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You are here: Home / Anderson On Health Insurance / Open enrollment games

Open enrollment games

by David Anderson|  October 16, 20152:24 pm| 41 Comments

This post is in: Anderson On Health Insurance

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A close friend of mine who knows me in real life and also as Richard Mayhew gave me a call this morning with some good news.  His wife is pregnant, he just got an awesome job offer to build something really cool while getting paid really well, and he would be in my home town the same weekend that my family and I are going back to visit my parents for an early Christmas.  Life is good, although the visit home may be expensive as I will be getting him a bottle of 25 year single malt Scotch to celebrate his first child and another bottle of the same to give to his child when s/he turns 21.  Scotch recommendations are appreciated in comments.

Besides telling me the good news, he wanted some insurance help.  He is giving his notice this afternoon at his current employer and probably won’t start at the new job until mid-November.  His new employer offers coverage only on the first of the month following ninety days of employment.  His current employer will cover him and his wife until the last day of November.  He and his wife are facing a three month gap.  What should he do?

This is an interesting question.

His family makes too much to qualify for subsidy so he can look on and off-Exchange or he can go COBRA for three months.

The most straightforward course of action is for him to get a PPACA compliant individual policy for the month of December and then another policy with a January 1, 2016 start date to use in January and February.. His family does well enough to not qualify for subsidies, so he can go either on or off Exchange. Going on-Exchange is simpler, but off-Exchange will have more choices.  His wife wants to keep her Ob/Gyn but other than that there are minimal constraints.

He can make a couple of bets.

The first part of the bet is an expected utility optimization bet.  Since he will be losing employer sponsored coverage, he qualifies for a special enrollment period.  He can buy a very low cost, narrow network Bronze policy for dirt cheap for the month of December.  The bet is that his wife can schedule her pre-natal visit for the last week of November and then mid-January and they can get any and all prescriptions for December in November.  It is hit by a bus insurance and they can afford the deductible and given their age and general health, the odds are in their favor that they’ll pay their premium and use absolutely no services.

Then during the regular open enrollment period, he can buy a Gold or Platinum policy for January 1.  This is mini-maxing.  He knows his wife will start having more frequent and expensive pre-natal visits and his indoor soccer season with the associated risk of blown out ankles starts the first week of January.  If she has the baby prematurely, the savings in deductible overwhelms the higher cost of premiums.

The other bet is a simplicity bet in that his family is doing well enough right now that they could afford COBRA premiums and the full deductible as his plan year restarted on October 1, 2015.  He would be paying a lot more cash for three months if he plays COBRA straight up but it is simple.

If he wants to save money, he can take the COBRA option to not select COBRA for sixty days after notification of his eligibility and only pay the retroactive premiums if his family ran up big multi-thousand dollar bills in December or January.  He would be running naked for December and January and paying cash out of pocket for pre-natal visits, but he could get a Bronze plan for February during the first week of January open enrollment that would bridge him to March 1, 2016 without significant risk.

The intersection of the end of the plan year and major life events allow for a number of games to be played with insurance to save some money.  He is in a spot where he can probably get effectively covered for 3 months for $500 or less if no major issues arise, or $3,500 if he gets hit by a bus.

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41Comments

  1. 1.

    narya

    October 16, 2015 at 2:29 pm

    One thing in favor of COBRA coverage (well, two things): unless the law has changed, he can possibly get a deduction for those health insurance premiums on his taxes, I think. Depending on his tax situation, that could be useful. The second thing, from my perspective, is that his wife can continue seeing the people she wants to see and there won’t be any issues with it. More expensive, yes, but if (fingers crossed no . . .) something goes sideways, last thing anyone wants is to be worrying about the health insurance situaiton on top of it.

    But I’m a worrier.

  2. 2.

    RSA

    October 16, 2015 at 2:32 pm

    My wife gave me a 25-year-old bottle of Macallan when I passed my Ph.D. dissertation defense. It seems to have tripled in price since the mid-1990s.

    http://www.wine-searcher.com/wine-78898-0001-the-macallan-sherry-oak-25-year-old-single-malt-scotch-whisky-speyside-highlands-scotland

  3. 3.

