As I've noted before, I have a little sticker on my phone as a constant reminder to always do what I think is in my clients' best interest (not that I need constant reminding, but it keeps me humble). Today I had another opportunity to take it for a spin, and I'd like to share that with you. A caveat, however: the story you're about to read is true, the names have been changed to protect private information, and I share it with you as an example of how I believe most professional agents would handle the same circumstances.
The gentleman who founded this agency almost 40 years ago is semi-retired, but keeps his hand in (mostly so his wife has an excuse to get him out of the house). One of his friends and long-time clients called him with a problem, and he referred this gentleman to me for assistance.
It seems that this gentleman, we'll call him Tom, has a 55 year old daughter, Susan. Susan was widowed some 20 years ago, and raised her two children by herself. The eldest has recently married and moved away to another city, and the youngest is in college away from home, as well. She has found herself becoming more and more depressed, and has found (as so many have) solace in a bottle. This has reached the point that her employer had to let her go this past summer, but continued to pay for her health insurance through the end of this year. At that time, she's on her own; worse, because of her health history (which include the alcoholism and other issues), she is uninsurable in the "regular" market.
I would like to point out that she chose to adopt that bottle, and that most of her other issues stem from that decision. We are all responsible for the decisions that we make.
In the event, I agreed to meet with her, primarily because of that sticker, but also out of loyalty to the retired gentleman. I was also intrigued by some of the side issues, which included an employer exemption from COBRA compliance. Something not widely known is that some organizations aren't required to offer COBRA continuation even though they might otherwise fit the requirements. She had worked for one such, so COBRA was not an option.
Believe it or not, there were others.
One was the state-mandated guaranteed option route. This is the same plan one would buy once one had exhausted COBRA (were it available and elected). The benefits of this plan were the low qualification threshold (doesn't get much easier than "guaranteed issue") and the fact that it would cover her pre-existing conditions. On the down side, it's rather mediocre coverage, but it is expensive. For Susan, the rate would be well over $1,000 a month.
I understand and believe in the value of insurance. But I also try to live in "the real world." So I absolutely understand if someone says "12 thousand dollars a year?! Plus deductibles and co-insurance? Are you kidding?!" So I can certainly understand someone who decides to roll the dice. And I can't say that I blame them, or even disagree.
Not at all. Insurance is about risk assessment ("I'm uninsurable") and risk management ("this stuff is expensive!"). If one can't justify the premium based on the cover, then that's a legitimate conclusion.
So I also proposed a limited benefit (or mini-med) plan as an alternative to the state-mandated one. My thinking was that it would serve to mitigate the damage should there be a large claim. Again, it's a question of risk management.
Finally, I also printed out the Ohio grid from Coverage for All (on our sidebar). The idea was that, even if she decided not to buy any insurance to offset her increased risk, at the very least I could help her find some way to soften the blow as she received the treatment she needs.
This is a sad situation, with no real "happy ending." But I was awfully proud to have been able to help in some small way.
Now that's a good day.