Midyear change of US health insurance. Cancer edition.
September 4, 2019 4:46 PM   Subscribe

I'm on the verge of getting a new job. We've maxed out our out-of-pocket for 2019 and will have to max it out a second time because our insurance will change. This is getting very expensive. Are there things we should be thinking about that we aren't considering?

On the heels of my post called Health insurance and the job interview. Cancer edition we're now considering what it looks like to have to pay an out-of-pocket max more than once in a year, and wondering if there are considerations/strategies we haven't thought of.

Our insurance ends on Sep 30 and we just had to select a plan on the exchange for insurance that will start on Oct 1. I don't have a new job offer yet, but I'm hopeful to have one by then.

Hopeful also that a new job will fully cover my spouse and that any new insurance kicks in by Oct 1, but it's more likely that a new job might partially cover my spouse and that there will be at least a 30-day waiting period for any coverage at all. The new plan we've selected will cover us through the year, and it will likely make the most sense for us to wait to switch to a new employer plan on Jan 1 because otherwise we'd be looking at paying an out-of-pocket max THREE times in 2019 and we just don't have those resources. Mr Origami has cancer and we can't mess around when it comes to health insurance. It may also come down to having two different individual plans. Questions:

-are we missing anything we should be considering?
-if it turns out that it makes the most financial sense to keep the marketplace plan through the end of the year, even if an employer offers insurance, what will the employer think of this? Are there any issues with delaying employer-provided insurance?
-Is there any likelihood that an employer might reimburse me for part of the premiums we will pay Oct-Dec because they save by not adding us to their plan? Is this a thing? And would making such a request be a bad way to start a new job?
-are there any tax implications?
-if we end up with me having insurance through a new employer and purchasing separate insurance on the marketplace for Mr Origami, is it possible to get his based on his income alone? He's now on SSD because Stage IV. He is not yet 50, FYI.

thanks everyone
posted by AnOrigamiLife to Health & Fitness (17 answers total) 3 users marked this as a favorite
 
You might have thought of this already, but might it make sense to do COBRA until your new insurance kicks in? This would reduce the number of switches.
posted by mai at 4:52 PM on September 4


Thanks mai, I should have mentioned that COBRA is not an option due to some combination of it being a very small business and the state we're in. I'd hoped for this too! Because I think it would have meant continuing on the same out-of-pocket max. But sadly no. Also FWIW when I was laid off my employer kindly offered to continue to fully pay our premiums for two extra months (ending Sep 30).
posted by AnOrigamiLife at 5:00 PM on September 4


>> Are there any issues with delaying employer-provided insurance?

If the employer’s plan is through a cafeteria plan (ie pretax premiums), you can generally only join the new employer’s plan when you are first eligible (ie after the new hire waiting period), at annual open enrollment, or if you have a status change that is consistent with IRS rules and the employer’s plan terms. So, if you decline coverage when you are first eligible, you can only join 1/1 if that’s the new employer’s plan year (open enrollment usually in November some time).

>> Is there any likelihood that an employer might reimburse me for part of the premiums we will pay Oct-Dec because they save by not adding us to their plan? Is this a thing? And would making such a request be a bad way to start a new job?

There is a very limited way an employer would be permitted to do this under federal benefits law. Generally, this is not permitted anymore, and only a very new type of healthy reimbursement arrangement (HRA) could be the vehicle. If the employer already happens to offer an Individual Coverage Health Reimbursement Arrangement (ICHRA) and specifically offers it to the category of employee you would be, it might be possible. However, it’s not at all likely that your employer offers an ICHRA.

Have you checked with the Social Security Administration about Medicare based on disability?

Feel free to message me - I’m on my phone and can’t do a bunch of links but I’d be happy to answer questions tomorrow.
posted by Pax at 5:37 PM on September 4


"very small company" presumably translates to under 20 FTEs. Companies that size are not required to offer COBRA.

even if an employer offers insurance, what will the employer think of this?
Don't worry about this, do what's best for you. Any employer is happy if you don't take their insurance.
posted by beagle at 5:39 PM on September 4


I would wait until you have the actual offer and health plan info in hand. Like, my employer’s plan year runs from September through August, so starting in January wouldn’t actually help you out all that much in a case like that. Maybe the new employer’s plan will be better than you expect, or much much worse.

Others are right to point out that you can’t just get on an employer plan in January unless that happens to be when their open enrollment period is.
posted by mskyle at 5:50 PM on September 4


I was/am in the exact same situation, except my insurance changed on June 1 (my employer switched plans). I don't want to be the bearer of difficult news, but the answer I got was that it's just bad timing. I had to swallow (am still swallowing) the costs associated with the change, resetting the deductible, etc. All options cost more than just accepting the new insurance and licking up where the previous plan left off.
posted by late afternoon dreaming hotel at 5:57 PM on September 4 [1 favorite]


Depending on when your company plan starts a new year, and your current expenses you may end up with a third it of pocket Max fairly quickly. My job switches over for new deductible Dec 1st NOT Jan first for example, so you could end up with a third or of pocket Max this year in some cases .
Have you looked at insurance formularies and requirements to start the regimen you are currently on? You may run into unforeseen complications with denials.
posted by AlexiaSky at 6:56 PM on September 4


Phrase it this way to your next employer:

I have the option to stay on my current health coverage until the end of 2019. Does your next open enrollment period have a 1/1 effective date? Are there any conflicts with other benefit options if I stay on my current medical plan until then?
posted by phunniemee at 7:16 PM on September 4 [1 favorite]


Make sure that you talk to the financial counselors at her clinic to see if there is any foundation support or copayment assistance that can be offered. My clinic frequently offers "grants" that help patients meet an unmet financial need (usually anywhere from $500 to a couple thousand dollars). You may be surprised by what kind of support they can offer.
posted by honeybee413 at 8:48 PM on September 4


Thanks for all the responses so far. Much to think about! Hadn't considered varying employer enrollment periods, only the fact that the marketplace period is Jan-Dec and so we assumed we'd purchase through the end of the year before shifting to another plan. This presents quite a challenge, especially if it comes to the prospect of possibly paying for three out-of-pocket maximums. As if cancer wasn't enough.

mskyle says I would wait until you have the actual offer and health plan info in hand and we would too, except that we have 60 days from my being laid off to choose a plan on the marketplace. We're covered through Sep 30 but had to select a replacement by Sep 6 (even if we don't have to pay for it until Oct 1). Hope that makes sense.

Also, Pax asks Have you checked with the Social Security Administration about Medicare based on disability? Unfortunately Medicare is not an option right now. He's young, and we're told this is an option based on disability only if he survives X years with Stage IV. I think X=4 but I don't recall. Moot at this point, I do know that.
posted by AnOrigamiLife at 12:08 AM on September 5


Is there any likelihood that an employer might reimburse me for part of the premiums we will pay Oct-Dec because they save by not adding us to their plan? Is this a thing? And would making such a request be a bad way to start a new job?

My experience diverges from what Pax describes - my employer, and another one I had previously, both have a standard amount of money that they pay you if you opt out of employer coverage. It's not a lot - $30/month where I am now - but I guess it's something. It is taxable, and therefore there are no special requirements for how one spends it.
posted by mosst at 5:22 AM on September 5


A little more info on that from googling - what I'm offered amounts to an unconditional opt-out payment; conditional ones (contingent on proof of other healthcare payments) are also legal/permissible. However, it seems complex enough that an employer would probably not want to start offering it if they don't (or can't) already.
posted by mosst at 5:27 AM on September 5


Well, the nice thing about the marketplace plan is that you should be able to cancel any time - so you could choose a plan now, then reevaluate when you know more.
posted by mskyle at 6:57 AM on September 5


Is there any likelihood that an employer might reimburse me for part of the premiums we will pay Oct-Dec because they save by not adding us to their plan? Is this a thing?

I don't have the knowledge I'd need to answer this correctly, but I'll throw this thought out for those who do -- What if, as part of your regular offer negotiation, you just asked for a signing bonus that happened to equal around the amount of the premiums they'd otherwise pay for you, and pointed out that it should be break-even for them to give you the requested bonus because you don't plan on taking them up on insurance right away? Would that still run afoul of the laws Pax describes?

(Obviously, this idea would only apply if it does end up working out for you to decline your next employer's insurance for a while.)
posted by daisyace at 7:07 AM on September 5


My experience diverges from what Pax describes - my employer, and another one I had previously, both have a standard amount of money that they pay you if you opt out of employer coverage. It's not a lot - $30/month where I am now - but I guess it's something. It is taxable, and therefore there are no special requirements for how one spends it.

Right - an employer can offer unrestricted taxable cash to opt out of the employer's plan. There are complications related to whether the opt-out is conditional on having other coverage and what kind of coverage, all related to various provisions of PPACA and tax code rules.

What it's impermissible to do is reimburse an employee for other coverage on a one-off basis and to reimburse for coverage in the individual market without establish an ICHRA.
posted by Pax at 8:01 AM on September 5



Well, the nice thing about the marketplace plan is that you should be able to cancel any time - so you could choose a plan now, then reevaluate when you know more.


This is true, just be aware that voluntarily dropping a marketplace plan alone would not be a qualifying event to join an employer-sponsored plan outside of open enrollment (or some unrelated event, like marriage or the birth of a child). I.e. it's not a "loss of coverage."
posted by Pax at 8:04 AM on September 5


Right - an employer can offer unrestricted taxable cash to opt out of the employer's plan. There are complications related to whether the opt-out is conditional on having other coverage and what kind of coverage, all related to various provisions of PPACA and tax code rules.

(related to what mosst pointed out - on non-preview)
posted by Pax at 8:06 AM on September 5


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