It is possible that many of these consumers could be locked out of the market. A similar grace period provision could help avoid losses of continuous coverage that some might view as unfair. Agents, independent contractors and directors who participate in the group health plan may also be qualified beneficiaries. But ultimately, the two policies are just different ways to skin the cat. RAND is nonprofit, nonpartisan, and committed to the public interest. Most Americans with employer-sponsored health insurance have the option of continuing that same coverage for 18-36 months, at their own cost, if they lose access to their coverage. The government wants you to have health insurance, and these are simply two options for incentivizing that behavior. Put simply, the entire health insurance industry works better and more cost-effectively when most or all people are insured. Supporters of continuous coverage say it encourages personal responsibility instead of mandating it. A qualified beneficiary generally is an individual covered by the group health plan on the day before a qualifying event who is an employee, the employee's spouse, or an employee's dependent child. Continuous coverage policies are an alternative to the Affordable Care Act's individual mandate. The Pre-existing Condition: Innovative Solutions to America’s Thorniest Healthcare Challenge. If he were to later develop high blood pressure and decide to purchase insurance, the insurer would be able to assess his health to determine his risk profile as a beneficiary. While the current individual mandate exempts families with income below the tax-filing threshold and contains exemptions for those with no affordable coverage options, replacement options do not contain hardship exemptions for job loss or other extenuating circumstances. Automatic enrollment has been shown to dramatically increase participation in employer-sponsored retirement plans and could help address the concerns of a continuous coverage mandate. O    If instead, Jane quit her job, went uninsured for a few months while she started her business, and then tried to get individual insurance, she could be charged a higher rate, healthy or sick. As commentators spanning the political spectrum warned prior to the law’s passage, this approach faces daunting logistical and financial hurdles. In certain cases, a retired employee, the retired employee's spouse, and the retired employee's dependent children may be qualified beneficiaries. Insuranceopedia Terms:    Evan Saltzman, Christine Eibner @Chrissyeibner. COBRA applies to private employers and state and local government health plans, but it does not apply to federal government plans and those sponsored by certain church organizations. Long term disability applicants often lose their employer provided health insurance coverage as a result of their disability. It is important in the context of both auto and health insurance, as it may have legal ramifications, leave the person susceptible to financial hardship due to an unexpected event, and affect premium rates and eligibility. But how do they work, and how are they different? In terms of which types of group health plans are subject to COBRA, plans for employers with 20 or more employees on more than 50% of its typical business days in the previous calendar year are subject to its requirements. Consumers would also gain new tools for comparing and using their insurance. Each part-time employee is counted as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full-time. The more you know about life insurance, the better prepared you are to find the best coverage for you. L    Coverage under the individual plan may also result in a gap in coverage between the date the person lost coverage and the date the new individual coverage is effective. The Pardee RAND Graduate School ( is the largest public policy Ph.D. program in the nation and the only program based at an independent public policy research organization—the RAND Corporation. 5 Research has concluded that the ACA’s coverage expansions led to significant improvements in access over the past 10 years. D    One issue lawmakers will have to confront: Not all coverage lapses reflect deliberate choices. Here’s how it would work. Employers are required to provide notices to employees about their rights under COBRA. If cognitive and informational barriers to buying insurance are a huge deterrent for the healthy so-called “young invincibles,” then a continuous coverage requirement could fail to serve its purpose of attracting the healthiest consumers. OBJECTIVE: To examine the importance of continuous health insurance for access to care by comparing the access and cost experiences of insured adults with a recent time uninsured to the experiences of currently uninsured adults and experiences of adults with no time uninsured within a reference time period (continuously insured). When you receive COBRA benefits, the cost involved for coverage is generally more than what you were paying previously. These studies show that even well-informed people procrastinate when faced with making complex, high-stakes decisions. If cognitive and informational barriers to buying insurance are a huge deterrent for the healthy so-called "young invincibles," then a continuous coverage requirement could fail to serve its purpose of attracting the healthiest consumers. G    Can I cancel my auto insurance at any time? Eliminating minimum benefit standards could be a particular concern when it comes to a continuous coverage requirement—individuals might purchase bare-bones plans when healthy and switch to more generous plans when sick. Here's the Insurance You Need, Having a Baby? Millions of people each year lose access to the health insurance they were offered through an employer (group health insurance coverage) due to a job change, divorce, job loss or other reason. Instead, you can be charged more by insurance companies if you have had a gap in your coverage. Our nation needs a way to protect access to health insurance for those with pre-existing conditions and empower patients to make the best choices for themselves and their families. Quiz: How Well Do You Know Life Insurance? For example, consider the case of Jane, a cancer survivor and mother of a son with severe asthma. At the same time, proposed reforms retain the consumer protections in the ACA that prohibit insurers from denying coverage for pre-existing conditions. For example, a 24-year-old in perfect health could make an informed decision to forgo insurance. Y   

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