Affordable Care Act: COBRA too expensive, what to do

“My wife is 62 years old and has been unemployed for nearly three months.  She went from full time, to medical leave and then to being unemployed.  She has been waiting to see if she is able to draw unemployment while she looks for a job.  So, she is currently earning no income and my income is not enough to keep us afloat.  She currently has no health insurance as her COBRA was way too much to afford.  We are left wondering what to do.  Any ideas????  Adding her to my work insurance is also way too much.  Thanks for any help you can give us.” 

Texas Hold ‘Em

 Dear Texas Hold ‘Em,  

You are between a rock and a hard place, that’s for sure.

Since your wife could join your plan at your job, she cannot get subsidies to buy a health plan from the Exchange or “marketplace”.  I am assuming that your plan at work meets the Affordable Care Act standards – which means that it costs you less than 9.5% of your income to cover yourself (not you and your wife, just you the employee).  You should have received a letter from your employer or your plan telling you whether the plan meets health reform standards.

There are no limits in health reform about what an employer plan can charge you to cover your spouse and family members.

You could look at buying her a plan “off exchange”, which means that it would offer no subsidies.  It is not likely that an off exchange plan would cost less than your group plan would.  Nevertheless, it’s worth finding an insurance agent to help you consider this option.

Since your wife has a health problem, it is not desirable for her to go without insurance.  If, however, you cannot find a way to afford a plan, then you should apply for any and all Patient Assistance programs at your local hospital and physician’s office.  Ask her current physician for help, ideas, and referrals to sliding-scale or free clinics.  You can find these also at Needy Meds.

Last, I would suggest applying for Social Security disability.  This takes a lot of time and effort, but if her health issues are disabling, it is a way for her to get Medicare before she turns 65 and to get Medicaid.  Texas is not expanding Medicaid, so she cannot qualify for this based upon your household income; she would have to be declared “disabled” by Social Security to get this coverage.

When she does get health insurance again – whether from your job, her new job or from a government program – she will be covered for all of her current health problems.  Pre-existing conditions go away as of January 1, 2014.

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.