I wonder how much medicare costs would be cut if people were allowed to use COBRA?

[lanejudy]

It isn't just COBRA though, there is also the requirement that a person slide onto Medicare if the person who carries insurance works for a business that employs less than 100 people.

So I tried to explain this earlier but you seem to be stuck.

"Creditable coverage" is non-Medicare health insurance that Medicare has deemed to be at least equal to Medicare coverage. Individuals who do not join Medicare (B, D, C) at the time of first eligibility (by age or disability) must show they had "creditable coverage" from the time they became Medicare-eligible until they time they do sign up for Medicare (B, D, C) or they pay higher premiums for their Medicare. Larger employers are required to have such plans; smaller employers are not. It's my understanding that if you have access to such a plan through a smaller employer, you simply need to provide that documentation proving the plan in which you are/have been enrolled is considered "creditable coverage."

Also, smaller employers have fewer employees/beneficiary lives (spouses/dependents) across which to share higher premiums and expenses. An individual with a disability is generally expected to have higher healthcare needs, thus the plan needs to absorb more expense of that individual. That is true whether a plan is self-paid (meaning the employer actually pays the medical bills) or plan-sponsored (meaning an insurance company like United Healthcare, Aetna, etc.). When a plan starts absorbing more expenses it tends to increase premiums. Increasing premiums among a small subset of employees may result in those employees not being able to afford their insurance coverage, while increasing premiums among a larger group of employees may not be as impactful.

Now regarding COBRA. COBRA is "temporary." An individual becomes eligible to enroll in Medicare only at certain times: 1) age or 2) disability (24-months after SSDI) or if not started at either of those eligibility points then 3) during a SEP (special enrollment period) which is a life event. Job loss/loss of employer-sponsored health coverage -- those are examples considered "life events" that allows for a SEP. Loss of insurance through other means (such as COBRA expiration) is NOT a "life event" because it can be timed and planned, since COBRA is a temporary offer for a set period of time. Whether COBRA is a PPO, HMO, HSA or whatever depends on what the employer's plan was at the time benefits were lost. COBRA tends to be at least 3x more expensive than an individual was paying for through employer withheld premiums because the employer is no longer required to pay anything towards the premium and it all falls on the individual.

It all comes down to risk assessment and mitigation. Medicare while on SSDI allows you to choose alternative coverage in most situations. It does not allow one individual to impact small business healthcare offerings (thus the limit in employer size). Nor does it allow an individual to get themselves into a situation where they are hit with Medicare "penalty" rates for not enrolling in a timely manner. Thus there are some restrictions in what alternative options are available to those Medicare-eligible due to disability.

Now if you absolutely NEVER intend to sign-up for Medicare, I suppose none of this is of any importance and you may continue on your merry way with whatever employer-sponsored health coverage or COBRA or a private plan. Medicare can only penalize you once you sign-up for Medicare coverage with premiums.

 

[LuvOrlando]

So I tried to explain this earlier but you seem to be stuck.

"Creditable coverage" is non-Medicare health insurance that Medicare has deemed to be at least equal to Medicare coverage. Individuals who do not join Medicare (B, D, C) at the time of first eligibility (by age or disability) must show they had "creditable coverage" from the time they became Medicare-eligible until they time they do sign up for Medicare (B, D, C) or they pay higher premiums for their Medicare. Larger employers are required to have such plans; smaller employers are not. It's my understanding that if you have access to such a plan through a smaller employer, you simply need to provide that documentation proving the plan in which you are/have been enrolled is considered "creditable coverage."

Also, smaller employers have fewer employees/beneficiary lives (spouses/dependents) across which to share higher premiums and expenses. An individual with a disability is generally expected to have higher healthcare needs, thus the plan needs to absorb more expense of that individual. That is true whether a plan is self-paid (meaning the employer actually pays the medical bills) or plan-sponsored (meaning an insurance company like United Healthcare, Aetna, etc.). When a plan starts absorbing more expenses it tends to increase premiums. Increasing premiums among a small subset of employees may result in those employees not being able to afford their insurance coverage, while increasing premiums among a larger group of employees may not be as impactful.

