Hi! I recently switched my family of four to my company’s medical coverage because my husband’s job changed. I’m finishing up cancer treatment at Kaiser and paying for additional insurance to stay with the same network and providers for now.
I’m mostly done with treatment, but I need follow-up surgery in February with the same plastic surgeon. Can I cancel my Kaiser coverage for the next four months and then turn it back on for the surgery? I don’t have another Qualifying Life Event (QLE), and since the costs are fully out of pocket, I’m unsure how this works. I know insurers usually have rules against this to prevent people from just signing up when they need care. I will still have coverage through my other plan, so I’ll remain insured. What do you think?
I know this isn’t your main question, but where did you get the extra Kaiser insurance? Your employer’s plan should be your primary insurance. What company is that with? Have you filed a coordination of benefits between the two plans? Did they bill the primary plan first for your care? I ask because having two insurance plans can be complicated, and I want to make sure you’re covered for the services you’ve already received.
My insurance through my company is Premera/Blue Cross. I bought the Kaiser plan directly from Kaiser as an individual. I didn’t file any coordination documents. I’m only billing Kaiser and not using Blue Cross at all, even though it exists.
Unfortunately, it doesn’t work that way. When you have two plans, you must file coordination of benefits. If you don’t, they’ll recover payments once they find out about the other primary plan. Ideally, Blue Cross, as your primary insurer, would deny the claims, and then Kaiser would cover them. However, this depends on Kaiser’s policy on coordination of benefits, which you can find in your Kaiser contract.
It’s very unlikely that you can do this because you need a Qualifying Condition to enroll outside the Open Enrollment Period.
If you voluntarily dropped your plan, you can’t enroll again until Open Enrollment or if you have a Qualifying Event.
Any plan available to you wouldn’t be ACA compliant and wouldn’t cover pre-existing conditions.
You are correct that the requirement to enroll during Specific Limited Periods helps insurers cover pre-existing conditions. It prevents people from trying to “game the system” by signing up only when they need expensive procedures.
Like the other poster, I also question whether you completed the Coordination of Benefits correctly, but that depends on how the specific plans interact.
i’m not trying to coordinate the 2 plans - I only want to use the kaiser one. The blue cross one is there in the background, but i am not using it at all, currently. But I would use it during the time frame when I don’t have kaiser.
They can discover each other and start taking back any payments they made. I strongly recommend that you coordinate benefits with each plan. Eventually, they will find out about each other and reclaim their payments. When this happens, the patient receives the bill. I’ve seen insurance plans recover money 1 to 2 years after claims were paid and settled, and it can create a huge mess.
You probably can’t drop your insurance for four months. You can’t get ACA insurance outside of Open Enrollment or without a Qualifying Event, which gives you a chance to enroll. You most likely won’t have that option.
i’m very confused - I am paying for an private, individual (not ACA) health care plan with kaiser, only using kaiser doctors/services - and paying everything out of pocket including premium, copays, deductibles. I am not using my other (blue cross) insurance AT ALL; they are not being billed for anything. they would not cover these services anyways because they cannot cover kaiser medical treatments, only kaiser members are eligible for those. I am paying for everything, on an individual plan that is month-to-month that i can end at any time. there should be no coordination needed, I am paying anything that kaiser doesn’t.
The issue is that your Blue Cross plan should usually be the primary one based on standard coordination of benefits rules. You can’t choose which plan is primary; the rules determine that for you.
If your employer’s Premera plan is primary and your individual Kaiser plan is secondary, Kaiser could retroactively take back all the payments they made to your medical providers.
I’d suggest looking into this further—some states have higher income limits for children on state health plans. It’s possible your kids could stay covered while you transition to full-time work and join the employee health plan.
That said, the main question is whether the extra income from full-time work is worth the time lost with your family. As a single parent with children under 16, giving up those hours and flexibility could be a big challenge.
I agree with others that you should weigh your options carefully. In most states, you can keep your kids on Medicaid or CHIP, and even if you have to pay a small premium for CHIP, it’s usually cheaper than an employer plan—unless your job offers really great benefits.
Great point about time management—they’re only young once, and I sometimes wonder if my pride clouds my judgment for this stage of life. I remind myself that Obamacare/ACA is also government-subsidized, so why should I feel bad? No one really knows or cares about my health insurance; it’s more of a personal thing I’m grappling with.