and find out what happens - or get on the phone now and start asking questions because you may want to delay taking him a month or so until you get new insurance (not sure about pre-existing conditions clauses, which is why you should check into that now).

Good luck - the insurance game is a royal pain!

Hi J.,
I was employed for over 17 years with Safeway. I had great benefits, then got hurt on the job and I am unable to return. I was lucky enough to pay for cobra/self pay for one year. When that ran out I was very worried about our medical. I did alot of research. I had been with Kaiser and wanted to stay with them. My husband is self employed so we did get a business rate through them. My daughter has to pay for her own due to her age. She was doing Blue Cross, but it became too expensive for her. Kaiser had some great plans with a variety of deductibles. You can do almost everything over the phone with them. They can fax or mail paper work fairly quickly. The toll free number is 1-800-730-4661. This may be for the business division, but I am sure they can point you in the right direction. I know alot of people talk bad about Kaiser, but they saved my son's life about 3 years ago and have been greatful to them since. Good luck with everything.

Hi J. -

Be very careful and check all of your options before switching health insurance. If you are not continuously covered by a group plan, you may be denied coverage in the future, especially if you or someone in your family develops a chronic or life-threatening illness which then becomes classified as a 'pre-existing condition'.

You may want to check out the State's website on health insurance...

Best of luck!

J.

Hi there!

I don't have an answer to your question about the premiums/cobra....but like a couple of the other moms I do suggest that you look into Healthy Families for your kids. It isn't any kind of free medi-cal, but it is state funded so it's cheaper. If you qualify, you only pay (according to income) around $15 for one child and then only a couple dollars more for another. AND, if you let them take payment directly from your checking then you get a 25% discount. You only pay $5 copay if you go to the doctors for anything other than a well or routine checkup. If it's a normal scheduled appt. with shots, etc.,you pay nothing. And prescriptions are only $5 as well. This covers health, dental and vision. Of course the only downside is that you'll probably have to switch to a doctor that covers it, which is actually quite a few. We just had to take my son off because we starting making too much, but i'm glad he was on it for those first 2 years! I had their AIM insurance when I was pregnant, and for the $20,000 hospital bill I only paid $300 for his circumcision and $500 over the span of my pregnancy for for the visits and tests. It's a great program and well worth it. I found the link for Healthy Families-
http://www.healthyfamilies.ca.gov/hfhome.asp
Good Luck!

Wow! Your insurance seems high. As for developmental delays, I have a now 5 year old daughter that is developmentally delayed in all areas. After going through our insurance to get therapy, one of the therapists suggested that I contact the Regional Center in our area. It was the best thing! They evaluated her, and put her in the Early Start early intervention program. They sent speech, occupational and physical therapists to my house several times a week (for free) until she was 3 years old. At 3 years old, she transitioned to pre-school and was put in a class with kids that have similar delays. The second year of pre-school, we opted to send her to send her 3 days a week to the same school, and 2 days a week to Tiny Tots pre-school so she could associate and practice communicating with kids that were not delayed. Then, when she started kindergarden she was re-evaluated, and put into a great special education class at her school. So, in the end, we used our insurance very little, although I may go through insurance again for OT, because I'm having a difficult time getting it through the school district. To learn more about the Early Start program, you can call the Regional Center in your county, contact the Department of Developmental Services at 800-515-BABY, or visit their website at www.dds.ca.gov/earlystart, or e-mail ____@____.com this helps!

