Like many Americans, I found myself in the unenviable position of needing to enroll in health coverage as a result of my spouse being laid off and, thus, losing our family health insurance through his former employer. He’d worked for a large industry distributor of products for over twenty years and his position seemed as assured as the sun and the moon appearing in the sky. So when the brakes to his employer-based insurance slammed our family into the wall of “how and where will we get health coverage” we threw a pity party then, once recovered from our soon-to-be amongst the uninsured stooper, we set about obtaining coverage.
The journey began with enrolling in and then getting off COBRA. For those not familiar with COBRA (an acronym for Consolidated Omnibus Budget Reconciliation Act), it gives workers and their families who lose their group (employer) health benefits the right to choose to continue being covered by that group plan. In most cases, employers pay part or all of an employee’s health insurance premium while they’re employed. The per month premium amount under COBRA is often the total responsibility of the employee and can be as much as 102% of the premium that their employer was paying for the same coverage.
COBRA is expensive stop-gap protection and the sooner you can get off it and onto other, more affordable insurance, the better!
Putting on my analyst hat, I decided to research the available options for obtaining more affordable health insurance for my husband, myself, and our two daughters and come up with a path forward. My experience went something like:
Drift, Lift, Fish, then Shift: Obtaining Health Insurance When Employer Coverage Ends
DRIFT: Drift under the safety of COBRA before exploring post-COBRA coverage.
Though I’ve spent years developing solutions, strategies, and writing papers about obtaining health coverage through Marketplaces and other direct-to-consumer health offerings, none of my knowledge or experience prepared me for the realities of purchasing health insurance outside of signing up for employer-sponsored plans.
It turns out there is a bigger wall beyond the wall of COBRA and once you get over it, there is a maze of confusing health coverage websites, eligibility requirements, plan designs, and enrollment processes. Getting beyond the wall requires visiting dozens of websites promoting health coverage, filling out online forms, and comparing plans and pricing options.
LIFT: Lift me and my husband off COBRA and onto coverage separate from a family plan.
Lift husband onto 65+ coverage by having him file for Social Security (which he is more than eligible for). Have him sign up for Medicare and enroll in a Medicare Advantage Plan (to cover Parts A and B for services that Medicare doesn’t provide).
I gave my husband a 15 minute tutorial on how insurance works for over 65, pointed him in the direction of a trusted broker, and said to text me if he gets stuck. Fortunately, being newly retired, he had plenty of time to sift through websites and recommendations and was able to enroll in a Medicare and Medicare Advantage plan with minimal effort.
Lift me onto an individual health plan. Though at times I may look it, I am years away from qualifying for Medicare and make a nibble too much to qualify for Obamacare. I would need to enter the narrow path to obtaining an “Off-Exchange” commercial health plan.
Since many payers have limited plan options for consumers who don’t have employer coverage, don’t qualify for subsidized coverage, and aren’t eligible for Medicare coverage, enrolling myself in an individual commercial health plan was only a matter of “does she or doesn’t she?” given the premium cost of an individual plan. I do want to have coverage and so I did enroll in an individual health plan.
FISH: Fish for coverage for both daughters through a Marketplace.
In addition to being cut loose from my husband’s employer health plan, both daughters were laid off and qualified for the Special Enrollment Period (SEP) during COVID-19. Being of low incomes, they both qualified for coverage at a subsidized rate and would need to seek out a Qualified Health Plan (QHP) through either a state or federal Marketplace ((aka ObamaCare, aka the Affordable Care Act (aka ACA)). Because both girls were in college, in different states, and in the middle of Finals week (and because I’m the mom), I took the onus to research their eligibility status, plan options, and premium costs.
Obtaining subsidized health coverage can be elusive and invasive!
It turns out that each Marketplace – whether state or federal – has unique layout, content, products, and support services. Shy of becoming a certified Marketplace broker or navigator, I’d learned enough to determine our daughters would likely be eligible, but getting them from “likely” to “definitely” to “covered” was a path I decided not to take given I do still have a day job and needed to get some work done.
After much dissatisfaction with the disjointed online world of “shop for and enroll in subsidized health and ancillary benefit coverage”, I turned to a trusted peer for advice and was directed to W3ll.
I turned to a trusted peer for advice and was directed to W3ll!
SHIFT: Shift to a trusted source for shopping and enrolling in health coverage.
Fortunately, W3ll provided all the information I needed in one place and translated much of the healthcare jargon into easy to understand language. They made shopping for health insurance almost as simple as online retail shopping.
After visiting W3ll, I was able to easily identify the plans available for each of my daughters through a seamless shopping and enrollment process. For each, I chose to seek plans that had their preferred physician in-network and covered any medications they were taking. Within seconds W3ll displayed the plans that best met their needs. Even better, they added the list of all QHPs the girls were eligible for making it simple to compare, select, and enroll.
W3ll makes shopping for health insurance as simple as online retail shopping!
For those of you who find yourself newly unemployed, uninsured, and beginning the journey of obtaining subsidized, ACA health coverage, my message of encouragement is simple: