Key Takeaways
- Spouse's plan is often the best option if available
- Short-term plans have major coverage gaps
- This decision matters but isn't permanent—you can change
Making the Decision
"My spouse has insurance—should I just join theirs?" — Often yes, but check the details
Option 3: Spouse's Employer Plan
If your spouse has employer coverage, your layoff is a qualifying event that allows mid-year enrollment.
| Pros | Cons |
|---|---|
| Often subsidized by employer | May increase spouse's premium |
| Familiar process | May have different network |
| One bill for family | May not cover dependents well |
Key question: What does adding you cost vs. COBRA or Marketplace? Get actual quotes.
Option 4: Short-Term Health Insurance
Short-term plans are cheaper but have major limitations:
| Feature | Short-Term Plans | ACA Plans |
|---|---|---|
| Pre-existing conditions | Often excluded | Must cover |
| Essential health benefits | Not required | Required |
| Premium | Lower | Higher (but subsidized) |
| Duration | 3-12 months | Annual |
| Counts as ACA coverage | No | Yes |
When short-term might work:
- You're healthy with no conditions
- Very short expected job search
- Need to minimize monthly costs
When to avoid short-term:
- Any chronic conditions
- Pregnancy possible
- Need prescriptions
- Want real coverage
The Decision Framework
Key stat: The average job search takes 5-6 months. Plan your health insurance accordingly.
Ask yourself these questions:
-
What's your expected job search duration?
- Under 2 months → COBRA might be worth it
- 2-6 months → Marketplace likely wins (most people)
- 6+ months → Marketplace definitely wins
-
Do you have ongoing medical needs?
- Yes → Keep current doctors (COBRA) or check network (Marketplace)
- No → Price is the main factor
-
What can you actually afford monthly?
- Calculate your runway (Module 4)
- Factor in health insurance
-
Is spouse coverage available?
- Get actual cost comparison
- Often the best option
Decision Matrix
| Situation | Recommended Option |
|---|---|
| Spouse has good coverage | Join spouse's plan |
| Low projected income, healthy | Marketplace Silver |
| Mid-treatment with specific doctors | COBRA |
| Already met deductible, short search | COBRA |
| Long search expected, healthy | Marketplace Bronze |
| Long search, some health needs | Marketplace Silver |
COBRA Panic
Middle-aged professional panicking about $1,800/month COBRA
Setup
A client is panicking because they just got their COBRA paperwork showing it will cost $1,800/month. They assume this is their only option and are calculating how fast they'll burn through savings.
Client says:
“I got the COBRA paperwork and it's $1,800 a month! That's $21,600 a year just for health insurance. I can't afford that. I have some health issues so I need coverage, but this is going to wipe out my savings. What am I supposed to do? I've always had employer coverage—I don't even know what the alternatives are.”
Practice Objectives
- 1Calm their immediate panic
- 2Introduce the ACA Marketplace as an alternative
- 3Explain how projected income affects subsidies
- 4Help them understand they have 60 days to decide
Which of these is NOT a qualifying life event that triggers a special enrollment period for ACA Marketplace coverage?