Dear J.,
I am an insurance agent, so I have some familiarity with this subject. I'm have not worked for some time while recovering from a broken leg, so I'm not affiliated with any certain carrier or brokerage. However, this was my area of expertise. That said, you didn't mention which state you are in or if you have actually elected the COBRA coverage. The laws are very specific about the time frame allowed to do that. You have several options and I would look into all of them. For one thing, it is possible for only one family member to elect the COBRA coverage. This is especially helpful for insured's who need the guaranteed issue coverage due to health issues or pre-existing conditions and it is necessary to keep the exact same policy in force. For instance, if you are in the middle of treatments for a broken leg. There is such a thing as temporary health insurance policies. These have less underwriting guidelines than traditional policies. The application is very simple. And basically, if you can answer NO to all the questions, you can get a policy issued. These were introduced to be used on a temporary basis, such as....Your husband started a new job and the waiting period for his new group coverage is 3 months. You can apply for a policy to bridge that 3 month gap. Then, there are "Individual" Health policies. Individual basically means not employer sponsored. The nice thing about these is that you can mix and match plans to suit your family's needs. The downside is, issuing of a policy is based on your health history. Taking me, for instance, I could not get an individual plan as I am currently under treatment for an injury. But, some of the plans are awesome for healthy males as you can purchase one with no maternity benefits and they are relatively inexpensive. There is zero risk that your husband will get pregnant! You could choose a different one that does have maternity coverage for you....just in case. Definitely, the main thing is to coordinate so that you do not have a gap in coverage.
I hope I haven't confused you! Anyway, I don't know how the relationship is between your husband and his former employer, but you can find out who their broker is. Then, you can call that agency and ask for help. If they are good, they will run you quotes for all of your options. If they only deal with one carrier, you can call in your local phone book and find one that can sell policies for many different companies. Depending on your area, you may have tons of choices. Which is all the better for you. What you need is a good, trustworthy agent who is familiar with all the carriers and laws who can help you make an informed choice. Let me know if I can help further in any way. One piece of advice....be careful with certain companies you may find on-line or see advertised on TV as they may have loop-holes in coverage and not be all they say they are.

Good luck!

I'm sorry, J., but I was compelled to edit my response and add some information.
Do not! I repeat, DO NOT with-hold information on your insurance application. Just as an example, if your kid got a weird rash and it went away and you never took him to the doctor for it, you don't have to mention that. If you tend to get a headache every month just before your period, but you've never been to the doctor because you just take some aspirin for it, it's not the same as a "condition". But any single thing that you have ever consulted for, sought treatment for, or been evaluated for is a matter of the medical records. If you suddenly have claims for a condition that was previously a matter of record and you didn't disclose it....you will lose your insurance policy and have to pay back any claims that were paid out. And you will have a difficult time getting insurance in the future. Honesty is the best policy. DO NOT think you can get away with the insurance company finding out later. You will find yourself in trouble. Get advice from a licensed agent right away.

We had the same issue when my daughter was born, we opted to insure her soley on her own (stinky) policy and take a chance that we wouldn't get ill and ride out the in between time... unfortunately, it was the wrong decision... she ended up catching everything under the sun, and my husband had a skiing accident and a motorcycle accident within 1 mnth of us making the decision. My hindsight advise is.... STAY INSURED! you never know what could happen and being engrossed in medical debt really SUCKS. -- i hope this helps ~A.

My husband is self employed so we have our own family plan. We have Blue Shield PPO at $500 a month, rather than the $1,450 a month we'd been paying. There is a $8,000 family deductible, so basically you pay for all doctor visits (usually at a reduced, negotiated rate--but not just the $35 copay--ours is $125 a visit), any any medical tests, etc. We've had 4 doctor visits and some lab tests so far this year, but it is still less than what we paid for one month on an HMO. After the monthly cost plus the deductible, I figure we are still ahead. I also found that the presecription rates are better. I always paid at least $20 on my previous plan for a prescription, in fact sometimes they were as high as $60 depending on the med. I actually paid $5.00 for an antibiotic yesterday for my son!

With regard to your son's speech delay, I too had a son born early with a speech delay that we noticed, and spoke with doctors about at just under two years old. Had his hearing tested through the pediatrician (special test--not just one in office). I don't know how much that was but we had an HMO at the time. You might want to explore "early intervention" through your school district. Our school district had him evaluated just before he was 2, and immediately started speech therapy with him (they had special facilities for this). He continued this through kindergarten when they decided he didn't need it anymore. I was glad that I had him start early--now, at 13, he doesn't shut up!! I also practice each day with him to get him to make sounds (M&M's make a great reward)--similar to what they did in the speech therapy. If you want to correspond more about this, I can tell you exactly what I did. Let me know.

