Switching from individual plan to group is okay

What will happen if I give up my self-paid private health insurance, and join the plan through my wife’s new employer?   Suppose I have an MRI done, and find that I need back surgery or physical therapy.  What if she leaves her job and we move to another state? Will I be considered a risk with “pre-existing conditions”, and not be able to be insured either privately, OR through a new group plan?

Doing The Limbo

Dear Doing The Limbo,

It’s simpler than you think, actually.

As long as you do not have a gap in your health coverage of 63 days or more, your plans will cover your MRI, back surgery, and physical therapy.  Starting January 1, 2014, even the no-gap-in-coverage rule goes away.  Your plan – whether it is individual or a group plan — will cover your care, no matter what.

If your wife leaves her job and the plan offers COBRA, you would be able to keep her group plan for at least 18 months.  Moving to another state may mean that the COBRA plan is not as useful to you.  Some plans do not pay for services from out-of-network hospitals and doctors, for example.   But, generally, the COBRA plan will be your best bet even if you do move to another state.

Of course, all of this changes on January 1, 2014.  A COBRA plan may be your least attractive option, when the health insurance marketplaces offer individual (non-group) plans.  It largely depends upon your age.  Older people are likely to find the rates more competitive than younger people.  But it’s all speculation at this point.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.