Only if you are fired or quit. If you are laid off, you have the option to continue your insurance at your employers discounted rate. The program is called COBRA if you want to look into it.
COBRA is temporary (for 18-36 months depending on the situation), and you need to not only pay what you have been paying, but you also need to pay the "employer's share". And it must be identical to the plan you left, so you can't reduce coverage or change anything at all about the plan or you'll lose eligibility.
That means people who quit or are laid off will end up having to pay more for their healthcare at a time when they don't have any income.
COBRA also has a lot of hidden "gotchas", like for example if the employer you left stops maintaining any health plan, your COBRA plan can also be terminated. (This means if the company shuts down, all past employees lose any ability to use COBRA. And this can happen even after you leave and are already on COBRA)
Also if you fail to pay the premiums for any reason, your plan can be terminated, and even worse you won't be allowed to sign up for a new plan via the Marketplace until the open enrollment period.
Yup — almost made this comment in another thread. There are tons of gotchas with COBRA. Sure, if you can afford it, it can be better than the alternative (especially if you have expensive medications or a pre-existing condition that requires lots of ongoing treatment), but I’ve had plenty of friends who have at various stages had to face questions about health insurance or rent — and as you say, if you’re late at all with COBRA, you lose it.
The fact that the United States doesn’t have universal, affordable healthcare is a travesty and the fact that our system has persisted for this long is utterly insane.
Late with Cobra is different from most insurance because you can pay the month after you receive services, not before.
This also allows you a little more flexibility than with a traditional plan where you have to prepay. For instance, if you're going to enroll in a new plan as of January, and don't end up using any medical services in December, you can decide in January not to pay for that month and Cobra will terminate coverage.
> but I’ve had plenty of friends who have at various stages had to face questions about health insurance or rent
Do affordability tests not apply once you are laid off? I would think your premium subsidies would go up and you can get an ACA plan.
At least living in CA, it generally feels like we have universal, affordable (by some definition) healthcare, but I'm sure there are edge cases where the affordability calculation breaks.
Affordability tests are based off what you’re projected to make and if you have any income or savings at all, that can impact that directly. Moreover, depending on your needs, the cheap plans might not work out. If you’re diabetic and require insulin and testing strips and other stuff, a high-deductible plan probably isn’t going to work out. The same is true if you’ve got specific prescriptions you need covered that are only up to a certain amount on a lower-tier plan or aren’t available unless you pay more. So in some cases, the ACA plan could cost the same as COBRA, and you’d be stuck starting from zero with your deductible, which if you had paid into under your employer, could be significant.
But beyond that, let’s say you anticipate you can make $3000 a month freelancing. Now, this isn’t enough for your rent and your insurance, but it’s still too high, perhaps, to qualify you for a lower-rated ACA plan. And it is certainly too high for Medicaid. So if you live in a high-priced city, you’re now stuck having to decide what you pay for — and that’s not always easy. Remember, it’s not like moving is that easy — you may have to break a lease (which costs money you don’t have), and you’re unemployed so signing a new, less-expensive lease is going to be challenging too.
The safety nets we have in place are really only designed for the very, very poor (and even then, they don’t go far enough). If you are anything but that — you’re really fucked, especially if you live in an medium-size or larger city/urban area.
Sure — but the point is that it isn’t a viable discount for most people who are laid off — regardless of your income level. A decade ago, when I went off my parents insurance (and before the startup I worked at offered insurance), COBRA was $1200 a month — it was more than my rent at the time. But my medication costs were $1500 or $1600 a month (primarily for an ADHD drug that was still under patent and no generic was available), so I paid it anyway. That was in part because my parents had really good insurance — and you’re paying to extend the same plan, you’re not able to negotiate for a different plan. When I last switched employers a few years ago, the COBRA amount was similarly high (I didn’t use it because my new employer had insurance but I saw the COBRA forms). Unemployment wouldn’t cover rent for many people — let alone COBRA.
Wow, sounds like you just discovered that health insurance is expensive! (Regardless of who pays it, your employer paying it is just a hidden reduction of your salary.)
That’s hardly something I “just” discovered. Practically every other first world country offers deeply subsidized or nationalized health care except the United States, and considering my 40% effective tax rate isn’t much lower than those places, I’d rather all citizens have access and not have to forego health insurance for food or rent.
It's the same price as what your employer was paying. It's only more expensive than getting it yourself if you are A) younger than the average of your employers' pool or B) qualify for premium assistance/medicaid.
COBRA is so intractably expensive that the only responsible thing to do is assume COBRA doesn’t exist and base policies and assistance around that reality.
Any analysis / estimate / policy that starts from any assumption of the existence or usage of COBRA is therefore so unrealistic and inaccurate as to be completely ignored.
That's because insurance is expensive. The price you pay for COBRA is identical to how much that policy cost while employed, except that while employed the employer is paying a large share of the cost, and while on COBRA you pay the full cost yourself. Spending some time on COBRA is a good way to appreciate the high cost of insurance.
I spent 12 months on COBRA when I started my startup, and while I didn't enjoy paying close to $2,000 per month for insurance I couldn't buy a comparable plan on the open market for my family for less.
I’m unclear the purpose of your comment. I never said insurance wasn’t expensive. Taking someone who has no choice but to base their life around not bearing that cost because they must rely on employers to bear it for them, then suddenly acting like it’s a benefit that they can optionally take on that cost their life has been fundamentally structured to not bear, is not a solution to anything.
Presumably the existence of COBRA is meant to assist people experiencing a hard time with health coverage. It does not achieve that purpose. If insurance itself is prohibitively expensive that mediating it through COBRA means people are unhelped by COBRA, then replace COBRA with something that pays the cost of the coverage. Take your pick of many options, but shifting the cost burden onto someone who was told to structurally depend on it being tied to employers is not a thing. It’s a non-thing that does not count as an assistance or benefit.
It’s like if you lost your job and suddenly now breathing oxygen costs an extra fee, but it’s OK because you can just pay the oxygen fee you were forced into letting your employer pay on your behalf.
That means people who quit or are laid off will end up having to pay more for their healthcare at a time when they don't have any income.
COBRA also has a lot of hidden "gotchas", like for example if the employer you left stops maintaining any health plan, your COBRA plan can also be terminated. (This means if the company shuts down, all past employees lose any ability to use COBRA. And this can happen even after you leave and are already on COBRA)
Also if you fail to pay the premiums for any reason, your plan can be terminated, and even worse you won't be allowed to sign up for a new plan via the Marketplace until the open enrollment period.