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

[VandVsmama]

I saw in the documentation I got that a person is forbidden to opt out of Medicare for a number of reasons including the size of a spouse's business and if the spouse ends up on COBRA.

These mechanisms seem to protect insurance carriers but hurt the person because they are prohibited from choosing coverage and hurt the US by shifting a loan to the taxpayers. I call it a loan because the thing about Medicare is it is really just a loan that costs taxpayers a ton of money because when you activate Medicare you lose the ability to choose many things and then, in the end, you or your estate gats billed for it anyway so it hijacks your wallet.

The other thing about Medicare is it tends to gobble up many people's entire Social Security Payments so if you get $1000 and you need to pay $250 in taxes and then your premium is $500 you aren't really getting any help.

The more I read the stranger it is because disabled people are forced into the coverage for hospitalizations no matter what, and that bit is the strangest part there is.

I do not understand your logic. What documentation? How is all of this a 'loan'? What?

Could you perhaps explain it to us a little differently? For example:

• "I'm eligible for Medicare Part ___ coverage because of _reasons_...
• My spouse is not currently eligible for Medicare coverage because of _reasons_... (i.e., still employed, not of Medicare-eligible-age, or whatever)
• I receive social security income each month...
• Prior to me being Medicare-eligible, my monthly insurance premium was $X.XX.
• Now on Medicare, my monthly premium is $X.XX.
• But if I was allowed to continue on my prior employer's COBRA insurance coverage, the monthly premium would be $Y, which is $__ cheaper per month than what my Medicare premium is...
• ...and that's really frustrating.

....is THAT what you're trying to say?

 

[kdonnel]

I think medical costs could decline under two scenarios.

1. A single payer system where all providers are run as a non profit.
2. Do away with employer provider insurance and instead make the consumer of the product the actual purchaser of the product causing the providers to compete for each consumer instead of just competing at the company level.

But in reality greed would kick in somewhere in the process keeping the costs high.

 

[Mackenzie Click-Mickelson]

It is still true that COBRA coverage can be very expensive. I covered my son along with my daughter, husband, and me for around $400 per month, subsidized by my employer. When my son reached 26 and could no longer be covered as part of my plan, he was offered a rate of $780 per month to continue his coverage under COBRA, because it was no longer subsidized. He found other insurance.

The level of subsidy varies by employer, and may be less for smaller employers so the increased cost of COBRA coverage is less. I just wanted to point out that COBRA coverage may not have the same cost as the same coverage through an active employee.

Agree

Yes COBRA is still expensive, I'm sorry if that wasn't clear in my comment. What I was saying is because my experience was pre-ACA in terms of the cost difference to 2025 costs I cannot discern since there was no marketplace situation like we have (where a lot of people have crazy high costs for just marketplace). That's why I added the subsequent comments regarding marketplace. Different laws over time, different situations even if you compared marketplace now to marketplace 10 years ago.

In the end most of us posters, including me as I said, on this thread have agreed COBRA is likely not the first choice for most primarily due to cost (of which I was speaking to).

 

[barkley]

Thank you so much.

Many people mentioned the Marketplace at the time and also my DH's company gives you the options of course to look into the Marketplace/shop around. I did it quickly. I do qualify for money off the quoted prices. Tried to compare a few, high deductibles, etc. The grief/mourning is too much even more so then. I could not think clearly and I had so many other matter to take care of that took months. I did not want to risk losing COBRA if I screwed up or did not like what I might have signed up for.

I already have it on my calendar three months before I qualify for Medicare (not this year), to speak to someone. I would like to still have my prescriptions, eye glasses, dental (do they cover dental?) - there is so much to learn and explore. I will most likely pay for a supplement but will discuss with someone who knows more than me first.