Wow, that premium is extremely high! I'd start with contacting your current provider and asking how to reduce your premium (maybe increase co-pay, or change level of coverage). Usually with COBRA you're unable to increase coverage, but you can reduce coverage.

Be cautious with self-insurance, I got taken by an indemnity insurance plan that offered a lower premium but covered so little on claims.

If you can show continuation of coverage for a previous 18-month period, you can shop other carriers to get better rates than COBRA. We found Kaiser to be very good for preventive care.

My child was also born 5 weeks premature. He's now very robust at 12, and never had any medical issues from being born premature.

I work for Blue Shield as an operations specialist in the Customer Service department. Before dropping cobra ... REALLY look into what the individual policy offers for you and their exclusions. many group health plans/cobra plans offer better more extensive benefits. Additionally, once you drop the cobra you are STUCK! Please be cautious when looking at the long term... i've had so many member want to save the monthly money now to only have something happen 6 months down the road an they are in big trouble. You can message me directly if you have specific details about the policies that you are looking and and want some advise.

A.

If your child has a pre-condition problem you wouldn't be able to get insurance anyway. If the insurance doesn't know about any pre conditons then don't tell them until after the fact and tell them it started after you got the insurance. I have looked into insurance when my husband was between jobs but was denied since my daughter had a pre-condtion were she was getting, OT, PT and speech at the time. Another words do not let them know of any speech problems ect when you check out for costs for insurance.

Hi J.,
My husband is self employed and I do not work. We use Blue Shield (where we are there is no HMOs) and we just have a high deductable, this keeps our monthly premium low. But if something major were to happen we would be covered. Also we have a HSA (health savings acct) you put money away every month and use it for co-pays and any health related expense, this is tax free. I don't have any wisdom to relate about your little boy, however, my girlfriend waited an extra year for kindergarten for her premie, she was a bit emotionally delayed. From what I've seen these kids catch up pretty fast. Good luck to you!

Hi J.,
My husband and I recently went through a similar situation. he got out of the Army and got a job out in Bakersfield, however there was a two month gap between when we lost army insurance and when he was eligible for benefits through his current job. I found a website for ehealthinsurance and looked at all the different plans. We selected one through Assurant Health. They specialize in short term medical insurance. Temporary insurance is really designed to be more in case something catastrophic happens like a hospital stay. We still had to pay for office visits, but the whole time only my husband had to go once to an accute care and it cost us $50. You can get a lot of prescriptions generic at Walmart for $4 a precscription. Just ask the Dr. to give you a generic of what you need. Our deductible was $1000, but after that was covered at 100%. You have the freedom to choose your own Dr. and there is a plan for prescription drug coverage. Obviously, you will have to do some research and find the best option for you, but we saved a lot over Cobra going this way. Our premiums were around $330 a month for myself, husband, and our 3 year old son. I was impressed with the company and we were glad we went this way. Once he got coverage through his current job, we didn't have a waiting period for pre-existing conditions because we had bo gaps in coverage, so that was nice as well. Hope this helps,
H.

We are on Kaiser and self insure and spend about $500/month with a $3000/year deductible in an HSA account. And that seemed like a lot to me. We have a healthy 10 month old baby that is covered as well. I would apply for insurance before switching.

Good luck
B.

Hi, Our family currently has the "savings plan 4800" - $500/mo for our family of 4 (2 kids under 3) and it has worked out great. My two boys have been covered for standard visit with only a $35 copay and when we had a 3 day hospital stay for our youngest we still didn't reach a yearly deductible.

Alternatively, you could place your child on a seperate plan and choose a catastrophic plan for you and your husband. When we only had one child we chose the "Active Start 35" - less than $101/mo that took care of all the regular visit and immunizations at $35/visit copay with a pretty low deductible.

You might want to check out Kaiser individual payer inurance. I did this and it was reasonably priced compared to COBRA and going thru my husbands insurance. However, we didnt have any major medical claim. you can check them out online and apply online. good luck

hi my name is leeanne and i am an office manager for a dr. no to cobra, you will find out that after all the paperwork is done it really is to expensive. my son was born early as well and at 5 is getting speech therapy thru the school district. if possible ask around different daycare facilities and your local middle school to see if there are any programs that are available. do not be to concerned about any medical problems that might come up. if he is in good health then check with your dr, maybe he only needs a well check every two to three months instead of every month, you will find a lot of drs and their staff do understand when you have insurance problems.

