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Timing is Everything (Still!)

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Working on an interesting case, and thought readers would be, um, interested:

Sally called yesterday about individual medical insurance. He husband had retired and is on medicare, she still has a couple years to go until she’s 65. In the meantime, her COBRA pan is due to run out in November, and she’s trying to figure out her options.

There are a bunch of issues here, and we discussed them at length (she’s my favorite kind of client, interested and engaged, asking really good, helpful questions). I’ll cover just a few of them in this post.

First is timing: if she rides out her COBRA until November she’s going to end up squarely in “regular” Open Enrollment Season at the very same time that she’s eligible for her own Special Enrollment opportunity. Which means she’ll be shopping for a 2-month-long 2020 ACA plan (if she goes that route) and a 2021 version. Which also means that she’s going to have 3 annual deductibles in about 60 days (2020 COBRA, 2020 ACA, and 2021 ACA). Not a great place to be, but as I explained to her, pretty common when we’re looking at plans this late in the year.

It turns out that she’s met very little of her 2020 COBRA deductible, so she might be better served cancelling that sooner rather than later; that way, any expenses that crop up would go towards the 2020 ACA (or other) plan. On the other hand, her COBRA plan is pretty decent, and is a PPO, unlike current ACA plans that are built on the HMO model with pretty much in-network coverage only.

Another option we’re exploring is a Short Term Medical plan, which offers better coverage and lower rates than ACA plans, but are underwritten and don’t cover pre-existing conditions. That latter isn’t really a problem, she’s in good health now, but some years ago she had a cancer scare, and we’re looking to see if that’s going to rule out the STM option.

This is the kind of case I most enjoy: challenging issues, an attentive, engaged client, and the opportunity to look at some outside-the-bun options.


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