What to do when your COBRA benefits run out

For millions of unemployed Americans, access to the temporary health insurance program known as COBRA is running out -- despite several extensions by the U.S. government.

Finding health insurance to replace COBRA is an uphill battle for many with pre-existing medical conditions -- even when cost isn't a factor.But life after COBRA isn't entirely without hope. Here are some ways to retain your health coverage without going broke:

1) Make an Appeal to COBRA
COBRA apparently isn't always the heartless bureaucracy that it generally appears to be. COBRA may extend coverage for you or your chronically ill spouse for up to 18 additional months if you pay the full cost of the premium plus a small administrative fee. After that, a HIPAA plan kicks in. To qualify, a person must have had employer-sponsored health insurance and then exhausted COBRA benefits. You also cannot be eligible for any government program or have another source of group insurance coverage, say, through a spouse's employer. You can buy HIPAA coverage for as long as you need, but the sheer expense of it drives people to consider other options.

2) Consider different coverage for different members of your family.

Check if your minor children qualify for the Children's Health Insurance Program, a federal-state partnership that provides insurance for families who are not eligible for Medicaid but who still can't afford to buy private insurance. CHIP is especially valuable if any of your kids have chronic medical conditions -- the things that send most health insurers scurrying like roaches when the lights comes on.

Go to http://www.insurekidsnow.gov/ for more information about eligibility.

If your children are in college, look into student health insurance plans, known as SHIPs. The College of New Jersey is among the universities that offer reasonably priced basic on-campus health care for its students. The college charges $123.50 a semester, so for under $250 a year students are eligible for basic care benefits that include free office visits, allergy and flu shots, HIV-testing and low-cost vaccinations. It isn't comprehensive coverage by a long shot, but may be just fine for your-never-sick-a-day-in-his-life college boy. Not all college plans are that reasonably priced. University of Massachusetts charges $2,322 a year per student to be insured through Aetna; Lewis-Clark State College is $1,230 a year. But again, it's insurance that accepts pre-existing conditions. And if you don't have to cover a child with asthma or Crohn's Disease under your own policy, it may just make you eligible and/or reduce your premiums.

Here's another thought: Become a college student yourself. University of Massachusetts considers you eligible for student status with just 5 credits. And since you can't find a job anyway, maybe it's time to learn a new trade. Community colleges are inexpensive and may have the added bonus of allowing you to buy health insurance as a student.

Do you have a spouse eligible for Medicaid? Dropping the 65 and older members of your family will likely reduce your premium and make you a more attractive candidate for insurance on the open market. Even better, does your spouse have a plan you can jump aboard during the next open enrollment period? Yes, it will raise the premiums, but it's coverage that you might not be able to find on your own.

3) Call your alumni association.
Remember all those solicitations for contributions you tossed unopened in the garbage? Tell them you're sorry and want to sign up! Many alumni associations provide what the industry calls affinity partnerships: If you medically qualify (there's that bugaboo again), you can get a discounted group rate by purchasing your policy as part of the alumni association. George Mason University in Fairfax, VA., has such an arrangement with Liberty Mutual.

The UC Berkeley alumni group does a bit better: It provides a competitive rate health insurance program though Marsh Affinity Group Services for all recent graduates up to age 40, regardless of pre-existing conditions. But you need to live in California to qualify.

Not all alumni associations have a health insurance plan, but it's worth the one phone call to find out if something is offered.

4) Join a professional organization.
The Writers Guild of America, considered by some to be the world's most influential lobbying group (since Guild members shape public opinion every time someone turns on a TV set or goes to the movies), is a leader in providing good affordable health care to its members. It's tough to qualify for membership in the group, not because of your diabetes, but because of the amount of money you must actually earn from writing - about $33,000 a year. But once you're in, you're set and after a number of years, you become eligible for lifetime benefits. And don't get me started on their sweet pension deal.

Other occupational umbrella groups also have health insurance policies for people who work in those specific professions. The National Association of Realtors has a policy for real estate agents, as do many trade unions and trade groups including the Chamber of Commerce. Interestingly, there is no big umbrella group health insurance plan for doctors, not even from the American Medical Association.

5) Buy a short-term plan.
If you expect to return to work soon or are close to being eligible for Medicare, a short-term plan may make perfect sense. These plans are good for up to a year and are less costly than traditional individual plans. You should also think about getting what's known as a catastrophic plan -- insurance that kicks in only after high deductibles. This isn't insurance for those who run to the doctor with each case of the sniffles since it won't pay a dime until you meet the deductible first. But that could happen quickly enough if someone has a heart attack or gets diagnosed with cancer.

6) Take a part-time job if it comes with health insurance.
Starbucks is attractive for more reasons than its lattes. If you work there 20 hours a week, you become eligible for its health insurance coverage. That line that stretches outside the door isn't people waiting for their morning Frappuccino; those are folks hoping to serve you yours.

It can be a part time job anywhere that offers a group plan. The magic words are "group plan" -- because then you can't be turned down because of a pre-existing condition.

7) Look for state help.
Every state offers a public medical coverage program to qualified residents. There are eligibility requirements based on income and not everyone qualifies. There is an eligibility quiz on the web site for the Foundation for Health Coverage Education to get you started. It also may help remind you that many are living on far less than what you are bringing in these days.
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