Now regarding COBRA. COBRA is "temporary." An individual becomes eligible to enroll in Medicare only at certain times: 1) age or 2) disability (24-months after SSDI) or if not started at either of those eligibility points then 3) during a SEP (special enrollment period) which is a life event. Job loss/loss of employer-sponsored health coverage -- those are examples considered "life events" that allows for a SEP. Loss of insurance through other means (such as COBRA expiration) is NOT a "life event" because it can be timed and planned, since COBRA is a temporary offer for a set period of time. Whether COBRA is a PPO, HMO, HSA or whatever depends on what the employer's plan was at the time benefits were lost. COBRA tends to be at least 3x more expensive than an individual was paying for through employer withheld premiums because the employer is no longer required to pay anything towards the premium and it all falls on the individual.

It all comes down to risk assessment and mitigation. Medicare while on SSDI allows you to choose alternative coverage in most situations. It does not allow one individual to impact small business healthcare offerings (thus the limit in employer size). Nor does it allow an individual to get themselves into a situation where they are hit with Medicare "penalty" rates for not enrolling in a timely manner. Thus there are some restrictions in what alternative options are available to those Medicare-eligible due to disability.

Now if you absolutely NEVER intend to sign-up for Medicare, I suppose none of this is of any importance and you may continue on your merry way with whatever employer-sponsored health coverage or COBRA or a private plan. Medicare can only penalize you once you sign-up for Medicare coverage with premiums.

I'm not stuck, I just don't agree with forcing taxpayer money to pick up the tab when people may have the will and the means to do things differently and select private insurance This is especially true when there are provisions that when using Medicare it can act like a loan and family be forced to pay it back meanwhile people on private insurance just get plain insurance that acts like insurance. There is no way to twist this that isn't messed up to me and just another way for families to be robbed of wealth passed down from one generation to another. This is mostly offensive because there are plenty of social services around that don't do this in any way so it seems like it is treating elderly and disabled people differently than every other class with social services support. As a result, if a person wants to stand alone and opt out of Medicare and all the things it beings with it they should be able to do so.


Also, not all small businesses are small dollars. Lets say someone's spouse owns a business such as a private Dr's office or CPA, maybe is a private contractor that builds homes or has a thriving landscaping business, maybe the family business is being a bunch of trust fund babies running a charity, the way the rules are now no matter how much money is in the business if it is under 100 it is treated like a mom and pop five and dime who can't opt in to cover themselves privately. It is the prohibition of opting out that is an issue. Let everyone who wants to stay in stay but why are people not permitted to opt out allowed? The individual who is disabled is a person who has nothing and can't work but the people around them may prefer to cover it. That person may be on SSDI to protect themselves and use the money for Medications Copays and all because it is expensive to be unwell and a person is extraordinarily vulnerable to be incapable of self care, but if there are caregivers who are willing and able, why not let them as long as possible? This doesn't make any sense.

Consider this, truly, isn't it odd that when it comes to student loans EVERYTHING is in the lap of the family for ridiculous contributions but in healthcare people get shoved into taxpayer dollars paying for everything even if the family would prefer?

None of the Dr's or healthcare systems I know will accept cash for some strange reason, I have asked at times when we were in between waiting for policies to sort out and have been told flat out, no. Maybe there are some but none that I have come across.

Bolded part: There is no way to not sign up or opt out and that is my point, if you are on SSDI you MUST be on Part A, it is in one of my screenshots.

 

[dizneegirl]

Why would someone be getting SSDI if they were independently wealthy or had a wealthy family?

 

[LuvOrlando]

Why would someone be getting SSDI if they were independently wealthy or had a wealthy family?

SSDI has zero to do with money. SSDI is to help a disabled person who can't work and so they can't take care of themselves alone. Being unwell is costly and even with insurance the copays and deductibles are very expensive now.

A wife of a wealthy man or husband of a wealthy wife has no wealth themselves and a child of a wealthy family has no wealth themselves, poverty is one divorce or one no away so it is important as a safety net for vulnerable people. However, as long as the family agrees to contribute they should be allowed to contribute.

Medicaid is related to household money, SSDI & Medicare is not.

 

[dizneegirl]

But, if you're getting government help as far as disability aid... it just makes sense to get government insurance...