Since he is out of work you can put your child on healthy families right now and cost you about $15 per month or so. Then you guys do the Cobra. Just sign up, if you don't use it don't pay it.

M.

Hi!
I totally understand, we went through this a year ago when my husband lost his job and my job wouldn't allow me to start insurance because it wasn't open enrollment time. Cobra is expensive, no doubt. What we did was investigate getting private insurance through Kaiser directly just for the kids but we weren't going to start it unless we needed it. We wound up calling the advise nurse once but never went in for an appointment and so we never actually bought the insurance. What happened was that we called for the quote and since we never used it, we were never charged.
Russian Roulette, I know, but it was nice to know that we could activate it at any time and we'd be covered. Worth investigating.

Hi J.,
I understand your concern about medical insurance however it would be a good idea to look into private insurance as it is much more cost effective. The corbra plan is only a stop gap inbetween jobs. I found it to be way too expensive. Remember that your husband will be getting a new job that will probably offer health insurance in the future. Check into your county health plan usually they are much less expensive.
Good luck and good health.
W. P

Hi J.

With Cobra I think that you can invoke it retrospectively only when you need it, but you will need to check with an insurance agent. We are self employed and have Blue Cross insurance. We decided to take a $5000 deductable, so it is really only for emergencies. We also have $4000 coverage through our auto insurance for medical expenses. Our health insurance premiums are around 520 a month, and my son was born 7 weeks early and thankfully is in good health. Let me know if you need an insurance agent, we use a good one in Sunnyvale. All the best.

M.

I'd look into Kaiser. We're planning a move, and trying to get pregnant, and have decided to stay in the Bay Area for another year so we can use our Kaiser coverage for the birth--the premium is lower and the benefits are better than what we could get elsewhere.

From a cost perspective, Self Insure is the way to go. But you mention that your child may have some developmental concerns which the insurance carrier may consider "pre existing" which means you may not get approved. Talk to an insurance broker ASAP (which is at no charge to you.) and they will direct you in the best direction.

Take Care~

You have 60 days from either the date you were notified of your COBRA rights or the date of the letter to elect COBRA benefits. From the Post Marked date of when you mailed back your election you have 45 days to pay premiums current. So what a lot of people do is wait the entire 60 and then submit the election form, and then wait the additional 45 days to pay the premiums current. The benefit of this is if w/in that 105 days you have not had a medical issue and they have obtained a new job, they wont pay and just let it lapse. OR if they have had medical treatment, but it was less $ than the COBRA premium again they will let it lapse and pay out of pocket. But if there were some big medical crises in that time frame they would pay their premium(s). The downside to that is you could be looking at paying up to 2-3 months premium at one hit. And COBRA law is specific and there are no 2nd chances to pay. Do you know if this is Federal or CAL Cobra? Certain laws are different based on California or Federal. Now if you have already elected the COBRA coverage and are almost finished with the term (18 for Fed or 36 for CAL) then in regards to pre-existing conditions I would look into HIPPAA this prevents new insurance companies from applying that to your care/coverage.
*Another side note: If you are still within your election window you can elect coverage for just your son. However you cannot add you or your husband back on the policy outside of that election window (unless you have a qualifying event i.e. birth of another baby). If you are currently covering all 3 you can still request to drop yourself and your husband off, generally the carrier requires this in writing, and most times they won't go retro-active (I would check though, never hurts to try)

Don't give up your cobra insurance without discussing this with an insurance expert! In California, where we live, insurance companies are required to offer coverage to people who are currently insured; it will not necessarily be affordable, but you can at least get catastrophe insurance. If you let your insurance lapse, they do not have to cover you at all.