Thank you again.

first-i am so sorry for your loss.

on selecting a plan-if you have providers you like/want to keep consider speaking to their offices and asking which local to you plans they are covered under and if they recommend one over another for ease in communication/access to specialist referrrals. if you have a particular pharmacy you prefer inquire of them as well (they are key in letting you know if a particular plan is more user friendly on getting meds that require prior authroization quickly processed). I have an advantage plan that has worked well for me-it does include optical exams and glasses (I am given a flat dollar amount for the glasses that I pay for with a pre-loaded visa card they provide me). mine includes dental (they have negotiated rates with providers just like other insurers, cover routine maintainance... but again I have a pre-loaded visa I can use to cover my shares of cost up to around $1000 per year). I am not limited to my hmo network (in network zero or lower co-pay if any) and can self refer to specialists or out of network providers.

I pay $37.50 per month more than the standard mediCARE premium but it's offset by receiving $70 every quarter loaded onto my prepaid visa for OTC products (which i've been surprised to find cover my basic household paper products, cleaning products, garbage bags and even odds and ends like coffee filters ).

good luck on your journey with this.

 

[tony67]

Speaking for someone else that I have been helping navigate this mess for several months - they have terminal cancer.

1 - Yeah Cobra is ridiculously expensive - basically you pay full price for the insurance plan as well as an administrative fee out of pocket on top of that.
2 - My preference would be to use the marketplace and buy a plan - but after several months of jumping through hoops and picking plans and changing PCPs they were forced to take a Medicaid plan - even though they wanted to stay with the Marketplace.
3 - Since they make too much to take a Medicaid "free" plan - they had to take a Medicaid paid plan for those that are disabled - and its not very good overall.

After all this they regret not going with "Cobra" - since they are in a union they could have kept the plan indefinably so its not really Cobra - but very similar. Unfortunately they don't have an acceleration clause for the plan like they do for a pension when you have a terminal illness. So cost is similar to Cobra.
They have had to jump through hoops and change PCPs several times and have had issues with medications not being covered.
For example they were prescribed something 3 times a week but Medicaid would only pay for 1 per week.
On top of that there is all the stress they added to an already awful situation over the last 6 months or so.
So - the added cost of cobra would have been worth it in hindsight.

There is also so concern of Estate Recovery with this that adds to overall stress - and its not 100% clear what the situation is with that.

Since it is a "paid" Medicaid plan it may not be an issue - but no one really knows - yeah we will talk to a lawyer at some point.
I've read a ton of stuff and I don't think it will be an issue - and that is what I told them for now - when they are gone it will be my headache to deal with.

The other issue is - treatment costs 4x as much under the Medicaid plan as it did under the health connector plan - because you don't get the contractual price - so we are talking $18000 every two weeks instead of $4000 - so if estate recover is an issue then that is really going to add a ton more stress.

 

[LuvOrlando]

I do not understand your logic. What documentation? How is all of this a 'loan'? What?

Could you perhaps explain it to us a little differently? For example:

• "I'm eligible for Medicare Part ___ coverage because of _reasons_...
• My spouse is not currently eligible for Medicare coverage because of _reasons_... (i.e., still employed, not of Medicare-eligible-age, or whatever)
• I receive social security income each month...
• Prior to me being Medicare-eligible, my monthly insurance premium was $X.XX.
• Now on Medicare, my monthly premium is $X.XX.
• But if I was allowed to continue on my prior employer's COBRA insurance coverage, the monthly premium would be $Y, which is $__ cheaper per month than what my Medicare premium is...
• ...and that's really frustrating.

....is THAT what you're trying to say?

No, what I am actually saying is I was forced onto Part A, on SSDI there is no ability to reject it.

If DH works for a smaller business I will be forced onto Medicare completely, if DH were to change jobs or start his own business where COBRA would be useful I would be forced onto Medicare as primary. Why force taxpayers to pay for my care when I want nothing to do with Medicare?

Medicare strictly regulates medical choices for all sorts of things so people get corralled into things they may not want. I prefer private because I want to choose.