 

[LuvOrlando]

But, if you're getting government help as far as disability aid... it just makes sense to get government insurance...

Truly, why?

 

[dizneegirl]

Because it makes sense to everyone but you.

 

[lanejudy]

Bolded part: There is no way to not sign up or opt out and that is my point, if you are on SSDI you MUST be on Part A, it is in one of my screenshots.

I've asked at least twice now... have you actually had any claims paid through Medicare Part A? If not, again I don't understand your concern about costing the taxpayers. Are you being charged a premium for your Part A? Most recipients are not. Therefore it's a moot point -- you aren't costing the taxpayers anything and you aren't being charged anything extra. What is the concern?

The individual who is disabled is a person who has nothing and can't work but the people around them may prefer to cover it.

So you are saying your spouse works for a small business (small determined by number of employees not bank account), and all the other employees at your spouse's small employer are willing to front higher premiums and likely higher OOP for their/their families' healthcare? Just so you can say "no Medicare. We take care of our own." You don't get to make that decision; the government has removed your ability to directly impact the healthcare expenses of a limited few by pooling you in a larger group of healthcare recipients.

This is especially true when there are provisions that when using Medicare it can act like a loan and family be forced to pay it back

Apparently you live in a state that does this. Medicare "clawback" is between the state and the federal and my state does not come after the individual or their estate. Possibly your state is different -- bring up with your legislators.

Truly, why?

Because the government has an interest in making sure SSDI recipients have access to adequate healthcare. Plain and simple.

 

[mistysue]

Why would someone be getting SSDI if they were independently wealthy or had a wealthy family?

In case you didn't notice this teeny detail- SSDI and SSI are not the same. SSI has super strict income limits, but from what I can tell SSDI is basically for people who put more into social security before becoming disabled. I looked it up while reading because I got confused too, thinking "how in the world did you qualify yet you can afford insurance?" knowing a few people on SSI who basically aren't allowed to own anything, have any savings, and can completely lose their benefits and insurance if they go so much as $1 over on a bank balance due to something like a birthday gift or trying to save for rent.

 

[mom2rtk]

Being on a group insurance plan, in this case through COBRA, keeps your experience (i.e cost) on the group plan. I'm sure the companies involved prefer not to have that experience coming into play at their next renewal. Especially for someone on disability. I'm sure they would fight that sort of change hard. The government is far better equipped to take on those costs than an average 100 person employer.

 

[Marrila]

The government is far better equipped to take on those costs than an average 100 person employer.

This.

 

[LuvOrlando]

Live and let live, my question was not if anyone agrees with me and I am not interested in changing minds. Opinions are neither right nor wrong so if people like it this way, go for it.

My question was, actually right there in the original post:

I wonder how much medicare costs would be cut if people were allowed to use COBRA?​

Things got sidetracked in grilling on underlying truths which I provided via links and screenshots. My question still remains and I would love to know the answer, maybe in the age of AI it can be quickly calculated by those who have access to the data and might pop out at some point.... who knows anymore.

 

[VandVsmama]

I don't think that Medicare costs would be reduced if people were allowed to use COBRA.

 

[LuvOrlando]

Because it makes sense to everyone but you.

I sincerely doubt it, actually, I doubt a very few not using it for some family member have ever thought about it or even has the foggiest notion of what all this really is or how it works.

In fact, I suspect the majority of people using it don't even know the vastly complicated rules. Things just work and people only ask questions when they don't work, and if things begin to work again they stop asking, like most people do with their plumbing.

 

[LuvOrlando]

I don't think that Medicare costs would be reduced if people were allowed to use COBRA.

OK, it is fair that you feel that way, go for it.

 

[honeymo78]

I suspect very little change in Medicare costs. In nearly all cases, I would suspect Medicare is vastly cheaper (esp considering Part A is usually free for SSDI recipients) than paying for COBRA. You'd have to change how COBRA works as well since it's only meant to be short-term. This sounds more like a solution in search of a problem.

 

[barkley]

The individual who is disabled is a person who has nothing and can't work

this is offensive to the disabled. being disabled does not automatically equate to having 'nothing' many SSDI recipients are capable of and can work which is entirely permissible within the program's rules and regulations.

