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Second Opinion: I’m Nearing Medicare Age. Can I Get Gap Coverage?

Second Opinion: I’m Nearing Medicare Age. Can I Get Gap Coverage?

Above: Linda Johnson is a microbiologist set to retire in about a month. She's concerned she won't be able to find an affordable health plan to cover her in the six months before she's eligible for Medicare. Video by Brian Myers, Media Arts Center San Diego.

Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours.

The Question: Can I find a short-term plan to cover me until I'm eligible for Medicare in six months?

Linda Johnson is a microbiologist for a company that develops lab tests to help doctors diagnose diseases and genetic disorders. It's a good job that comes with really good benefits. But Johnson is retiring in five weeks and won't qualify for Medicare for another six months. She's worried she could be without affordable, comprehensive benefits for the first time in 46 years.

Aired 9/23/13 on KPBS News.

A retiring microbiologist considers how to fill a gap in coverage before she's eligible for Medicare.

Special Feature Speak City Heights

Speak City Heights is a media collaborative aimed at amplifying the voices of residents in one of San Diego’s most diverse neighborhoods. (Read more)

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Here's her question:

"What do I do for health care through the health exchanges from the time that I retire and six months later when Medicare kicks in?"

The Takeaway: You aren't locked in to health insurance policies and can cancel at any time.

Johnson's first option is to sign up for COBRA, which will extend her employer-based coverage until she finds a new health plan.

But Johnson is concerned about the cost. Under COBRA, you pay the whole premium – what both you and your employer had been paying combined, so it's often a lot of money.

Johnson said her preference is to find a short-term plan through Covered California, the state's insurance exchange.

But Johnson doesn't really need to find a short-term plan.

The policies offered on the exchange will be managed by the big providers already operating in the state — in San Diego that's Anthem, Blue Shield, Health Net, Kaiser Permanente, Molina Healthcare and Sharp HealthCare. The exchange just helps regulate the cost of those plans and hands down federal subsidies to those who qualify.

So the policies will be managed in much the same way they've always been. That means Johnson can stop her coverage at any time. She wouldn't be locked into a yearlong contract if she buys a plan through the exchange. To cancel, she'd need to call her provider and follow their steps for canceling her plan.

The trouble is that the Covered California plans don't go into effect until Jan. 1. For coverage to start before that, she'd have to find something on the private market, where Johnson said she's having trouble finding something in her price range.

There are short-term catastrophic plans that she can purchase in month-long increments. But, starting next year, those plans are only supposed to be for individuals under 30 or those who can't find something within 8 percent of their income. So there could be some upset down the line if Johnson chooses a catastrophic plan that isn't grandfathered into Obamacare.

The Orders: Make sure you're covered before you abandon a health plan.

Stephanie Wood, an administrator with insurance brokerage Barney & Barney, said it's a good idea to keep your current coverage – or in Johnson's case, not decline COBRA – until you know you'll be accepted by another provider.

And another note: Though Johnson wants to find coverage because her doctor advised her to, she should know that she doesn't necessarily have to worry about the fine for going without coverage. The individual mandate allows for a three-month gap in coverage.

Check out last week's Second Opinion: How do former inmates sign up for Obamacare?

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