In the end Medicare forces states to Clawback what was spent from the estate. If you pay it back it is a loan, regular insurance does not do this so it is a loan.

Again, I wonder how much money taxpayers would save if people could opt out and use COBRA?

 

[AnnaS]

first-i am so sorry for your loss.

on selecting a plan-if you have providers you like/want to keep consider speaking to their offices and asking which local to you plans they are covered under and if they recommend one over another for ease in communication/access to specialist referrrals. if you have a particular pharmacy you prefer inquire of them as well (they are key in letting you know if a particular plan is more user friendly on getting meds that require prior authroization quickly processed). I have an advantage plan that has worked well for me-it does include optical exams and glasses (I am given a flat dollar amount for the glasses that I pay for with a pre-loaded visa card they provide me). mine includes dental (they have negotiated rates with providers just like other insurers, cover routine maintainance... but again I have a pre-loaded visa I can use to cover my shares of cost up to around $1000 per year). I am not limited to my hmo network (in network zero or lower co-pay if any) and can self refer to specialists or out of network providers.

I pay $37.50 per month more than the standard mediCARE premium but it's offset by receiving $70 every quarter loaded onto my prepaid visa for OTC products (which i've been surprised to find cover my basic household paper products, cleaning products, garbage bags and even odds and ends like coffee filters ).

good luck on your journey with this.

Thank you so much.

Good idea about asking my doctor/s (or front desk) and pharmacy!!

 

[lanejudy]

If DH works for a smaller business I will be forced onto Medicare completely, if DH were to change jobs or start his own business where COBRA would be useful I would be forced onto Medicare as primary. Why force taxpayers to pay for my care when I want nothing to do with Medicare?

No. Again. It is your choice to go on Medicare or not. The difference will be the premium you have to pay if/when you do finally go on Medicare. After you become Medicare-eligible you must show you had "creditable coverage" when you sign-up for Medicare. You are not "forced" onto Medicare and you are welcome to pay top dollar for any other coverage you prefer. That coverage may or may not be considered creditable, and thus your Medicare premium could increase when you eventually go with Medicare. You might never opt for Medicare as is your choice.

 

[ClaraOswald]

I as well don't see why many people would continue on COBRA due to the huge costs. Most people I know that have left employment prior to Medicare age just get plans on the marketplace. The only reason I would think I'd continue on COBRA after leaving employment until I started another plan is if I hit my high deductible already then while I know I'm paying a large COBRA premium each month, I don't have a deductible for any medical issues.

When my husband was laid off, we did the math and all of our choices were expensive. We went with COBRA because we had already hit our deductible so it made the most sense. It was still so much money and I'm glad it was only temporary.

I don't think so, why can't I do what I feel is in my best interests and avoid passing off my care to taxpayers when I can use the private system with the care I prefer and the choices I can make for myself as long as possible? Why can't everyone else young and disabled or the caregivers of disabled children/ minors?

It makes no sense why my government would coerce people to have care paid for by taxpayers if there is a private option available and preferred.

I don't think it is unique, I expect there are thousands of people like me and children whose families have private insurance through COBRA or through small businesses?

https://advocacy.sba.gov/2023/03/07/frequently-asked-questions-about-small-business-2023/

Passing off your care to taxpayers? But aren't YOU and your household tax payers? I mean, if you pay into the system, why not use it?

I honestly understand very little about Medicare at this point since it will be decades before I'm old enough for it. But I feel like you may actually understand even less than me.

If your husband isn't at risk of losing his job....what does COBRA have to do with your situation?

 

[VandVsmama]

No, what I am actually saying is I was forced onto Part A, on SSDI there is no ability to reject it.

If DH works for a smaller business I will be forced onto Medicare completely, if DH were to change jobs or start his own business where COBRA would be useful I would be forced onto Medicare as primary. Why force taxpayers to pay for my care when I want nothing to do with Medicare?

