California COBRA recipients now eligible for CoveredCA individual health insurance during short-term Special Enrollment Period

April 15th, 2014 marked the end of the first round of open enrollment for the Affordable Care Act.  However, if you are still in the market for health insurance, you may not be out of luck. CoveredCA, the California state-based health insurance exchange, recently announced that they would extend a one-time Special Enrollment Period to those individuals who are still on COBRA coverage.  COBRA coverage is offered to individuals who leave their jobs but would like to continue their health insurance coverage. It’s a temporary arrangement, usually lasting 12-18 months, allowing the individual to get back on their feet and get coverage either from their new job or via the individual market.

Until now, those who were on COBRA would have to exhaust their COBRA benefit before being eligible for CoveredCA plans and subsidies.  With this announcement, CoveredCA extends the option to get covered to those currently on COBRA without having to exhaust the coverage.  So who might benefit from this open enrollment period?

  • Individuals who earn less than 400% of the Federal Poverty Line– about $46k for an individual or $95k for a family of four.  These folks can obtain a subsidy to help pay for their coverage
  • Individuals who are close to the expiration of their COBRA coverage and would like to get a jump on their new programs, allowing them to maximize the time they are on the new policy in the 2014 calendar year.
  • Individuals who would like to change their provider network, perhaps from HMO to PPO or vice-versa. 
  • Those who have used some or all of a particular benefit on the COBRA policy that resets yearly, like a physical exam. Switching to a new plan via CoveredCA would reset these benefits.

What might be the downside of taking advantage of this SEP?

  • Just as the good benefits of the plan reset, so do the bad.  This means if you have already satisfied your deductible/OOP for the year, it will reset when you start a new plan- even if you stay with the same company.
  • If you earn over 400% of the FPL, you don’t qualify for a subsidy. Unsubsidized coverage might not represent a discount on what you are currently paying for COBRA coverage
  • If you currently enjoy a wide network or have a doctor that doesn’t accept the networks assigned to the plans under the CoveredCA umbrella, and you don’t want to switch providers, you will want to avoid taking advantage of this CoveredCA SEP.
  • If someone is contributing funds toward your COBRA plan as per the terms of a severance, you may lose those additional funds if you switch to CoveredCA. Check with the person with whom you made this agreement with in the first place, as it may be advantageous to them to see you switch from the COBRA plan on to the CoveredCA coverage.

For plans and pricing available during CoveredCA’s Special Enrollment Period, just call 800-783-0802.

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