I was dropped by BCBS in New Jersey because I am the only employee of a small law firm where I work. They claimed to have sent a letter in September, but I never received anything in the mail or by email. My firm has been with BCBS for 25 years, and this has never been a problem before, even during my 12 years as an employee. They now say that the firm needs at least two employees working 25 hours a week to qualify as a small business. This does not seem logical to me. I only found out because my doctor called the day before my appointment to tell me that my BCBS coverage was terminated. Does anyone know if this is a new policy or how I can resolve this?
It’s not surprising, since most employer plans require at least two employees to qualify as group coverage. If you’re the only one, you might need to look into the individual ACA marketplace.
Ask your employer if they plan to offer any other health insurance now that BCBS dropped the firm. If not, you should go to healthcare.gov and sign up for a plan through the ACA while the enrollment period is still open.
@Mai
Does this mean if something urgent happens, like appendicitis, you’re stuck without coverage until the plan kicks in?
Zeek said:
@Mai
Does this mean if something urgent happens, like appendicitis, you’re stuck without coverage until the plan kicks in?
You should be able to bind a marketplace policy quickly.
@Foster
Marketplace policies don’t start immediately. Coverage starts the following month. I learned this the hard way.
Chen said:
@Foster
Marketplace policies don’t start immediately. Coverage starts the following month. I learned this the hard way.
That’s tough.
Chen said:
@Foster
Marketplace policies don’t start immediately. Coverage starts the following month. I learned this the hard way.
Cobra might be the best option here since it can be retroactive.
@Foster
But can you get COBRA if the company no longer offers a group plan? My understanding is that COBRA only works if the plan still exists.
Zeek said:
@Foster
But can you get COBRA if the company no longer offers a group plan? My understanding is that COBRA only works if the plan still exists.
That’s a fair point.
@Foster
I had to use COBRA for one month because my ACA plan didn’t start in time. It’s expensive since you pay both employer and employee portions, but it’s better than being uninsured.
Chen said:
@Foster
I had to use COBRA for one month because my ACA plan didn’t start in time. It’s expensive since you pay both employer and employee portions, but it’s better than being uninsured.
Hopefully, the employer might continue to subsidize it. They should, in my opinion.
@Foster
For small plans, COBRA might not be required. Instead, the employer could offer state continuation coverage, but it could be more expensive.
Most small group plans require at least two employees. The plan administrator usually verifies this each year during renewal.
If BCBS dropped you in September, you may already be without coverage. Talk to your employer to see if they’ll offer something like a QSEHRA or ICHRA to help cover individual premiums. Otherwise, check healthcare.gov and make sure you sign up for ACA coverage by the deadlines.
If you’re a W-2 employee, your employer might have to offer COBRA coverage. If they don’t act quickly, go to the ACA marketplace and get an individual plan. This is also a conversation you should have with your employer about how they plan to handle health benefits.
@Hadi
Health insurance is part of your compensation. If your employer isn’t offering it anymore, they should make up for it with a raise or other benefits. There are ways for employers to contribute to premiums without making it taxable for you.
If you’re older, group plans might cost less, but individual BCBS plans are usually cheaper. Call BCBS to ask for an individual plan, and check with your employer about whether they’ll subsidize it.
If there’s no group plan, there’s no COBRA. Your employer could offer a reimbursement program for individual coverage.
BCBS is on the marketplace in some states. If your employer doesn’t need to offer insurance due to size, they could still give you a raise to help cover costs.