    Mnemosyne (iPhone)

    October 16, 2015 at 2:39 pm

    Me, I’m a worrier, so I would probably do COBRA if it wasn’t going to be a financial hardship, because I wouldn’t want to take that risk when it’s a first pregnancy. YMMV, but to me continuity of care would be more important.

    We were a little surprised at how much even a Bronze plan in LA (CA) is if you’re not eligible for a subsidy. Luckily, we were able to put my (now) graduate student spouse on my very good employer insurance for a lot less.

    (We had an unexpected one-time windfall this year, plus the spouse got six months of severence pay, so it would have been a hard sell to try and convince Covered CA we should get a subsidy for 2016.)

  4. 4.

    Blue Galangal

    October 16, 2015 at 2:44 pm

    Lagavulin! Lagavulin 16 or, if you want to splurge, Lagavulin’s 1998 Distiller’s Edition.

  5. 5.

    Brachiator

    October 16, 2015 at 2:46 pm

    and probably won’t start at the new job until mid-November.

    Sounds like it’s good to have lots of choices. Would any delay in employment affect anything?

    Price does not appear to be a major consideration. I would go for convenience. The plan that plan that let my wife keep her doctor, make appointments at her convenience, and allowed for the unexpected.

    and his indoor soccer season with the associated risk of blown out ankles starts the first week of January.

    Sounds like it’s time to give up or cut back on the soccer.

    No clue about the best scotch. Some years back a former boss found bottles of a single malt scotch that hid been hidden away in the attic for over 70 years. Can’t recall if he ever cracked open a bottle.

  6. 6.

    dedc79

    October 16, 2015 at 2:49 pm

    @Blue Galangal: Should probably note that Lagavulin has an intense peat-smoke flavor. Lots of people like it, lots of people don’t.

  7. 7.

    Gin & Tonic

    October 16, 2015 at 2:51 pm

    Not that I’ve had all that many opportunities, but I’ve not generally found unblended whisk(e)ys to really improve much past ~20-21 years. That Lagavulin rec above is very good. I’m partial to the Islays, myself – Bowmore and Laphroiag, although that tends to be an acquired taste.

  8. 8.

    Roger Moore

    October 16, 2015 at 2:53 pm

    For the 25 year-old Scotch, might I suggest Bruichladdich Black Art 1990? Bruichladdich is very unusual in making an Islay single malt that’s unpeated.

  9. 9.

    Bodacious

    October 16, 2015 at 2:53 pm

    I can not lie, Glenmorangie has been at the top of our list (and not the super old stuff; 10 year is fine). Best to be shot on cold nights!!!!! Makes my mouth water just thinking about it~

  10. 10.

    p.a.

    October 16, 2015 at 2:53 pm

    this

    Helping my local economy- not scotch here.

  11. 11.

    Gin & Tonic

    October 16, 2015 at 2:53 pm

    @Brachiator: Some years back a former boss found bottles of a single malt scotch that hid been hidden away in the attic for over 70 years.

    The age may be a curiosity factor, but once it’s in the bottle, it doesn’t change/improve.

  12. 12.

    Roger Moore

    October 16, 2015 at 3:01 pm

    @Gin & Tonic:

    The age may be a curiosity factor

    It might be interesting to compare it with a contemporary bottle from the same distiller. Most of them will gradually change their style over time to keep up with changing tastes, and they can’t keep a completely stable style permanently, anyway. I remember reading about people recovering champagne from an old shipwreck and discovering that the style at that time was very sweet instead of as dry as possible as it is today.

  13. 13.

    sparrow

    October 16, 2015 at 3:04 pm

    If you like Peaty scotch, my very favorite that I ever tasted was Ardbeg Galileo. https://www.thewhiskyexchange.com/P-17923.aspx

    When I had it it was about $100 a bottle and I’m very sorry I didn’t buy a couple. It’s that good.

    Also, funny comment from otherwise serious scotch review website:

    Galileo’s concept is in celebration of the well-publicised experiment whereby small quantities oF Ardbeg were sent into space at the end of 2011 to see how they mature in zero gravity or something.

  14. 14.

    p.a.

    October 16, 2015 at 3:05 pm

    And the general flavors of the various regions.

  15. 15.

    schrodinger's cat

    October 16, 2015 at 3:11 pm

    @sparrow: Are you still in India?

  16. 16.

