Notes from the health care trenches

Two months ago, all I knew or cared about with my health care coverage was that I had some. But right after we clocked over to 2006, my spouse ended up in the hospital and I took a new job -- which means trolling the fine print of health-care policies is my new leisure-time activity. Here are a few quick things I've learned, answering questions I'd had about how these mysteries work:

- My health care premium is somewhere around $100 a month. I suspected COBRA premiums would be higher, if I elected to continue my coverage for the gap month I'll have before my new coverage kicks is. I did not expect them to be $400 higher. The helpful sheet HR sent me today puts my monthly COBRA rate at $457.42. Covering my teeth as well as the rest of my body would be an extra $41.94 per month.

-The good news: When you leave a job, you have 60 days to decide whether you want to pay for COBRA continuation coverage. And it's retroactive. So, I don't have to commit now to paying for health care coverage I probably won’t need. If I break my leg in two weeks, I can then retroactively opt in on COBRA. The grace period is even a little longer, in practice: After you elect COBRA coverage, you have 45 days to make your first premium payment, and not making one effectively cancels the coverage, with no penalty.

-My other concern about health care and job changes was the nasty "pre-existing condition" exclusions I hear about. If carriers can deny coverage on existing medical issues, I wondered, how the hell would anyone ever be safe to change carriers? If I developed a chronic condition requiring regular care, would that forever lock me to my current job?

Not exactly. First, the maximum length of time insurers can block coverage of existing conditions is 12 months. Not great, but also not indefinite, at least. More importantly, the preexisting condition exclusion is only allowed against those who have a gap in their health care coverage. If you are currently covered under a health-care plan, and you move directly to another, you can take with you $10,000 monthly bills for an entire diagnostic manual's worth of ills and the carrier can't exclude it. (COBRA counts as a qualifying plan. So, if you leave a job and elect COBRA, you avoid the gap.)

You even get a bit of leeway with the "directly" part. You're allowed a 62-day stretch without losing your prior-coverage qualification, and if your employer imposes a waiting period before health benefits kick in, that also doesn't count as a gap: your clock on insurance qualification starts on your start date.

Which means that those with typical company health-care plans, like me, can leave one job and not have any pre-existing condition worries so long as they start a new job (assuming it carries similar benefits) within two months. Whew.

Can we please just socialize the damn system?