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Semi-retirement plan & questions

Posted

Specializes in CVOR/General Surgery. Has 29 years experience.

I have been an RN, BSN (General Surgery/CVOR) for almost 29 years and am now looking toward the future and possibly, semi-retirement. I traveled as an RN in '17 and 18', then settled back into a perm job but am thinking of traveling again. My questions are: If I were to do say, two 13-week assignments a year with three (or six) months in between, would the gap time (time away from clinical specialty and hospitals) be an impediment in securing my next contract? More specifically, would a potential employer look unfavorably at this? Also, is it possible to stretch out COBRA medical coverage for 90 days post-contract and then only retroactively pay if services were needed? I haven't yet seen any type of independent medical plan that is even remotely affordable for a married couple so I'm trying to 'think outside of the box'. Have a good day everyone and thanks for any advice/suggestions

Edited by morelostthanfound

Doing two contracts a year will raise no questions for potential employers.

Insurance is a complex problem. First you have to realize that the cost to COBRA is as much as an exchange plan. At least your permanent employment plan. Second is that few agencies have insurance plans for travelers comparable to either of those options. So if you COBRA an agency plan, you again get what you pay for, lower cost for poor insurance.

Becoming a traveler makes it obvious who is paying for insurance: it is you! If your employer wasn't paying for it, they could pay you much more in cash compensation. In fact, that is why in-house per diem and travel pay (usually) more in cash than regular staff: loss of benefits. So there is no free lunch, but you are going to have to consider the true cost of insurance, especially year round insurance and working half a year.

Yes, COBRA has a lot of employer unfriendly workarounds such that you can be covered for a period of time without having to pay. But it won't cover you for 6 months and if you need it, you would of course have to pay premiums for the lapsed period.

In the pandemic with a large number of elective surgeries being cancelled, there has been a significant drop in OR assignments. However, CVOR still has assignments, and many are paying well. I'm tempted myself, but I'd hate for my next assignment to do permanent injury. Now OR nurses are perhaps equipped with more knowledge than most about how to protect ourselves and others from infection, but do consider that at our age we are at high risk from complications should we become infected.

morelostthanfound, BSN

Specializes in CVOR/General Surgery. Has 29 years experience.

1 hour ago, NedRN said:

Doing two contracts a year will raise no questions for potential employers.

Insurance is a complex problem. First you have to realize that the cost to COBRA is as much as an exchange plan. At least your permanent employment plan. Second is that few agencies have insurance plans for travelers comparable to either of those options. So if you COBRA an agency plan, you again get what you pay for, lower cost for poor insurance.

Becoming a traveler makes it obvious who is paying for insurance: it is you! If your employer wasn't paying for it, they could pay you much more in cash compensation. In fact, that is why in-house per diem and travel pay (usually) more in cash than regular staff: loss of benefits. So there is no free lunch, but you are going to have to consider the true cost of insurance, especially year round insurance and working half a year.

Yes, COBRA has a lot of employer unfriendly workarounds such that you can be covered for a period of time without having to pay. But it won't cover you for 6 months and if you need it, you would of course have to pay premiums for the lapsed period.

In the pandemic with a large number of elective surgeries being cancelled, there has been a significant drop in OR assignments. However, CVOR still has assignments, and many are paying well. I'm tempted myself, but I'd hate for my next assignment to do permanent injury. Now OR nurses are perhaps equipped with more knowledge than most about how to protect ourselves and others from infection, but do consider that at our age we are at high risk from complications should we become infected.

Thank you Ned and this gets at my question. If I understand correctly, a traveler could work a 13 week assignment and post-contract, he/she would have COBRA coverage for 90 days if they had taken the company insurance while on contract. I realize that it would likely be very expensive and probably subpar, but for a healthy individual, wouldn't this be a viable 'work around' to ensure continual coverage at a very basic level for free? Thank you again

Edited by morelostthanfound

The following is excerpted from a PanTravelers article on health insurance. It does predate the ACA, however the COBRA law was not amended by the ACA. Make sure your agency is covered by COBRA though, there is a minimum employee threshold. I suspect you will be better off seeking the best compensation package rather than looking for good or even adequate insurance coverage.

Quote

If your agency is covered by COBRA regulations, this is your best option (unless you have private insurance). And you can be covered for a long period of time without having to pay, more than enough to take some time off before starting your next assignment. This is very beneficial for the traveler but not the insurance company. It was designed by Congress to protect permanent employees when they lose their jobs, and as such, it is a huge loophole that works to travelers’ advantage. Here is how it works:

When your contract ends, your agency is required to send you a letter explaining your COBRA rights. You then have 60 days from the end of your contract (or 60 days from the letter’s date) to positively select COBRA coverage. Be sure to check with your agency if you haven’t seen this letter in good time. After you elect coverage (no reason not to), you have 45 days to pay the premium. This gives you an effective minimum of 105 days (three and a half months) of insurance coverage without paying a cent.

So what does this mean? It means that you are covered by your agency’s insurance for well over three months after the contract ends if you select COBRA coverage at the last moment. And there are no consequences from not paying the premium three months later other than your insurance coverage will be canceled retroactively back to when your contract ended. If you had no events during this period that required insurance, you have just received a free ride! And if any events do occur, they would have to add up to more than $1,000 (your minimum likely premium during this period) to be worth paying the premium. This is an insurance company nightmare – clients fully covered but electing to pay only if the insurance benefits are more than the cost of premiums.

morelostthanfound, BSN

Specializes in CVOR/General Surgery. Has 29 years experience.

44 minutes ago, NedRN said:

The following is excerpted from a PanTravelers article on health insurance. It does predate the ACA, however the COBRA law was not amended by the ACA. Make sure your agency is covered by COBRA though, there is a minimum employee threshold. I suspect you will be better off seeking the best compensation package rather than looking for good or even adequate insurance coverage.

Ned, this is perfect and confirms what I thought! Thank you so much for offering this no nonsense explanation.

The minimum numbers of employees is 20 to trigger employer requirements of COBRA. I assume that means FTEs however I wouldn’t put it past agencies to claim they have no FTEs. Usually agency office staff and travelers have very different health insurance. Not sure how exactly that is legal unless they separate two classes of employees into separate corporate entities. In any event, if you anticipate activating COBRA coverage after an assignment, I’d discuss it with the agency benefits person before signing a contract.

Another game that is played is your health insurance may not be active day one and you may even have to extend before it goes into effect.