Definition of Predicament: People Who Don’t Have Access to Employer Coverage, Aren’t Medicare Eligible, and Don’t Qualify for Subsidies

Yes, this is a bit anecdotal. Nevertheless, I think it’s  worth reporting and some may find it interesting.

First, recently our team managed the annual open enrollment process for the group health plan of one of our employer clients. After a quick but thoughtful evaluation of options, one employee who was previously covered by an individual market policy opted to enroll on the employer’s group plan (family coverage) and terminate coverage under the individual market plan. Both the individual plan and the group plan were Qualified Health Plans (QHP) under ACA. The plans had similar benefits. And, they were underwritten by the same large insurance carrier.

Savings?

$600 a month in gross premium. That’s quite a spread.  Add in the employer contribution and the savings to the employee were even greater.

Another interesting recent experience worth recounting. A very sharp, healthcare savvy, business owner and client of BBG was helping a relocating family member find individual coverage in Wyoming. The family member was not eligible for a subsidy. Here’s the response received from a local agent to whom they were referred:

“…I am sorry to say all of the health companies I wrote have left the State of Wyoming………. I am not sure who write(s) in Wyoming. Health care in Wyoming is just ugly. Our premium rates are the highest in the nation because we have such a small population (less than 500,000 total) the companies do not feel like we have enough business to offer so we have very limited choices. My advice is to speak to a navigator at our local hospital and see what is offered through the Affordable Health Care Act.”

My guess is there are plenty more stories like these out there.

Health insurance is expensive and it’s complicated for most of us. But employer sponsored plans make it less so. Thankfully many employers still mitigate some of the high cost of health coverage for their employees. They also provide employees through their group plans with the access to information, support, and service to make things a little less complicated and a little more understandable.

Open enrollment for the individual market later this year promises to be a real eye opener — most especially for those people who don’t have access to other coverage and don’t qualify for individual subsidies.

The healthcare cost conundrum continues.  And, things are still a “far piece” from any new normal.



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