By: Revanche

Open Enrollment for the COBRA participant

November 16, 2009

This year’s updated Comparison of Medical Coverage and 2010 COBRA rates have been published, and the results are not pretty at all.

Hitting the highlights of the changes:


Office Visits 

Before: $20 copay
After: $25 copay for primary care; $40 for specialist 
Comment: I only see a specialist, so this is a major uptick in cost.  100% increase in cost; $100 v. $200 for 5 visits a year.

Prescriptions

Before: $15/generic and $30/brand name for a 100-day supply
After: $15/generic and $30/brand name for a 30-day supply
Comment: With 2-3 prescriptions going at any given time, we’re looking at 200% increase; $157.5 v. $540

Routine Eye Exams

Before: $20 copay
After: $25 copay
Comment: I’d probably skip this if my meds didn’t carry a risk of eye damage.  Not worth skimping on $5.  25% increase; $20 v. $25.

Eyeglasses/Contact Lenses

Before: $125 allowance every 24 months for eyewear purchased from HMO
After$125 allowance every 24 months for eyewear purchased from HMO NONE. No coverage at all.
Comment: It’s a darn good thing I’ve already replaced my reading glasses and only rarely need them.

HMO Monthly Premiums

Before: 324.82
After: 352.98
Comment: 9% increase on top of doubling and tripling my copays, and nearly killing off the vision care benefit. When ARRA expires and I’m paying the full price, we’ll be looking at an additional $28.16/month.

Dental Monthly Premiums

Before: 49.18
After: 51.90
Comment: 5% increase with no stated changes in coverage.  To be fair, I have not been particularly on the ball about researching this area.  The summary of benefits provided on the website is here:

The maximum annual benefit paid under the Dental Plan is $1,500 per each covered person. There is no deductible for services at the Employer School of Dentistry and a $50 per person deductible ($150 for families of three or more) for services at any other Dental provider. When you use a Plan dentist (about 93% of dentists in California), the plan pays eligible, reasonable and customary dental expenses as follows:

  • 100% (no deductible required) for diagnostic and preventive services, such as exams, cleanings (up to two times in a calendar year), fluoride treatment, and space maintainers.
  • 80% for basic services, such as oral surgery, fillings, endodontics, periodontics, and sealants.
  • 60% for major services, such as crowns, jackets, fixed bridges, and dentures.
  • 50% for implants up to a lifetime maximum of $1,500.

If you use a non-Plan dentist who charges more than Plan’s allowance for service, you must pay the additional cost. Under the Plan, you also may use the services of the Employer School of Dentistry (including the faculty practice). At the Dentistry school, you get 100% coverage of most expenses and a 50% orthodontia benefit ($1,500 lifetime limit).

So if I were willing to travel 50 miles into the city and use the Employer’s students, I could save quite a bit. $50 right off, and then up to $200-300 if I have to have real work done beyond the basic cleaning.

Summary

My ARRA [temporary discount on COBRA rates] expires in March 2010, and if I’m still with this HMO, I should expect to spend no less than $3500 in premiums alone, and another $800 in routine check-ups and prescriptions through 2010. Going without medical coverage is pretty much not an option for me so I’ll either have to continue with this coverage in the absence of an employer-sponsored plan or research individual health plans.  *shudder*

3 Responses to “Open Enrollment for the COBRA participant”

  1. Have you thought about getting private insurance? A little over 3years ago my company dissolved. It was so small that we didn’t qualify to receive Cobra. I ended up unknowingly going a couple of months without health insurance. Since I had no other options, I looked into private insurance.

    Depending on the state it can be fairly inexpensive. At the time I was living in NJ, which unfortunately is the high end of the spectrum and was about $200 a month. If you’re young enough and don’t expect any serious health problems it might be worth looking into a cheaper option.

  2. Wow! That seems high. On the other hand, you get a LOT more than we do.

    Our vision coverage is a separate plan & is said to be pretty worthless. It’s $2.33 per pay period; when I get on the ARRA for COBRA in December, it will drop to $1.75 a monthy, but by then I’ll have a couple pairs of new Costco glasses & so will drop the plan. It will not cover the full cost of the Costco eye exam and the cheap Costco glasses I bought yesterday.

    Dental coverage here is about $28 a month; I think it’ll be about the same on the COBRA with ARRA. If it doesn’t go up, I’ll keep it until I’m eligible for Medicare in May, at which time dental coverage evaporates. Delta Dental here covers the cost of two cleanings a year and precious little else. It will cover about half the cost of a crown, but if your crown is damaged it will cover nothing toward repairs or a new crown for five years after the first one is installed. From what I understand, it doesn’t cover anything else. I’m told that when you have to pay the whole freight out of pocket, it costs more each year than the dentist charges for two cleanings.

    We’ve never been allowed a 100-day supply of anything. All drugs must be generic; if you need a drug that does not exist in generic form, you’re out of luck.

    Eye exams are not covered on our health insurance. You have to get Avesis, which from what I gather will cover up to $75 toward a pair of glasses. One pair of glasses. That’s all.

    It sounds like you should consider finding private insurance. However, I gather the benefit of staying with COBRA until it runs out is that after that insurers have to take you without regard to pre-existing conditions. If you’re buying $540 worth of prescriptions at a whack (am I reading that right??), then you might be better off to stay with COBRA to the bitter end.

  3. Revanche says:

    Cents in the City: I have considered private insurance, but I do have a chronic condition or two that would send the insurers screaming in the other direction … or pounding towards me waving hugely inflated premiums.

    If necessary, though, I will get quotes for private coverage to see what I’m facing.

    Funny About Money: Good grief your insurance doesn’t cover a whole lot. I guess I shouldn’t be complaining, my plan seems a lot more premium in comparison.

    Yes, at this point, because of the preexisting condition, I might have to stick with COBRA until it expires simply so that I’m not rejected out of hand by every private insurer. We’ll see.

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