Individual Coverage Transition

Individual insurance marketplace reforms under the Affordable Care Act remain poorly understood. State environments vary widely and often change from year to year. Most states have an annual enrollment window of November 1st through December 15th. That narrow window is challenging for those who need to understand their coverage options. Others face a transition outside the annual enrollment window due to a qualifying event like COBRA ending. Because options in the individual market are often not as attractive as the coverage one had through an employer, even more consideration must be provided to evaluate what are often too many alternatives among suboptimal choices.

We highly recommend our subscription services for clients new to the individual insurance market or in an environment likely to change from year to year. We are best able to support clients we know, for whom we have information on providers and preferences and access to on-line benefit information. For those who desire a one-time project-based engagement, the individual consulting service should begin three or four months before the transition date and ends three months after the new coverage is effective.

Our Coverage Transition Service includes:

  • Background research using your physicians, preferred hospitals, prescription medications and premiums in order to evaluate coverage options
  • Assisting with the transition to new coverage
  • Educating you about the network and rules of the new Plan
  • Assistance and advice regarding provider networks, rules of the plan, selecting a primary care physician, transitioning prescription medications or other problems or issues of concern

Deposit: $1600 for an individual. Fee customized for couple or family.*

Higher fees apply if engagement does not begin at least three months before transition date.

* Our fees are largely based on time as described in our Professional Services Agreement included under Forms.  The notable exception is our Medicare Essentials Consultation which is a fixed fee for an individual or couple.  Most individual clients pay us $1600 for a consulting engagement.  When fees are higher it is typically because the client’s situation is unusually complex, or an enrollment problem has occurred outside our control that is time-consuming and/or difficult to resolve.