    PJ

    October 16, 2015 at 3:17 pm

    My family came into a few bottles of unopened 65-yr old Canadian Club. Upon opening, it tasted fine, but not significantly different from modern day CC, albeit a little smoother.

  17. 17.

    Gin & Tonic

    October 16, 2015 at 3:18 pm

    @Roger Moore: I was fortunate to participate in something like that, by sampling a ~40 year old bottle of a ~17 year-old bourbon.

  18. 18.

    jl

    October 16, 2015 at 3:20 pm

    @p.a.: Thanks for the interesting guide. I want to go to Scotland, so will remember this info. I’ll try some since everyone says that stuff is great, and if people like it, that is a nice thing.

    But after a very (very) few tastes, my real feeling is that I am drinking kerosene. Anyone know a good guide to drinkable kerosenes for comparison purposes?

  19. 19.

    constitutional mistermix

    October 16, 2015 at 3:23 pm

    Glenmorangie Nectar d’ Or

  20. 20.

    BottyGuy

    October 16, 2015 at 3:25 pm

    As Ron Swanson says Lagavulin 16 is the nectar of the gods, but a lot of people apparently don’t like nectar. But if my grown kids ever get me a bottle for my birthday it will be my happiest birthday ever.

    For a non-smoky scotch I would go with a Balvenie and if you have the money the 21 yo Port Wood

    For smoky maybe Laphroaig 18 Year Old or Caol Ila 18 Year Old if you can find it. any Islay older than that goes for ridiculous prices.

    Talisker 18 Year Old is probably the best buy in this age category.

    It’s all too expensive though.

  21. 21.

    Brachiator

    October 16, 2015 at 3:26 pm

    @Gin & Tonic: RE: Some years back a former boss found bottles of a single malt scotch that hid been hidden away in the attic for over 70 years.

    The age may be a curiosity factor, but once it’s in the bottle, it doesn’t change/improve.

    Yeah, the age marked it as maybe Prohibition era liquor.

  22. 22.

    MobiusKlein

    October 16, 2015 at 3:27 pm

    90 days to wait for insurance is a crock of shit.

    If he has any sway in the matter, given his special circumstances, he should negotiate a early onboarding for coverage from his new company.

    I’ve never had that long a wait at a job before – it always starts the first day of the next month after hire. Or sooner.

  23. 23.

    p.a.

    October 16, 2015 at 3:32 pm

    @jl: 1)in a 1/3- 1/2 full whisky glass cut the scotch (or bourbon) with a tablespoon of room temp Poland Spring water. Tap water a last resort.

    2) Small sip. DO NOT SWALLOW. Let the liquor warm in your mouth. No delicate way to put this: your saliva production will increase and release the flavor and smell of the liquor on your tongue and into your sinuses. Breath deep then swallow and at least pretend you like it. Others will be impressed. As long as you don’t drool.

    If you really want to snob it up, if you are in the region of production, the scotch (or bourbon) should be cut with the water it is produced from.

  24. 24.

    Tom

    October 16, 2015 at 3:43 pm

    One can never go wrong with Macallan or Oban for Highland or West highland scotch. If he is not currently a scotch drinker,I would avoid the Islays such as Ardbeg or Lagavullin as the smoky,peaty flavor is even more of an acquired taste than the others.As an aside,I understand that the scotch does not continue to age once it’s bottled.

  25. 25.

    bcinaz

    October 16, 2015 at 3:56 pm

    I favor anything over 18 years finished in Sherry Casks. Aberfeldy 25 is pretty awesome.

  26. 26.

    JustRuss

    October 16, 2015 at 4:01 pm

    @Tom: I’ll second Macallan. The 8 is good, the 12 is really good, and the 15 my daughter brought back from Scotland was fantastic. 25-year-old should be amazing.

  27. 27.

    pharniel

    October 16, 2015 at 4:26 pm

    auchentoshan 21 is my current favorite. I prefer lowlands.
    Let me thrid Macallan – the 25 I got on my way out of Heathrow one time was, indeed, fantastic.

  28. 28.

    cosima

    October 16, 2015 at 4:32 pm

    @Roger Moore: My husband loves that one! He’s a fan of the peaty whisky.

