Assist Tom and Shelley, both under age 65, in choosing between COBRA and Individual Market insurance as they prepare for early retirement.
A combination of research, coverage analysis and cost-benefit comparisons of COBRA vs. Individual Plans.
Using comparisons of coverage and costs, Tom chose an Individual plan while Shelley opted for COBRA. The result was a total savings of $4,000 per year.
Fitting the Insurance to the Individual
Choosing an employer-sponsored plan is relatively simple. A couple, individual or family considers its history and expected utilization of the healthcare system and selects the plan with the best fit and price. Once the parties are faced with replacing their employer health coverage with COBRA or individual insurance, however, things quickly become more complicated.
Fortunately, both Tom and Shelley are in good health, visiting their physicians regularly for routine exams, screenings and minor medical conditions. However, they differed widely in the prescriptions they each took regularly. Tom was taking several higher-priced brand-named prescriptions, while Shelley’s routine medications were generic and, therefore, much lower in price.
Is the Price Right?
At first glance, a review of monthly premiums and benefit summaries pointed to COBRA as the less costly of the two options for the couple. To be certain, however, we needed to determine their costs for medical care and prescriptions under both COBRA and Individual insurance. That’s because each individual’s unique requirements drive the out-of-pocket insurance costs. Without a complete analysis of these, there would be no way to predict which plan would be best.
To estimate the costs of each option, we created a cost summary showing the actual costs of premiums, deductibles, co-pays and coinsurance for healthcare and prescriptions under each plan.
- Gathered information from Tom and Shelley about their health histories, medications and medical providers.
- Researched the provider networks of each plan to determine whether their providers were part of those networks.
- Calculated the costs of their medications to determine which plan offered the lowest out-of-pocket prescription costs.
- Prepared a spreadsheet illustrating the costs and benefits for each of them under COBRA and individual insurance.
- Guided Tom and Shelley through the process of evaluating their options and selecting the plans that were the most suitable for each of them.
- Facilitated Tom’s enrollment in an individual market plan while assisting Shelley in transitioning to her employer’s COBRA coverage.
Tom and Shelley are very pleased with their insurance coverage. They have the comfort of being able to see their preferred providers; peace-of-mind knowing they will have the insurance they need going forward; and satisfaction in the knowledge that they are paying a reasonable price for the coverage required (without spending money on what they don’t!).