Other Information

Getting Help Paying COBRA Premiums

In March of 2009, the federal and California governments passed laws that drastically decrease COBRA and Cal-COBRA premiums for people who recently lost their jobs. You may be eligible if you have involuntarily lost your job between September 1, 2008 and May 31, 2010. People who qualify only have to pay 35% of their COBRA or Cal-COBRA premiums. That means that someone who would normally pay $400 a month for health coverage through COBRA could get the same coverage for $140.

The reductions are for COBRA or Cal-COBRA coverage that started after February 16, 2009. The U.S. Department of Labor has an excellent website that gives all of the details about the premium reduction. You can get the information in alternate formats by calling 202-693-8664 (Voice); 202-501-3911 (TTY).

Continuation Coverage Ends

The 36 month time limit described above is the maximum amount of time you can continue coverage in California. It can end earlier for a number of reasons:

  • You fail to pay your premiums on time or miss other deadlines.
  • You get health coverage through another plan, including Medicare. If that plan has a service wait or a period of time when it doesn’t cover pre-existing conditions, you can keep your continuation coverage until that period ends or you have passed the time limit for continuation coverage.
  • The employer who sponsored your health coverage no longer offers a plan to any of its employees.
  • You are on COBRA for the maximum amount of time, but aren’t eligible for the Cal-COBRA extension.
  • You move out of the area that your plan covers.

If you’re on COBRA and the employer who sponsored your health coverage has a plan that covers the new area, you must be offered coverage in the new area. For Cal-COBRA, your employer is not required to offer continuation coverage even if they have a plan that covers the new area.

Other Options

If you have lost your employer-sponsored health coverage, there may be other ways to get health coverage besides continuation coverage. These may also be options if your continuation coverage ends and you don’t have new health coverage.

You may be able to convert your employer-sponsored policy into an individual one. You could also buy individual coverage yourself. Although it may be difficult to get an individual policy if you have a pre-existing condition, a law called HIPAA, along with similar California laws, may guarantee your right to buy individual coverage. For more information, see DB101’s descriptions of Private Health Coverage and HIPAA & California Protections.

If you have a disability that prevents you from working at a certain level, you may be eligible for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). If you qualify for SSI, you get Medi-Cal right away. If you qualify for SSDI, you get Medicare roughly two years later.

If you are eligible for Medi-Cal, but are earning too much to qualify for free coverage, you may be eligible for the California Working Disabled program. You pay a monthly premium for Medi-Cal coverage that ranges from $20 to $250 (for individuals) and is based on your countable income.

If you can’t get coverage through individual policies because of a health condition and have used up your continuation coverage, there’s a program in California called the Major Risk Medical Insurance Program (MRMIP), commonly referred to as “Mister MIP”. It offers 36 months of coverage, followed by guaranteed coverage after that time period is up. To be eligible, you have to be a California resident, be ineligible for Medicare Part A and B (unless you have end-stage renal disease), have used up or be ineligible for COBRA or Cal-COBRA, and prove that you can’t get adequate coverage. You can apply for the program if you’re currently on COBRA or Cal-COBRA but know that it is ending soon. For more information, see the MRMIP Application and Handbook.

Filing a Complaint

If you have problems with your continuation coverage, you should first contact your former employer or the health plan. If the problem continues, you can file a complaint. The California Department of Insurance can answer questions and help you file a complaint. Contact them here.

Sources

The following links are provided for those who want detailed information on Continuation Coverage. For those looking for more general information, please go to DB101’s Continuation Coverage Resources page.

The U.S. Department of Labor (DOL) has a page that lists DOL resources on COBRA.

The California Department of Managed Health Care has pages dedicated to COBRA and Cal-COBRA.

The code governing Cal-COBRA can be found in section 1366.20 to 1366.29 of the California Health and Safety Code.