r/HealthInsurance • u/Master-Rice-6779 • 24d ago
Employer/COBRA Insurance Wife laid off 1 week before child birth. Decide between cobra and UHC
My wife’s entire department got laid off just one week before her due date. We were both on her BCBS Massachusetts health insurance through her job — $0 payments during pregnancy and a $0 balance on a $6k deductible.
Her employer offered to subsidize COBRA for 3 months, so we thought it made sense to keep BCBS for a little while. My company has United Healthcare (UHC), but after reading stories about denied claims and poor “continuity of care,” we decided to stay on BCBS for her delivery and recovery. Honestly had too many things on our mind then.
The plan was: keep her on BCBS for 3 months, I’d enroll myself in UHC now, and later move her and the baby to my plan once BCBS processed all bills. My employer was OK with this approach.
Fast forward to today — we just got hit with unexpected $6,000 bill from BCBS. Turns out there was a fine print we missed: postnatal care is subject to the deductible.
Since COBRA will expire in 2 months anyway, I’m wondering if I should just switch my wife and baby to UHC now backdated to baby’s birth date. UHC has a similar deductible, so at least the $6k would count toward the rest of the year instead of paying BCBS for just 2 more months.
The problem? When I asked both BCBS and UHC about overlapping coverage, each said their plan would be “primary” — which makes no sense and makes me worry we could end up with an even bigger bill.
Why is health insurance so unnecessarily complicated?
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u/Wide-Chemistry-8078 24d ago
Enroll both now.
BCBS is primary for your wife. For the baby the primary plan belongs to the parent with the birthday earlier in the year. Example January 10th is earlier in there year compared October 10th.
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u/Salty-Passenger-4801 24d ago
Is this a universal rule about the birthday? I never heard of this. Is there a name for this (I'd like to read more about it)
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u/Zorggg_ 24d ago
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u/hbk314 24d ago
Worth noting that the birthday rule doesn't apply if one of the parents is on COBRA. I believe coverage through dad would be primary as it's an active employer coverage.
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u/Zorggg_ 24d ago
Pretty sure the birthday rule was applicable, even with cobra.
https://northriskpartners.com/wp-content/uploads/2019/12/Most-Commonly-Asked-COBRA-Questions.pdf
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u/LowParticular8153 24d ago
Active employer is primary. Plan that covers laid off persons then the plan is secondary.
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u/sally02840 24d ago
Loss of an employer’s COBRA subsidy is not a qualifying event to join your employer’s plan.
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u/Master-Rice-6779 24d ago
My employer explained that if i stop paying COBRA premiums, my wife & baby would lose health coverage and losing coverage is a QLE
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u/sir_fixalot13 23d ago
Voluntarily losing COBRA coverage due to non payment is not a QLE normally. I'd be very wary about following that advice and would check it out with the government help lines for COBRA.
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u/professorpumpkins 24d ago
I have nothing to add, but this is bullshit, I’m sorry OP. I gave birth in MA under Tufts Health. My LO was added to my husband’s plan (UHC) pretty immediately without a lot of hassle. Massachusetts probably has more protections than other states. This is the last thing you need to be worrying about with a newborn!!! I hope this gets resolved ASAP!
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u/CaptainFlynnsGriffin 24d ago
Insurance companies don’t typically eff around with maternal and baby care. Literally it’s the only time that they don’t mess around. I would personally keep the BCBS COBRA as the specter of hidden 90 day exclusions would scare me more and it won’t compromise your wife’s established care team.
Be forewarned that BCBS takes forever to fully clear hospital bills. I’m talking three years plus. I have routinely received large checks from the hospital system that routinely overcharges me for my portion of fees to only randomly send me hefty checks years later after (I’m guessing) routine audits and full insurance payments have been received. I literally just received a check for hundreds of dollars - for unspecified overcharges for cancer treatment from over four years ago.
Fuck Ronald Reagan in particular for allowing for profit healthcare to exist! I fervently hope that his consciousness exists in a place where he’s in unimaginable pain waiting for prior approval for an emergency appendectomy and zero of his labs, medications or the “private room” is covered by Medicare, private additional insurance, or any insurance. In fact they’ll come back and suggest six weeks of expensive physical therapy that they’ll cover a penny of before getting a MRI or surgery.