Why would someone be getting SSDI if they were independently wealthy or had a wealthy family?

there are a number of reasons but one that is rather common is in the case of having a disability (non service connected) based pension or long term disability insurance plan that carries a requirement to apply for and receive social security if one is eligible. for many it's also because they DO want to have that link to mediCARE after the 2 year waiting period.

SSDI has zero to do with money. SSDI is to help a disabled person who can't work and so they can't take care of themselves alone

again, people can and do work when they apply for and receive SSDI (there are even supportive services within the program to facilitate employment). again, it is offensive to say that just because a person is disabled they can't work. it is incredibly offensive to say that a disabled person can not take care of themselves alone. many of us do, will continue to do so and encourage others.

 

[LuvOrlando]

this is offensive to the disabled. being disabled does not automatically equate to having 'nothing' many SSDI recipients are capable of and can work which is entirely permissible within the program's rules and regulations.



there are a number of reasons but one that is rather common is in the case of having a disability (non service connected) based pension or long term disability insurance plan that carries a requirement to apply for and receive social security if one is eligible. for many it's also because they DO want to have that link to mediCARE after the 2 year waiting period.



again, people can and do work when they apply for and receive SSDI (there are even supportive services within the program to facilitate employment). again, it is offensive to say that just because a person is disabled they can't work. it is incredibly offensive to say that a disabled person can not take care of themselves alone. many of us do, will continue to do so and encourage others.

I am disabled, if a person is on SSDI you can't work more than a scarce amount of hours so there is no means of support, that is literally the requirement not being able to support yourself via work. There is literally no way I could pay for premiums and rent and food and medications and co pays on my own, nor could I do the physical requirements of managing a household by myself, I need help. Why would this be offensive? I don't think it is offensive that people like me can't take care of myself or be self sufficient, it is weird that would be offensive and sort of dehumanizing to be honest.

How much do you work? Do you have a full time time job? I was told by the SSDI lawyer I can't work anymore and I didn't find it offensive at all, it is simply a fact, it is why I qualified young.

Came back to say that you know what, I guess there is a possibility people could be working full time on SSDI making the over 100K you need to live in Boston, Massachusetts and that would, I suppose, just prove my point that the whole process is very muddy and that even people on it do not have any understanding of all the rules. None of the rules are easy to look up I just trusted my lawyer.

 

[barkley]

I am disabled, if a person is on SSDI you can't work more than a scarce amount of hours so there is no means of support, that is literally the requirement not being able to support yourself via work. There is literally no way I could pay for premiums and rent and food and medications and co pays on my own, nor could I do the physical requirements of managing a household by myself, I need help. Why would this be offensive? I don't think it is offensive that people like me can't take care of myself or be self sufficient, it is weird that would be offensive and sort of dehumanizing to be honest

I'm sorry that these are the circumstances in which you find yourself. my point is that not EVERYONE on SSDI can't work and many do, not EVERYONE is incapable of the physical requirements of a household and requires help. everyone has their own individual path with a disability and the limitations and challenges one person faces are not universal to everyone.

i'm confused though-you complain that absent SSDI you would be unable to pay for 'premiums' but you are angry to be forced onto mediCARE part a which provides coverage at no cost. as you've said SSDI is necessary for most to cover at minimum their housing and food (and it sounds like perhaps you are receiving in home supportive services which I know are very costly), I just can't understand with these expenses wanting to forego no/low cost (the optional medicCARE part b portion) health care in favor of significantly higher private insurance that the national average shows costs for would eat up on average 50% of the average individual's SSDI check.

 

[sam_gordon]

I am disabled, if a person is on SSDI you can't work more than a scarce amount of hours so there is no means of support, that is literally the requirement not being able to support yourself via work. There is literally no way I could pay for premiums and rent and food and medications and co pays on my own, nor could I do the physical requirements of managing a household by myself, I need help.

I know nothing about SSDI or Medicare (other than it's available when you get to be 65). But this statement makes no sense to me, can you explain it?

If someone can't support themselves via work and relies on SSDI, where would they get the money to pay for COBRA Insurance?