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Losing my group coverage - What are my options?

This page is designed to help you understand your options if you have lost health insurance benefits provided by your employer.  Each of the bolded headings is a link to the document that answers the questions that follow it. 

COBRA (Consolidated Omnibus Reconciliation Act)

  • What is COBRA continuation health coverage?
  • What does COBRA do?
  • Who is entitled to benefits under COBRA?
  • How does a person become eligible for COBRA continuation coverage?
  • What group health plans are subject to COBRA?
  • What process must individuals follow to elect COBRA continuation coverage?
  • How long after a qualifying event do I have to elect COBRA coverage?
  • How do I file a COBRA claim for benefits?
  • Can individuals qualify for longer periods of COBRA continuation coverage?
  • Is a divorced spouse entitled to COBRA from a former spouse's group health plan?
  • If I waive COBRA coverage during the election period, can I still get coverage at a later date?
  • Under COBRA, what benefits must be covered?
  • When does COBRA coverage begin?
  • How long does COBRA coverage last?
  • Who pays for COBRA coverage?
  • If I elect COBRA, how much do I pay?
  • Is the COBRA premium reduction (subsidy) still available to individuals who have lost their jobs?
  • What can I do if I believe I am eligible for the premium reduction but my plan sponsor has denied my request for treatment as an "assistance eligible individual?"
  • I have been on COBRA with the 65 percent premium subsidy for almost 15 months.  What should I do?
  • What if I cannot affort to pay the full premium for the remaining three months?
  • If I did not make the premium payment on time and my coverage was canceled what can I do?
  • Can I receive COBRA benefits whild on Family and Medical Leave Act leave?
  • What changes did the Trade Act of 2002 and the 2009 American Recovery and Reinvestment Act make with regard to COBRA continuation coverage?
  • What is the federal government's role in COBRA?
  • I am a federal employee.  Can I receive benefits under COBRA?
  • Am I eligible for COBRA if my company closed or went bankrupt and there is no health plan?
  • How do I find out about COBRA coverage and how do I elect to take it?

Click here for the COBRA guide published by the U.S. Department of Labor, "An Employee's Guide to Health Benefits Under COBRA."

State Continuation of Coverage Under Kentucky Law

  • What rights to continuation coverage are provided by Kentucky law?
  • How long would my continued coverage be in effect?
  • What are the conditions for state continuation coverage?
  • Who notifies the insuracne company that I am leaving the group, and who tells me about my eligibility?
  • Who do I pay for my continued coverage?
  • What happens if my former employer changes insurance companies?
  • How is my coverage affected if the health insurance plan is terminated for the entire group?
  • Who, in addition to the group member, is eligible for state continuation?
  • Are there exceptions to this eligibility?

Rights to Conversion Coverage Under Kentucky Law

  • How is conversion different from continuation?
  • What rights to conversion coverage does Kentucky law provide?
  • What are the terms of conversion health insurance coverage?
  • Who, in addition to the group member, is eligible for conversion under state law?
  • Are there exceptions to this eligibility?

Extended Notification Requirements For Both State Continuation and Conversion

  • What can I do if I am not notified of my right to continued group health benefits or conversion health insurance coverage?
  • Who do I contact for help or information on state continuation and conversion?


What if I can't afford the COBRA or state continuation premiums or do not want to exercise my COBRA or state continuation rights?

One option may be to apply for health insurance in the individual market.  Click on the following link, Individual Market, for more information.

If you cannot afford to pay for medical care right now, a publicly funded program called Medicaid might make it possible for you to get the care you need to stay healthy.  Medicaid is a program for families and individuals who have income and resources within the established guidelines.  The guidelines and income standards are not the same in every state.  It can also lower your costs or cover more benefits if your other coverage is limited.  The federal government provides a portion of the funding for Medicaid and sets the guidelines for the program.

For children not covered under a health insurance plan, the Kentucky Children's Health Insurance Plan (KCHIP) offers free or low cost health insurance for children.  KCHIP is for children under the age of 19 who do not have health insurance and whose family income is below 200 percent of the federal poverty level.

If you are 65 or older, under 65 with certain disabilities, or an individual with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant), you may be eligible for a health insurance program called Medicare.  There are multiple Medicare parts, Part A, B, C and D (prescription drug program).  For more information regarding Medicare, please click on the link, Medicare .

If I am not eligible or cannot afford any of the options identified above, are there other options available?

If you need health care but lack insurance, finding a provider you can afford can be a problem.  Fortunately, there are places you can go for a wide variety of health needs that may provide free or reduced cost care.  They include some hospitals, health centers and clinics.

These places may provide prenatal care, childhood immunizations, prescription drugs, general primary care and specialized care for more serious conditions including mental health, substance abuse and HIV/AIDS.  Anyone can use a community health care center, whether you have health insurance or not.  How much you pay will depend on your income.

There are many clinics operating in Kentucky, both privately and publicly funded.  Clinics might not be available to you if your earnings exceed a certain amount, but their criteria are not nearly as strict as government-controlled health insurance programs.  Clinics may be a good option for people seeking care in the short term.

The National Association of Free Clinics (NAFC) is the only national nonprofit whose mission is solely focused on the needs of free clinics and the populations they serve.  There is a link to a list of free clinics in Kentucky in the related documents listed below.

Kentucky Prescription Drug Assistance Program - This program assists the public with accessing prescription drug programs and free medications that are offered by discount drug programs, drug manufacturers and various discount pharmacy programs.

Health Kentucky - This nonprofit organization has formed partnerships with various agencies, professional associations and health care providers to provide free health care and medications to eligible patients.

Community Action agencies located in each county are another valuable resource to help you better understand what may be available to you in your area.

 

Related Documents
Description
Community Action Agencies (by county) [PDF-219K]
Extended Notification Requirements for Both State Continuation and Conversion [PDF-155K]
FAQs for Employees about COBRA Continuation Health Coverage [PDF-66K]
Free Health Clinics in Kentucky (by county) [PDF-357K]
Glossary of Health Coverage and Medical Terms [PDF-87K]
State Continuation of Coverage Under Kentucky Law [PDF-219K]
Related Publications
Description
An Employee's Guide to Health Benefits Under COBRA [PDF-709K] More Info
Choosing a Medigap Policy  [Order] More Info
Closing the Coverage Gap - Medicare Prescription Drug Coverage [PDF-779K]
Companies Selling In Kentucky's Individual Market [PDF-85K]
Companies Selling Individual Dental Insurance in Kentucky [PDF-131K]
Companies Selling Short-Term Major Medical Insurance in Kentucky [PDF-12K]
Consumer Alert: Medicare Advantage - Know Before You Enroll! [PDF-3M]
Helping Seniors [] More Info
Insurance Information for Seniors [PDF-3M]
Kentucky Children's Health Insurance Program [] More Info
Medicare & You  [Order]
Medicare Supplement Guide [PDF-580K]
Protecting Medicare and You from Fraud [] More Info
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