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u/Artistic-Cap256 24d ago
Coordination of benefits can be tricky. Usually for kids the parent whose birthday occurs earlier in the calendar year would be the primary plan. So I would look whose birthday is earlier in the calendar year. If yours is earlier then I would add the baby to yours for sure and have it backdated to birth.
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24d ago
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u/BeLOUD321 24d ago edited 24d ago
EDITED: Cobra is 18 months - it’s not expiring any time soon ALTHOUGH ending of employer subsidies is a second qualifying event BUT not paying your portion or stopping after you are paying full cobra premiums is NOT a qualifying event.
and you would have to wait to switch coverage until the next enrollment with Obamacare for Jan or your standard work enrollment
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u/barrnowl42 24d ago
Birth of a child is a qualifying event
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u/BeLOUD321 24d ago
Yes I was confused about employer subsidies of cobra after employment ends - that change when a SUBSIDY of premium ending is another qualifying event
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u/Master-Rice-6779 24d ago edited 24d ago
My employer said i have 60 days from birth to enroll both wife & baby onto UHC, backdated to date of birth. As far cobra, it expires in 18 months, but i can choose to just stop paying cobra monthly premiums anytime and the plan will drop. Sorry for the wording in the post
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u/katsrad 24d ago
Just know that non-payment of premiums that leads to cancellation might be considered a voluntary loss of coverage so you wouldn't have a QLE then. I think this plan of adding backdated to DOB of infant is the best idea.
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u/BeLOUD321 24d ago edited 24d ago
Non payment AFTER your employer FULLY PAID subsidy of premium is does qualify as an event to elect new coverage. Not paying your portion of cobra is not qualifying
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u/Master-Rice-6779 24d ago
My employer explained that if we stop paying for COBRA, my wife & baby would lose health coverage and losing coverage is a QLE
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u/Mr_Gneiss_Guy 24d ago
Losing COBRA premium assistance in the middle of the election is actually a QLE. I believe that OP is stating that the employer premium assistance is expiring in two months, not the plan itself.
Source: https://www.healthcare.gov/unemployed/cobra-coverage/
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u/Master-Rice-6779 24d ago
Yes that was the original plan. Wife stays on employer subsidized bcbs cobra for 2 months ( we thought our pregnancy bill would be 0$ per her plan) -> then stop paying premium and treat that as QLE to enroll them onto my UHC plan.
This 6k bill from bcbs was unexpected. That’s why i am considering options if i should take the birth of child (60 day) QLE option to enroll them on UHC backdated to baby’s birth date and pay the 6k to UHC
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u/misserg 24d ago
So I also have BCBS of MA, though potentially a different plan and had a baby earlier this year. I had $0 for prenatal care but the birth went up to my OOP max of $6k. From my understanding most plans charge for the birth itself but it sounds like you were expecting it to be 100% covered?
Did your wife get laid off from clean harbors?
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u/Thick-Equivalent-682 24d ago
Your plan would be primary for you, her plan would be primary for her. For your son, primary is whomevers birthday is earlier in the year (the birthday rule).
Most important before selecting this will be making sure the hospital is in-network with both plans. In addition, you will want to know if the UHC plan is a high deductible plan or one with copays. If it is high deductible, you may not save much.
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u/visitor987 24d ago
You also should check with a civil rights lawyer. A lay off that close to her giving birth may be ruled pregnancy discrimination. Contact the EEOC and file a complaint https://www.worker.gov/actions-eeoc-claim/ and then speak with a civil rights lawyer and give them the EEOC complaint no
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u/andreanichole1 24d ago
Pregnancy isn’t a protected class
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u/visitor987 24d ago
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u/andreanichole1 24d ago edited 24d ago
Her entire team was laid off she wasn’t singled out she isn’t protected. Her team is no longer needed.
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u/PrestigiousDrag7674 24d ago
Yes. You must be very very careful about doing the back date. When BCBS finds out you had 2 insurance, they might deny your child birth coverage, they both might be pointing at each other whose insurance to go first.
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u/Forward-Implement789 24d ago
Unfortunately, having a primary and secondary coverage can mean double payments depending on how the two plans coordinate. Unless you can cancel the BCBS plan and have your wife and child added to only the UHC plan, it may actually cost you more in the long run.
As a reminder, you probably have 30 days (sometimes employers allow 60 days) after a qualifying life event to make an update to your insurance elections
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