- Nearing the End of Life
- Your emotions as you near the end of life
- The importance of communication
- Making end-of-life decisions
- Advance directives
- Health care coverage
- Money and income
- Choosing home care
- Choosing hospice care
- Physical symptoms in the last 2 to 3 months of life
- When death is near
- Facing death
- To learn more
Health care coverage
COBRA: A way to keep your health insurance after leaving your job
Employer-based health insurance is usually a type of group insurance, which can be to your advantage. If you left work because of your health, you are entitled to keep your job-based health insurance for the next 18 months. But you must elect to do so within 63 days of when you stopped working. You can do this under the federal law called COBRA (the Consolidated Omnibus Budget Reconciliation Act). You pay the premium for your insurance plus up to 2% to cover costs. Your employer might help with the costs of your insurance premiums, but is not required to do so.
Before you sign up, you’ll want to compare your COBRA costs with a similar marketplace plan. (See below, “Getting coverage through the health care marketplace.”) Be sure to include any employer contributions to COBRA or financial help with marketplace plans as you work through this comparison. Consider also coverage, co-pays, and co-insurance on services and medicines you’re likely to use.
COBRA applies to nearly all businesses that employ 20 or more workers. If you are disabled you can continue your coverage for 29 months. The Social Security Administration decides whether you are considered disabled. For more information please see our document called What is COBRA?
Getting coverage through the health insurance marketplace
Since the Affordable Care Act became law, each state has a health insurance marketplace offering private, individual health plans. These plans are not allowed to reject you due to your pre-existing condition. The marketplace plans set premium costs based on your age, location, and tobacco use. If your income is low you might also qualify for financial help to buy a plan.
The health care marketplace has open enrollment each year, in which you can make changes or enroll in a plan without penalty or explanation. For 2014, open enrollment extends through March 31, and will re-open in November. But if you’ve lost or quit your job, or if you’ve had a change in life circumstances such as marriage or divorce, you qualify for a special enrollment period in the marketplace. This special enrollment lasts only 60 days. You can enroll in a marketplace plan by:
- Finding your state’s marketplace website: visit www.healthcare.gov/, click “enroll”, and choose the state where you live
- Calling the marketplace helpline at 1-800-318-2596
- Enrolling by mail. You can download an application form from the healthcare.gov website or call the 800 number above to find out how to get one mailed to you
If you are having trouble getting coverage, you can get more detailed information by calling the American Cancer Society and asking for our Health Insurance Assistance Service at 1-800-227-2345. You can also ask for our document called Health Insurance and Financial Assistance for the Cancer Patient or read it online.
Are you currently collecting Social Security Disability Insurance (SSDI) income? Keep track of the number of months you’ve been on SSDI. After you’ve been covered for 24 months, you’ll be eligible for Medicare. Some health care providers and hospices accept Medicare. This will give you some choices in your health care. You can learn more about Medicare by calling 1-800-MEDICARE (1-800-633-4227), from your nearest Social Security Administration office (check your local phone book), or by talking with your cancer care team social worker.
Adding to your Medicare coverage
If you are on Medicare now, you may be able to add more coverage with a Medigap policy or a Medicare HMO. If you get an add-on policy within 6 months of going on Medicare, you won’t have to wait out a pre-existing condition exclusion period. If you get an add-on policy after 6 months of being on Medicare you likely will have to wait before the plan would help pay your medical bills. Find out how long the wait is – it may be too long to help you.
There are still a few government programs that might help if you don’t have coverage. But to qualify for many of these programs, your income must be very low.
Medicaid is another government program that covers the cost of medical care, but not all health providers accept Medicaid. To get Medicaid, your income must be very low, below a certain level. (These levels vary from state to state.) Since the new health law went into effect, some states have allowed people with higher incomes to sign up for Medicaid. If your income is low, you should think about re-applying for Medicaid, even if you’ve been rejected before.
If you are 55 or over and qualify for Medicaid, state programs must try to recover the cost of certain benefits they paid on your behalf. This means that after your death, most or all of the money that comes from the sale of your assets (your estate) could be going to the state Medicaid program. States may not recover the money from your estate if your spouse is still alive, if you have a child under age 21 or if you have a blind or disabled child of any age. Each state sets up its Medicaid recover program in its own way, so you’ll need to check with your state Medicaid office for details.
Some people try to qualify for Medicaid by giving away their assets, or selling them for less than they are worth. But anything you give away (or sell for less than its market value) up to 5 years before applying for Medicaid is still counted toward your income. So, giving away assets could delay qualifying for this program. Also, it’s a federal crime to help someone get rid of assets in order to qualify for Medicaid. You can talk with your social worker or contact your state Medicaid office about what’s required to qualify.
Last Medical Review: 01/14/2014
Last Revised: 02/06/2014