Greg came home from his route on Thursday with a folded sheet from his HR office in his shirt pocket, a little smudged with flour. "Here's your number," he said, and went to take a shower. That sheet settled about half of a question I'd been chewing on since March.
My school-district plan ends June 30. The two real choices were joining Greg's plan, which comes with a $100 monthly spousal surcharge, or buying my own plan on the marketplace. COBRA was off the table at about $712 a month. Here is how I lined up the other two.
What Greg's plan would cost
Right now Greg pays $118 a month for employee-only coverage. Employee-plus-spouse is $312 a month. On top of that, his employer adds the $100 surcharge for a spouse who could have gotten coverage elsewhere. HR confirmed that being able to buy a marketplace plan or COBRA counts, so I don't get out of it.
So the true extra cost of adding me is $312 minus $118, plus $100. That's $294 a month, or $3,528 a year. The deductible on his plan is $1,500 per person, $3,000 for the family, and the out-of-pocket maximum is $6,500 per person. My doctor is in network. My $9 generic stays about the same.
What the marketplace showed for a 55-year-old
I spent most of Saturday morning on the marketplace site with Emily on speakerphone, because she's done this for friends. Age matters a lot in the pricing. At 55 I'm charged a good deal more than someone in their thirties for the exact same plan.
The other thing that matters is help with the premium. Since 2023, whether a spouse can get a tax credit depends on whether the family coverage offered through the job counts as affordable compared to household income. With Greg's wages, his family premium does count as affordable. So the site showed me no premium help at all. I'd be paying full price.
Full price looked like this for plans in our county:
- A bronze plan at about $590 a month, with a $7,500 deductible.
- A silver plan at about $780 a month, with a $4,800 deductible.
- A gold plan at about $905 a month, with a $1,900 deductible.
Even the bronze plan is $7,080 a year in premiums before I'd see a dollar of coverage beyond preventive care. Compare that to $3,528 on Greg's plan with a much lower deductible.
The side-by-side
I drew two columns in the green notebook and figured three years: a quiet year, a medium year and a bad year.
In a quiet year, like most of mine, I see the doctor twice and get bloodwork. Greg's plan costs us $3,528 in added premiums and maybe $200 in copays. The bronze plan costs $7,080 plus whatever the office visits run before the deductible, call it $400. Greg's plan wins by about $3,700.
In a medium year, say my knees finally need an MRI and some physical therapy, I'd guess $3,000 in billed care. On Greg's plan I'd pay toward my $1,500 deductible and then coinsurance, maybe $1,900 out of pocket on top of the $3,528. On the bronze plan I'd pay all $3,000 on top of $7,080. Still not close.
In a bad year, the kind nobody plans for, I'd hit the out-of-pocket max either way. That's $6,500 plus $3,528 on Greg's plan, versus roughly $9,200 plus $7,080 on the bronze. Greg's plan again.
I kept looking for the catch. There wasn't one for us. The surcharge stings because it feels like a penalty for being married to someone with a decent job, but even with it, adding me to his plan is less than half the cost of buying my own.
Greg's reaction when I showed him the columns: "I told you that in March." He did. He also didn't do the math, so I'm counting this one as a tie.
What we decided and what's next
I'm going on Greg's plan starting July 1. HR said he has 30 days after my district coverage ends to turn in the paperwork, but I'm not waiting. I want the forms in the week after my last day, June 6, with a copy of the district's coverage-end letter attached.
A few things I'd tell a friend in the same spot. Get the real per-paycheck numbers from HR, not the brochure. Ask exactly what triggers the surcharge, because the rules differ from one employer to the next. Check whether you'd qualify for premium help before you assume the marketplace is cheaper. And run more than one kind of year, because the cheapest premium isn't always the cheapest plan.
Our situation won't be yours. Your income, your age and your spouse's employer will all change the answer. I'm not an expert, just a careful person with a calculator. If the numbers are close for you, sit down with someone who does this for a living.
For us, it wasn't close. The surcharge stays, and it now has its own line in the budget.
