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Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

Health Insurance; COBRA; OBRA; HIPAA; Medicare. If requested, might you state that you just knew that every one 5 of those subjects had the identical factor in widespread: medical insurance protection for you and, maybe, your loved ones? Would you understand the {qualifications} for every? Well, on this article, we are going to focus on them. For a timeline that depicts, graphically, the time relationship between them, please see the timeline in http://www.disabilitykey.com.

HEALTH INSURANCE Coverage from Work

If we’re fortunate, we, and/or our partner, work for a company that gives, as a profit, health insurance protection for us and our household. If so, we’re very fortunate. Even if that’s true, there are some key issues that you just would possibly need to take a look at to see if in case you have ENOUGH protection.

1) From your Human Resources Department (or wherever else you’ll go to get details about your health insurance) get what is known as a “Summary Plan Description” (SPD). This doc ought to be stored the place you possibly can all the time discover it, because it comprises all the knowledge you’ll need about what your insurance covers and what it would not.

2) Look up “Coverage” and “non-coverage” in your SPD.

These will let you know what your plan covers and would not cowl. You must see if, maybe, you or one of many lined members of your loved ones has a situation or circumstance which may not be lined, the place you want further protection. For instance, as an example that your loved ones has a historical past of most cancers; maybe your plan restricts the variety of hospitalization days for care; or, restricts the times per situation. In this case, (like my youngsters) you would possibly need to get further “most cancers insurance” (I feel that AFLAC would possibly present any such protection).

It can be a good suggestion to contact a Health Insurance profit Broker and ask him/her to learn your SPD and see if in case you have any gaps in protection. They then might help you complement protection BEFORE YOU NEED IT!


You could be one of many rising members of our society that, via one circumstance or one other, does NOT have health insurance protection for your loved ones. In this case, I strongly encourage you to contact a Health Insurance Broker and get instant protection of what’s known as “catestrophic” (undecided if I spelled this accurately) protection. In any such protection, you’ll usually have massive deductibles, however could have protection if, say, considered one of you has to enter the hospital.


Whenever you name or electronic mail a Health Insurance Broker, it is vitally vital to organize forward of time. WHAT, particularly are you searching for; how a lot are you able to afford to pay each month; what circumstances do you need to make it possible for your loved ones is roofed for. In this manner, you may make positive to focus in your crucial wants.


COBRA is an acronym ( how can I spell acronym accurately, but not ensure that I spelled catestrophic accurately?) that stands for: Consolidated Omnibus Budget Reconciliation Act. Basically, it’s a federal law that permits you to pay on your Company-paid health insurance, as an lively member, when you now not work for that company for, usually 18 further months.

1) COBRA is “triggered” (that’s, you, or a lined member of your loved ones, grow to be eligible for COBRA) by occasions similar to the next: resignation from the company; termination (FOR ANY REASON) from the company; divorce of a partner; a lined chile’s birthday makes them ineligible for protection. These are the primary “triggering” occasions for COBRA.

2) Now, when eligible for COBRA, you can be requested to pay for 100% to 105% of the company’s worker/worker and household protection quantity. You ought to get a letter out of your company explaining what that quantity will likely be. BEFORE YOU DECIDE TO TAKE COBRA, there are some vital issues so that you can contemplate.

What will likely be your price, and what would be the protection for that price?

Sometimes the fee is an excessive amount of for the protection. In these instances, you would possibly need to choose HIPAA protection, as a substitute (see HIPAA under).

Or, you would possibly simply need to get catestrophic protection as was talked about earlier, and look forward to full protection below your subsequent job.

Part of this determination ought to be whether or not or not you or a member of your loved ones has what is known as a “pre-exisitng protection” situation.

Here once more, earlier than mechanically taking COBRA, it might be sensible to contact a Benefits Insurance Broker and provides him/her your whole choices, and get their enter. I’ve labored extensively with a Benefits Insurance Broker, and he’s completely improbable!


What, you ask, is OBRA? I’ve by no means heard of it, you say, and nobody I do know has heard of it both! Well, that is as a result of, 99% of Human Resource or Benefit people that I do know have by no means heard of it! OBRA is a federal law that was handed that extends COBRA for an extra 11 months FOR DISABILITY PURPOSES ONLY!! Why, you ask, is that this vital? Thanks for asking, let’s examine if I can clarify.

If you might be as nieve (did I spell this incorrect too? sorry!) as I used to be once I first began trying to bridge my health insurance from working to Medicare, I assumed that once I obtained via all the hoops to qualify for SSDI (Social Security Disabililty Insurance) I’d IMMEDIATELY be eligible for Medicare, RIGHT??? WRONG!!!!

When you FINALLY qualify for SSDI, it’s a must to wait for five months earlier than you get your first test. AND, the principles state that, you might be eligible for Medicare 2 years (24 months) FROM THE DATE OF YOUR FIRST SSDI PAYMENT. Well, when you add 24 + 5 you get, 29 months between qualifying for SSDI, and Medicare protection.

OK, I mentioned earlier that COBRA is for 18 months of protection. Well guess what 18 months of COBRA + 11 months of OBRA equal – 29 months!

BUT, there are two catches to OBRA; initially, you’ve a small window of 30 – 60 days to use ( this window opens the date of your SSDI approval); and, it may possibly price as much as 150% of your plan protection quantity. BUT, if in case you have a “beforehand present situation” this could be one of the simplest ways so that you can proceed.

Again, you will need to contact a Health Insurance Broker that will help you with the chance/price ratio of all of those conditions.

It can be improtant to know all of those deadlines as you intend to make sure that you and your loved ones have vital health insurance protection.


HIPAA is a federal law that is known as, briefly, the “portability” law for health insurance. What which means is that while you go away a bunch (learn company-paid plan), the service that offered that plan, should supply to you, one other plan, completely different from COBRA, while you go away the group protection. Generally this will likely be what is known as a “naked bones” plan. Again, the very best factor so that you can do is to name/electronic mail a Health Insurance/Benefits Broker with your whole info: SPD, COBRA information, HIPAA information, wants, price limits, and let him/her aid you discover the optimum plan protection for you.


OK, now, lastly, we have reached Medicare! BUT (you actually did not assume it might be that simple, did you?) if in case you have certified for Medicare due to incapacity, there are RESTRICTIONS (of COURSE there are!).

First of all, in case you are qualifying for Medicare due to incapacity, you might be most likely below the age of 65 – regular retirement age.

Medicare protection does NOT cowl pharmaceuticals, which, these of us with disabilities most likely want, and which price tons.

But, Congress prescribed that states (all however 11) supply what is known as “Medicare complement” plans, a few of which do supply prescription coverages.

BUT, these plans ARE NOT REQUIRED TO, and don’t, supply these medicare complement plans that supply prescription coverages to people who qualify below age 65! So, in case you are qualifying due to incapacity, your medical insurance plan would not cowl considered one of your main price expenditures!

Here once more is the place you have to contact a health insurance/profit dealer. Again, he/she will work with you, and your particular circumstances, to get you the protection you want.

Hope that this info was useful to you. If you’ve any questions, please really feel to ask them by commenting on this weblog, and I’ll be blissful to get you a solution.

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