Medicare strictly regulates medical choices for all sorts of things so people get corralled into things they may not want. I prefer private because I want to choose.

In the end Medicare forces states to Clawback what was spent from the estate. If you pay it back it is a loan, regular insurance does not do this so it is a loan.

Again, I wonder how much money taxpayers would save if people could opt out and use COBRA?

Everyone who receives a paycheck from pretty much any company in the US pays a % of their paycheck to the US federal government as a Medicare tax. So you and/or your DH have been paying for Medicare for all of these years even though you haven't been using Medicare yet.

I'm still not quite understanding what is upsetting about the situation. Perhaps contact your congressional representative to complain? Or submit a complaint to CMS?

If you're in a dual-coverage sort of situation (i.e., where you have Medicare + another health plan), just make sure that you fill out the required COB (coordination of benefits) forms for the secondary health plan. And make sure you notify your healthcare providers of the dual coverage, if you're in that situation.

As to Medicare "forcing" you to do certain things, it's still a free country. So technically speaking, just because, let's say, Medicare care guidelines strongly recommend a colonoscopy every X years after the age of ___, you can still choose to NOT do that. My MIL did a lot of that...refused a lot of screening tests, like mammograms, colonoscopies, well woman check ups. As a result, she got uterine cancer because she refused to go to a gynecologist for 25 years...and once it was diagnosed, she died 2 weeks later. It was pretty horrible.

So like Yoda says, do or do not.

Life is all about choices.

Find a primary care provider who you like, who you feels listens to you, etc., and who is 'in network' for whatever insurance you have. And decide what health choices you want to for yourself.

 

[LuvOrlando]

@VandVsmama I don't think you are reading what I am writing, but that is OK by me I hope you have a very nice day

 

[LuvOrlando]

No. Again. It is your choice to go on Medicare or not. The difference will be the premium you have to pay if/when you do finally go on Medicare. After you become Medicare-eligible you must show you had "creditable coverage" when you sign-up for Medicare. You are not "forced" onto Medicare and you are welcome to pay top dollar for any other coverage you prefer. That coverage may or may not be considered creditable, and thus your Medicare premium could increase when you eventually go with Medicare. You might never opt for Medicare as is your choice.

Not true, but not understanding the issue even with links is ok, I hope you have a very nice weekend.

 

[lanejudy]

Not true, but not understanding the issue even with links is ok, I hope you have a very nice weekend.

You added links after I’d read posts so I never saw those.

However, I stand by my understanding that it all comes down to being able to show “creditable coverage” to avoid paying penalty rates.

You are already receiving government assistance in the form of SSDI. The government has a vested interest in you having access to adequate healthcare. Creditable coverage means a plan meets or exceeds the minimum standard set by Medicare. There is no clawback from estates of Medicare members (unless benefits were paid out fraudulently).

 

[tvguy]

Medicare strictly regulates medical choices for all sorts of things so people get corralled into things they may not want. I prefer private because I want to choose.

Now I am confused. The beauty of traditional Medicare is that you have every option on the table. There are no referrals or prior authorization needed. No provider network. You can go anywhere Only thing is the provider has to take Medicare, which something like 98% of all providers do.
If you have private, you have to go to the providers THEY have contracts with.

 

[tvguy]

I think medical costs could decline under two scenarios.

1. A single payer system where all providers are run as a non profit.
2. Do away with employer provider insurance and instead make the consumer of the product the actual purchaser of the product causing the providers to compete for each consumer instead of just competing at the company level.

But in reality greed would kick in somewhere in the process keeping the costs high.

Must be different in your area. We don't have a single payer, but all our providers are not for profits here.
The HUGE advantage of employer providing insurance is, they are buying in bulk and getting a big discount. Insurance companies offer employer groups their lowest rates because they are selling coverage to hundred or thousands of people at once.
Of course, some big companies that provide health coverage, it isn't health insurance. The employer puts your premium money into a pool, and they hire a company to negotiate fees for service, and pay claims. The employer is actually the one paying any claims, gambling that claims will be less than the money they collect. Which makes sense, because if they buy insurance coverage for employees, the insurance company is the one gambling that premiums will cover claims.......plus they tack on more money for a profit. The company, by assuming the risk, might be saving money by not having to cover the insurance company's profit margin.

