Group Health, Medicare, and Other Health Coverages
Group coverage
One master contract is issued to the employer and employees receive certificates. Underwriting looks at the group rather than the individual. Contributory plans require a participation percentage, often 75 percent, and eligible employees must be actively at work. Conversion privileges generally run 31 days after coverage ends. COBRA applies to employers with 20 or more employees, with continuation of 18 months for termination or reduced hours, 29 months for disability, and 36 months for divorce, death, or Medicare entitlement.
Medicare
Part A (hospital, usually premium-free with 40 quarters), Part B (medical, with an income-related premium), Part C (Medicare Advantage), and Part D (prescription drug). Initial enrollment is the seven-month window around age 65. Medigap open enrollment lasts six months with guaranteed issue. Late enrollment penalties apply to Parts B and D.
Other coverages
Medicaid and Washington Apple Health for low income; workers compensation (Washington runs a monopolistic state fund through Labor and Industries, with self-insured employers permitted); TRICARE and CHAMPVA for military families; specified disease and critical illness policies paying a lump sum; hospital indemnity; accident; dental and vision; and short-term medical.
Traps
COBRA continues the employer plan rather than creating an individual policy. Group life conversion is a limited window. Medicare does not cover custodial nursing home care, and Medigap cannot be sold alongside a Medicare Advantage plan.
Rule of thumb: COBRA 18 months, 29 with disability, 36 for dependents.