The gray area in the ‘qualifying life event’

We have all heard family and friends discuss the qualifying life event, even if you did not know that is what it is called. When two people get married, they have a qualifying life event and have a 30-day period to consolidate health insurance coverage to one company. Having or adopting a child is a qualifying life event, death of a spouse or dependent is a qualifying life event, and loss of coverage is a qualifying life event. What happens when you are a single individual and you have a loss of coverage? This is the gray area.

Many of us have experienced this gray area, the loss of coverage. Most of us who have experienced this go without coverage. This is not an ideal solution, but it is a solution nonetheless. What if you have a preexisting condition that requires medication? What if you have a car accident? What if you become ill? Then the dreaded cost analysis, number crunching, gut-wrenching decision happens. Do I just ignore what is happening to me? Or do I face the terrifying cost of the medical care I require?

Recently, I had to answer these questions. My fiancé was in the fire academy at the time. While I was insured, he was not because he had changed careers from being a full-time paramedic to be a full-time paramedic/firefighter. While we both analyzed the decision, ultimately, we both wanted him to pursue his dream of working for a fire department. With that decision came the qualifying life event and loss of health insurance coverage.

On July 31 he called me after a long and grueling day of training to tell me that while he was running the tower, he became lightheaded, dizzy and thought he was going to pass out. His fellow trainees noticed, and alerted his instructor, who then alerted the on-site paramedics. He was then transported to the nearest hospital and had a battery of tests performed. He was ultimately released from the hospital and cleared by the occupational health department with a diagnosis of dehydration. At the time, while I was obviously concerned, I did not think much of it.

Then, a couple weeks later, the same thing happened again. This time I was more concerned. Two times in a two-week period? Odd, however, it was summer and extremely hot and humid during both incidents. My cardiac nurse mind could not be quieted, however. The what-ifs were endless. This time the occupational health department was not buying the dehydration diagnosis that the emergency room handed my fiancé as a reason for his symptoms. His worst fears were realized. My worst fears were realized. The occupational health department asked him to be evaluated by a cardiologist. Until this happened, he would no longer be able to participate in any training activities with the fire academy. My thoughts immediately turned to health care cost while uninsured.

As of September 2018, 194,000 or 5.5% of Connecticut residents were uninsured. Overall, our state uninsured rate is better than the national average of 8.7%, however, we could still do better. When an individual loses their insurance coverage due to loss of employment a COBRA letter is issued. COBRA stands for Consolidated Omnibus Reconciliation Act and helps people who lose coverage due to change of job.

The catch? Since your employer is no longer chipping in for coverage, you pay all the cost for your health care plan plus an additional 2% of administrative costs. This does not include the copayments that you will still be responsible for. A family health insurance plan costs an average of $20,000. With an employer, a family will pay approximately $6,000 for coverage. On COBRA, a family will pay $20,000 plus the 2% administration cost and all copayments. COBRA is expensive.

When looking for coverage for an individual on the Access Health CT web page, my fiancé qualified for coverage from $200 to $650 monthly. If you are thinking, apply for Medicaid, it is not that simple. To qualify for the Connecticut Medicaid program, an adult age 19 to 64 who does not receive Medicare, who is not pregnant and who does not have dependent child(ren) under 19 in their household, must make less than $17,237 annually. Let that sink in.

With the growing health care debt climbing, more individuals will attempt to go without health care coverage. Recently, this has become a “hot-button” topic in the news. One in ten American adults delay medical care due to high cost. Nearly 43 million Americans possess medical debt. Sixty percent of those debt holders have health insurance. Two million Americans have claimed bankruptcy due to medical debt. Those are some startling statistics.

Health care spending, debt, and coverage is one of the leading platforms for the 2020 Presidential race. I do not hazard to give you a stance on the right choice for our country. I will leave you with this information and you may form your own opinions.

Rebecca Harrison is a registered nurse from Southbury.

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