    Ardbeg. Octomore (spelling?). Lagavulin. Laphroaig. Balvenie. (Note: I am probably spelling most of these incorrectly)

    Yes to Macallan. I was up to check our drink cabinet to see what my husband currently has on offer, and it looks like only the dregs are out, apart from the new, unopened, bottle of the new Ardbeg that I got him for Father’s Day. K&L Wines is an excellent resource (they do have a website), I ordered some hard-to-get whisky for hubby from them when we lived in the US.

    Re: insurance — never go uninsured if you have options. I presume that that was your #1 bit of advice for your friend. It sounds like your friend has many options. There are a lot of things that can go wrong & add up to a lot of money with a pregnancy, never mind the randomness of life & health in general. Congrats to you friend on his wonderful new job & impending arrival, and the availability of COBRA (which he should pony up for).

  29. 29.

    p

    October 16, 2015 at 4:46 pm

    ladies and gentlemen,a point.
    25 year old maccallan is too sweet.
    the 18 is as close to perfect as my palate goes.
    but as an alternative,a vintage port or
    Bordeaux from the birth vintage is traditional.
    but that’ll require a few years wait until the 16’s are released.buy mom and dad the scotch,wait and buy the child the wine,and hope for a good vintage.
    cheers all….

  30. 30.

    Keith

    October 16, 2015 at 4:55 pm

    Scotch recommendation – The Balvenie – any year, pretty much any grade. (Though doublewood 12 is preferred hereabouts, 15 and 17 are available).

    Very smooth, subtle.

  31. 31.

    Richard mayhew

    October 16, 2015 at 6:14 pm

    @p: I will take this recommendation under strong consideration

  32. 32.

    Riggsveda

    October 16, 2015 at 6:30 pm

    It’s not 25 year, but Balvenie 21 year old Portwood is really wonderful…and I’ve tasted a lot of good ones.

  33. 33.

    dp

    October 16, 2015 at 8:12 pm

    @JustRuss: Macallan is an excellent choice (and one of my favorites). I like Laphroig too, but If you give them a peaty Islay like that, you’re liable to turn them off of Scotch altogether if they haven’t developed a taste for it.

  34. 34.

    dp

    October 16, 2015 at 8:16 pm

    @Keith: Excellent choice.

  35. 35.

    dp

    October 16, 2015 at 8:17 pm

    @Tom: I already commented on Macallan, but Oban is wonderful as well. I also repeated your warning about the Islays.

  36. 36.

    Mathguy

    October 16, 2015 at 10:26 pm

    1998 Glenrothes, if you’re looking for something not peaty, and smooth and delicious. Really delicious.

  37. 37.

    Blue Meme

    October 17, 2015 at 12:52 am

    @Riggsveda: Balvenie Portwood is the best distilled spirit I have tasted.

  38. 38.

    moderateindy

    October 17, 2015 at 4:03 am

    First off, be sure he’s actually a scotch drinker. Lots of people that enjoy whiskey, do not particularly like scotch. It’s too smokey, or peaty for a lot of peoples tatse. Bourbon is often a more approachable liquor, and if you can find it I can’t recommend Rock Hill Farms enough. That being said Oban 18 is always a nice way to go, as it is not overbearing, and even novice scotch drinkers seem to enjoy it. Also, it’s usually at a better price point than Macallan.

  39. 39.

    D_Cassatt

    October 17, 2015 at 5:55 am

    COBRA and have the new employer pick up the cost. That’s what I did when transitioning from post-doc to real job.

  40. 40.

    Dan

    October 17, 2015 at 10:13 am

    Red breast single malt Irish Whiskey

  41. 41.

    Kevin Nelson

    October 18, 2015 at 7:30 pm

    @moderateindy: Yours is a very cogent comment. A current gift should be something the recipient likes. A gift of a 25 year old single malt will be very expensive, and if that is your way of showing love and appreciation, so be it. I am this moment having a sip of Jura Superstition, a non age labelled lightly peaked Islay. I like it very much and I got it at the duty free in Rome. Don’t get a 25 year old for an infant. It may show that you have a lot of money to spend, but the recipient at 21 will not appreciate it. If I had a 25 year old anything, I’d probably put it in a wall safe. If I had a wall safe, lol. I have had 40 year old Tullibardine, which goes for a grand a bottle, and it was wonderful. A friend has shared some Caol Isla 21 with me, which he received as a gift, bless his heart. Prices and numbers and years do not matter.

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