Medical Coverage/Disability Questions?

Question

My husband recently became disabled and can not work due to a back injury (which did not happen at work). He is going to have surgery but it hasn't been scheduled yet (kaiser insurance and they take forever). My brother is my husbands employer. What happens with medical insurance in this case? My brother currently pays about 800.00 per month for medical for us and we are trying to save him some money. Can he legally fire my husband so that we can get cobra? Would cobra cost us more than the 800.00 per month? If someone has some answers to these questions that would be awesome. I have already been to the government site and looked over things but i'm not getting much info to specifics so please don't tell me to look at the EDD site. Thanks so much.

Teresa W. If you read this, could you email me please? [e-mail]

Answer 1

COBRA is a federal law which provides a way for employees to continue their group coverage if an employee leaves under certain conditions. You can only continue on COBRA for 18-to-36 months, again it depends on your unique circumstances. Federal COBRA is usually available when the employer has 20 or more full-time employees.

Some states, like California have a state version of COBRA (e.g., Cal-COBRA) which covers employees in groups of less than 20 full time employees. It operates in a fairly similar manner, although there are a few differences.

If you leave the group plan you'll pay the full premium PLUS an administrative fee of 2% under Federal COBRA or 10% under Cal-COBRA. And, as others have noted, you lose the employer subsidy. It's very nice of you to want to save your brother-in-law some money, but staying on the group plan is usually the safest, most affordable approach you can take.

Answer 2

I don't know what state you live in, but I live in California and this is how it has worked for us. My husband also has Kaiser Insurance (which, as you know, can be the pitts!) He has had two back surgeries in the last 2 years. Like your husband, my husband's surgeries were not a result of a work-related injury - he has degenerative disc disease. First of all, keep in constant contact with Kaiser and your neurosurgeon, and keep pushing them for authorization for the surgery (if this is the course of treatment you have decided on) and for a surgery date - otherwise they will take forever (as you already know) and meanwhile your husband will be in constant, and probably ever increasing pain. While my husband was in the hospital recuperating from his last surgery, his boss visted him and told him not to worry about his job. Then about 2 weeks later he turned around and told him he was going to have to let him go. I think his boss was afraid that my husband would not be able to come back and physically do the same job he had done before (he works as a certified mechanic and licensed smog technician). Instead of waiting to see, he let him go and hired someone in his place. So, I'm not sure about the laws in your state, but I would suppose your brother could let your husband go for the same reasons my husband's boss did - he has a business to run, and needed to fill the spot. Your brother may want to get some legal advice on this issue since I am not a lawyer. My husband still has Kaiser insurance (I doubt that there are too many insurance companies that would want to insure him given he has had 2 back surgeries) under the Cobra plan and currently pays about $240 per month; however, that is just to insure him by himself, and not the rest of our family. Hopes this helps. I hope everything goes well for your husband and his surgery.

P.S. Contrary to what another person said, Cobra is a continuation of your existing insurance policy, not a brand new policy, so therfore, there are no pre-existing conditions to worry about.

Answer 3

Do not let your husband get fired. The employer pays 50% of the cost of your insurance, With COBRA you pay 100% of the cost.

There is no advantage to going on Cobra whatsoever.
I understand your desire to save your brother in law money, but in this case, you need to do what is good for your family.

Another thing to consider. Your husbands injury would be a pre-existing injury on a new Cobra plan, It may not cover his back injury.

Answer 4

With cobra you will pay 100% also i believe if the employer doesnt have more than 20 employees he is not required to have cobra so he may not even have cobra.The best thing would just keep Kaiser. Without any insurance it will just cost to much to have the surgery.

Answer 5

COBRA is a continuation of your current plan, pre-ex would not apply. Downside of that is you have to pay 100% of the premium your employer and you were paying as well as the possibility of an administrative fee. I want to say that they can only charge up to 125% but I am not sure on that.

In other words I believe COBRA would cost you in excess of $800 a month.

Answer 6

most likely, cobra will be at or around $800.00
First off, your husband should file for workers comp IF he got hurt AT WORK.
If he did not, he needs to apply for social security disability, which is what my husband is on due to SEVERAL back surgeries resulting from a work injury.
If your husband is awarded disability through social security he will get medicaid and medicare which will cover all insurance costs except a small $2 to $5 copay. it will be between 2-5 for dr.s and prescriptions, the cost depends on the state of which you live in. ;)
I hope that all goes well for your husbands surgery. Stay strong!

Answer 7

Cobra is not usually cheap!! I would not recommend getting him fired. Just pay your brother some money to cover his cost.

Answer 8

COBRA will be significantly more expensive than the $800 a month now.

Answer 9

tsk, tsk, Wonder. Don't you realize by now that sitting in front of your owners computer on a Friday night browsing free cat-porn with nothing but a bowl of catnip and your furballs is NOT considered a date? Besides, you can't catch anything that way so don't stress the vaccines.