After qualifying circumstances that would otherwise result in the termination of coverage, individuals can continue their employer-sponsored group health insurance coverage for a short time under the Consolidated Omnibus Budget Reconciliation Act (COBRA), federal legislation. These occurrences include, among others, the covered employee’s death, divorce, and reduced working hours. To avoid coverage gaps during transitions, COBRA makes sure that people and their dependents have the choice to continue their health insurance coverage temporarily.
The length of time a person’s health insurance coverage can continue under COBRA depends on the qualifying event. In general, coverage can be extended for up to 18 months in the event of job loss or a decrease in hours worked and for up to 36 months in the case of other qualifying circumstances like divorce or the death of the insured employee. However, benefits may end if the person qualifies for Medicare or another group health insurance plan. If the employer’s health plan is no longer in place, the worker was fired for flagrant misconduct, or the person does not pay the necessary premiums to maintain coverage, COBRA benefits may be withheld (Chu et al., 2021).
Costs of Obtaining Coverage under COBRA
COBRA offers the opportunity to keep your insurance but at a cost. The premium amount, including the employer payment, is often demanded of people who keep their COBRA coverage. This may result in significantly higher expenses for the person and their dependents. These higher expenses may cause financial hardships for many people with job loss or other qualifying situations (Crespin & DeLeire, 2019).
Analysis of COBRA in Light of the PPACA
Comprehensive healthcare reforms were adopted under the Patient Protection and Affordable Care Act (PPACA), popularly known as the Affordable Care Act (ACA), including expanding Medicaid and establishing Health Insurance Marketplaces. The goal of the ACA was to increase people’s access to affordable health insurance. The retention of COBRA benefits has been a point of contention, given the ACA’s restrictions. Through the Health Insurance Marketplaces created by the Affordable Care Act, people can obtain health insurance coverage outside of employer-sponsored plans. These markets offer a range of projects with different levels of coverage and prices, usually with income-based subsidies to make coverage more affordable. Low-income individuals and families are covered by the Medicaid expansion in participating states (Chu et al., 2021).
With more options available to buy health insurance under the ACA, the usefulness of COBRA benefits might need to be reevaluated. The ACA’s provisions are meant to fill some gaps and overcome some of COBRA recipients’ difficulties, notably the high expenses of maintaining coverage. COBRA may still be helpful in some circumstances for people who choose to keep using their present healthcare providers or have particular medical needs (Crespin & DeLeire, 2019).
In conclusion, COBRA is an essential bridge for retaining health insurance coverage during transitional periods. However, the ACA’s increased possibilities raise questions about whether the COBRA’s legal obligations will still be necessary. Finding a balance between maintaining coverage continuity and utilizing the ACA’s provisions to increase accessibility and affordability is a hotly debated issue in healthcare policy.
References
Chu, R. C., Branham, D. K., Finegold, K., Conmy, A. B., Peters, C., De Lew, N., & Sommers, B. D. (2021). The American Rescue Plan and the Unemployed: Making Health Coverage More Affordable After Job Loss.
Crespin, D., & DeLeire, T. (2019). As insurers exit Affordable Care Act Marketplaces, so do consumers. Health Affairs, 38(11), 1893-1901.
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