Tip 243- Is This Sustainable?

Ed is covered by an employer sponsored group plan; one that offers coverage only within an integrated care system. Basically, it’s an HMO.Ed has a health condition that will require surgery some time in 2016. He’s been doing some research and believes he’ll get the best results using a surgeon out east; definitely not in network.

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.