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To buy or not to buy

Tuesday, February 28, 2017 7:47
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So here’s an interesting real life case study:

Bob’s a single guy, somewhat short for his weight, whose part-time job just changed up to a full-time position. As a result, he’s now eligible to sign onto his employer’s group health plan. Problem is, it’s kind of a budget buster.

So he calls me for help (referred to me by his boss). First thing I suggest is that he actually ask for details of the group plan, and while he’s getting those I’ll see what I can dig up for him.

I also explain that, since he’s outside of Open Enrollment (and he doesn’t seem to have any Special Open Enrollment triggers), his options are limited: short term medical (STM) or “Dave’s Plan.”

The other challenge is that he’s 5’7″ and clocks in at just over 320 pounds. Most of my STM carriers top out at 300 pounds. The good news is that one carrier asks no medical questions and has no height/weight guidelines. I ran a quick quote and found a plan with a $2500 deductible that cost about $270. That’s the good news; the “bad” news is that STM plans don’t cover pre-existing conditions (he has a couple minor ones) nor do they satisfy the tax penalty mandate. That may not be a deal killer, of course, but something to know. Again, really need to understand the work coverage before making a decision.

So this morning, I get this in email:

“The group plan costs $291/month ($145.50 per pay period), which will leave my take home pay under $500.

The deductible is $2700, but Annual Exam covered. This, of course is an ACA compliant plan.”

So, about the same as the STM, but covers his current medical issues and avoids the fine. On the other hand, not exactly a bargain, either, so I again suggested that he contact Dave about his plan. I also pointed out that he may be eligible for Medicaid, and that it might be worth pursuing that angle.

I really don’t know how this will ultimately shake out, but it struck me as an interesting situation, and one that I’m pretty sure isn’t unique.

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