Thanks to the Open Enrollment provisions of the ACA, Ed can drop out of his employer’s plan and sign up for private insurance to be effective January 1. Ed will pay about $750 a month of premium. His surgery will cost in excess of $100,000.
Next year, during his employer’s open enrollment, Ed can jump back into the group plan. Or switch his individual coverage to a new insurer.
There’s been a lot of news in recent days about insurers losing money in the individual market, both on and off the Exchange. Some have exited this market. Others are planning to do so in 2017.
Perhaps this anecdote explains in part why.