We applied for private insurance after my husband left his job through which we had insurance. We were denied coverage because we each had very benign 'existing conditions' for which we had seen physicians and been given clean bills of health. If we hadn't kept our COBRA coverage, we would have been uninsurable! We were offered HIPA insurance which is extremely expensive ($1,500/month for the two of us; our 8 year old son has his own policy for $250/month) but we are covered in case of catastrophe.

An aside: we have always kept our son's inurance policy, which originally was attached to my employee insurance policy, because he was born prematurely and we know that it is unlikely that he will ever qualify for insurance if he applies as an individual. If your son has been seen by a doctor for ANY prematurity-related conditions, he will most likely be denied coverage if you apply for new coverage in the future. If you do not choose to cover yourselves, investigate whether you can keep your son's coverage under the COBRA policy.

Hi,
I am an insurance agent and an authorized Blue Cross Representative. My first suggestion is for you to consider purchasing an individual policy for your son with rich benefits and consider a " catastrophic / self-insure type plan " for you and your husband. Of course we should talk so all the variables can be considered. At the very least I can provide you with sound advice. Feel free to call me.
D.
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Hi,
We went through the same thing and found out if we let our cobra go anything that can be considered a pre existing condition will be. In short you may not be able to get coverage or they won't cover anything you have had in the past! Just be careful, the cobra protects you, because there is a law in California that states if you don't let your insurance lapse they have to cover all of your conditions.

I would look into Kaiser for insurance for your family. We were on Kaiser on a Personal Plan while my husband and I were both self employed. We were really happy with the service and especially with the price. For the three of you the monthly cost should be much less. Check it out. We are now on Kaiser again and I am very pleased with the Pediatrics department in Campbell and Santa Clara. Good luck!

Hello J.,

This one is right up my area of expertise.

If you are current covered by Blue Cross under Cobra, you may want to check with your husband’s ex-employer to see when the next open enrollment will take place and if you will have an option to downgrade your plan. If this is not taking place for a while, you can contact Blue Cross and ask if it is possible to convert your coverage to an individual policy. Often times you have to finish your cobra before you can convert the coverage but I am not sure how close you are to the end of this period.

You can also apply for individual insurance but it is subject to medical underwriting but you could be denied coverage even if you and your family are healthy in general terms. To get and idea about the cost and the type of questions asked by insurance companies, you can visit their sites and look under individual coverage links.

Bluecrossca.com
Blueshieldca.com
Healthnet.com

Hope this helps.

-M.

Hi, J.. This is definitely a case in which you should check out available options for self-insuring with other private insurance plans or HMO's. Since you are all in good health, you might pay higher deductibles for office visits, etc. but would recoup that early on by the amount saved in reducing those $1700 monthly premiums! Do the math and see what insurances your doctor(s) will accept and comparison shop for the best coverage at a more reasonable cost. Best wishes.

B.

My ex-husband chose COBRA and then he didn't pay the policy - I found it almost impossible to get health insurance - be sure you can make the COBRA payments. On the converse, I now have the catastrophic coverage with PPO 2500 Plan - meaning I must spend $2500 out of pocket and meet $2500 deductible. The health insurance company has made it impossible to meet the deductible for the three years I have paid the policy. They completely disallowed the costs of a fractured ankle saying I didn't go to Emergency - within 3 months I reinjured the same ankle and went to Emergency - they then denied saying pre-existing condition. Two weeks ago my doctor operated on the ankle, and they have already refused to pay for the MRI or even if I pay they won't apply to deductible. If you can handle the COBRA, it will give you the coverage and security you need.

Have you looked into state supported health insurance for children? HealthyKids is one off the top of my head and your son may be eligible for it.
Good luck!

Hello,
My husband used to be self employed so we were on our own for health insurance. Having two little ones myself, we were worried about "something" happening and being cought with no insurance. I know many people have mixed feelings about Kaiser, but they by far had the best coverage for the lowest out of pocket expense. I cannot remember the name of the program but, I am sure you can find it on their web site or by calling them. A few years ago we paid $440 a month for full coverage. I am sure it has gone up since then but, it should be far cheaper than the $1700 you pay now. Just thought I would let you know of an option that worked for us. Good Luck,
M.