 

[kdonnel]

The HUGE advantage of employer providing insurance is, they are buying in bulk and getting a big discount. Insurance companies offer employer groups their lowest rates because they are selling coverage to hundred or thousands of people at once.

In my opinion, the further you separate the actual consumer of a product from being the purchaser of a product, the more corrupt the system.

If the millions of consumers actually purchased their own policies, insurance companies would still have the same economy of scale but the consumer would be more aware of costs instead of them being hidden in a black box payroll deduction.

 

[tvguy]

In my opinion, the further you separate the actual consumer of a product from being the purchaser of a product, the more corrupt the system.

If the millions of consumers actually purchased their own policies, insurance companies would still have the same economy of scale but the consumer would be more aware of costs instead of them being hidden in a black box payroll deduction.

Affordable Healthcare Act changed everything. My Financial Planner used software for planning purposes starting back in 2000. Using actual prices for COBRA and Private Insurance at the time, the game plan for my retirement was to use Private Insurance for the gap between retirement and qualifying for Medicare at age 65 because it was far cheaper. Fast forward to 2021 when I retired, COBRA for my wife and I was not cheap at $1,200, but far cheaper than what ACA did to private insurance rates, $2,000 a month in our case. I did not qualify for subsidies. ACA did good things for people who could not get insurance any other way, but it did bad things to rates because Congress refused to look at the actuary tables to find out what the cost of providing the coverage would be. I can see where they might distrust data from the insurance industry, but the U.S. Government runs Medicare and Tricare military health insurance, Congress refused to even look at those actuary tables. Congress said any issues would be addressed with "cleanup" legislation. 15 years later, that legislation still have not been introduced.

 

[Cannot_Wait_4Disney]

Medicare strictly regulates medical choices for all sorts of things so people get corralled into things they may not want. I prefer private because I want to choose.

No it doesn't. Medicare allows you the choice of any doctor that takes it. Now if you sign up for Medicare advantage (run by a private company, then you get corralled into network doctors.

In the end Medicare forces states to Clawback what was spent from the estate. If you pay it back it is a loan, regular insurance does not do this so it is a loan.

You're confusing Medicare and Medicaid. And yeah, when the government is footing the bill for long term care because someone can't afford it, they're going to take the bill out of the estate when both married partners die.

Again, I wonder how much money taxpayers would save if people could opt out and use COBRA?

None It would cost them. Several posters have told you that. Try paying attention.

 

[barkley]

No it doesn't. Medicare allows you the choice of any doctor that takes it. Now if you sign up for Medicare advantage (run by a private company, then you get corralled into network doctors.

unless you choose to pay more for out of network providers. i'm in an advantage plan largely b/c the largest/best providers in my area are part of it and as a plan member it's easier to get appointments. I can (and have) opted to use out of network providers on occasion which I can self refer for but I do pay a higher co-pay or share of cost. I find I have had much more freedom of choice on traditional medicare or my advantage plan than I ever had with private insurance (both ppo and hmo).

 

[tvguy]

unless you choose to pay more for out of network providers. i'm in an advantage plan largely b/c the largest/best providers in my area are part of it and as a plan member it's easier to get appointments. I can (and have) opted to use out of network providers on occasion which I can self refer for but I do pay a higher co-pay or share of cost. I find I have had much more freedom of choice on traditional medicare or my advantage plan than I ever had with private insurance (both ppo and hmo).

Yes, Advantage plans are a whole different animal. No networks with Medicare, just Medicare Advantage plans which are in fact private insurance for people who opt out of regular Medicare.