Workers who have lost their job will face an even more shocking reality: The cost of keeping their health coverage may exceed their unemployment benefits.

A study by a health care policy group released yesterday showed that nationwide, while the average monthly unemployment compensation for laid off workers was $1,278 a month, the average monthly cost to that worker to continue family health benefits under COBRA was $1,069, or 83.6 percent of the unemployment check.

In a state-by-state survey, the authors of the report found that in 41 states, including Pennsylvania, the cost for a family exceeded three quarters of the average unemployment insurance income.

In Pennsylvania specifically, the average monthly unemployment insurance income is $1,468 while the average cost to cover a family under COBRA is $1,107 or 75.4 percent of the unemployment income. The average cost to cover an individual is $403 a month or 27.5 percent of the unemployment insurance income.

In West Virginia, the numbers are even worse. COBRA for family coverage is typically 104 percent of the monthly income provided by unemployment insurance. In that state, the unemployment insurance pays out an average of $1,017 a month while family coverage costs $1,059.

"This very important right is often not meaningful in reality," said Ron Pollack, executive director of Families USA, the health care policy non-profit in Washington, D.C., that did the survey.

For every 1 percent uptick in the unemployment rate, there is a corresponding increase of 1.1 percent in the number of people who are uninsured.

COBRA, which officially stands for Consolidated Omnibus Budget Reconciliation Act, is meant to allow people whose health care coverage might otherwise be terminated to pay for it to continue. It is one of the programs that could be tinkered with as a new president and Congress attempt to deal with the nation's economic problems.

Mr. Pollack said the reason that the ranks of the uninsured are growing faster than the unemployed is because so many breadwinners have dependents on their insurance.

"COBRA health coverage is great in theory and lousy in reality," Mr. Pollack said. "The vast majority of the people who are eligible cannot afford to participate."

He said Families USA would like to see federal legislation to allow unemployed workers to be covered temporarily on Medicare or that the federal government provide a COBRA subsidy to the unemployed.

Under the current system, the coverage can last 18 to 36 months. Mr. Pollack said some families can cut that cost by enrolling their children in the state Child Health Insurance Program while the parent stays on the company insurance as an individual.

Ellen Laden, of UnitedHealthcare's Golden Rule Insurance Co. in Indianapolis, said there are other ways workers can get protection without bankrupting themselves.

COBRA is so expensive, she said, because while workers usually contribute to their health insurance, companies usually subsidize 75 to 80 percent of the cost. But, when those jobs are gone, the worker then has to cover up to 102 percent of the cost of that insurance. The 2 percent, is for administrative fees.

Many workers, she said, can cut the cost of insurance by going to high deductible (up to $2,500) short-term plans lasting one to six months that can roll over to a year.

"No one can afford to be without health insurance," she said.

While even a short hospital stay can easily cost $20,000, she said, insurance "won't send you into medical bankruptcy."

The benefit of a high deductible plan, she said, is that even the costs that come before the deductible is met are billed at a rate negotiated by the insurance company, which is generally more than 30 percent less than the hospital would charge someone without insurance.

Ms. Laden said people who are leaving their employer's insurance should shop around before making the leap and make sure they are dealing with a reputable company by checking with independent rating agencies such as Standard and Poor's or A.M. Best.

She said they should make sure the health coverage meets their needs by figuring out what their bottom line will be in a good health year and what it would be in a bad year.

Consumers should know what the plan covers and more importantly, what it does not cover and they should make sure they can accept the doctors and hospitals covered by their new insurance, because if their current doctors aren't in the new network, they have to be willing to switch doctors.