Household of two · Montgomery County, Ohio · employer coverage ends 3 August 2026 · reviewed 28 July 2026
Marketplace figures are derived estimates from filed Montgomery County age-27 rates converted on the federal age curve, cross-checked to within 4% of Ohio's published benchmark. COBRA is derived from payroll; the election notice is authoritative. Note that COBRA and the cheapest gold plan are the same number, and that gold costs only about $400 a year more than silver for roughly ten more points of actuarial value — because this household receives no cost-sharing reductions and so pays silver's loading for nothing. The cheapest silver and cheapest gold are different carriers, so compare gold against silver within one carrier once you have narrowed by network.
| Option | Per month | Per year | Note |
|---|---|---|---|
| Cheapest expanded bronze | $1,420 | $17,040 | HSA-qualified; high deductible |
| Cheapest bronze | $1,615 | $19,380 | HSA-qualified |
| Cheapest silver | $1,920 | $23,040 | Pays the CSR loading for no benefit |
| COBRA, medical only | $1,952 | $23,424 | Keeps PPO, formulary, and accumulated deductible |
| Cheapest gold | $1,955 | $23,460 | ~80% actuarial value for ~$400/yr more |
| COBRA, medical + dental + vision | $2,042 | $24,504 | Dental and vision may be separately electable |
| Path A · bronze from 1 Sep | Path B · COBRA Aug–Dec | |
|---|---|---|
| Premium Aug–Dec | ~$5,680 | ~$9,761 |
| Deductible credit | resets | carries over |
| Network | HMO, no out-of-network | existing PPO |
| Formulary | re-adjudicated; step-therapy risk | unchanged |
| HSA | $10,750 available | none |
| Premium deductible? | yes, §162(l) | probably not |
Path A's ~$8,500 gross advantage is eroded by the deductible reset, full-cost brand medication before the deductible, HMO network risk, and the HSA last-month-rule testing period running through 31 Dec 2027. Decide by 25 September.
It is a step, not a slope. Replacing the lost credit takes roughly $26,000 of additional gross income — so MAGI between $86,560 and about $113,000 is a dead zone in which earning more leaves the household poorer. That is a pricing constraint on consulting revenue and a reason a December invoice may belong in January.
Ask whether an 1 August effective date is available for a 3 August loss of coverage. 45 CFR 155.420(b)(2)(iv) permits it if a plan is selected by the last day of the preceding month; sources conflict on whether HealthCare.gov exercises the option. The downside is nil — the fallback is 1 September either way, and plan selection is not effectuation.
The full $3,400 election is available regardless of contributions to date, and the employer cannot recoup. Glasses, dental, prescriptions, diabetic supplies, over-the-counter items. The expense must be incurred while covered. Health FSA coverage most commonly ends on the termination date itself, not month end — confirm, and assume the earlier date.
COBRA elected in the window is retroactive to the loss date. Declining nothing costs nothing and covers the 4–31 August gap for free. Signing a waiver destroys that. Leave the box blank.
Exact coverage end date · Summary of Benefits and Coverage · year-to-date deductible and out-of-pocket accumulation · FSA run-out deadline · group life certificate and conversion forms · COBRA administrator · insured or self-funded · any COBRA subsidy in the severance.
See the verdict below. Do not enroll, pay a premium, sign a W-4 or I-9, or provide a Social Security number or banking details.
All 130 Montgomery County marketplace plans are HMOs with no out-of-network benefit. Kettering Health is accepted by all eight carriers; Premier Health appears in only four. Call the practices directly.
31 days to convert without evidence of insurability — application and first premium. Shop underwritten term in parallel; conversion is the backstop, not the default.
Solo 401(k), HSA, §162(l), and income timing against the $86,560 cliff. Establish the retirement-plan structure while there is still time to act in 2026.
Across 41 pages the funding type is recorded only as "Employee and Employer Contributions." A self-funded plan financed solely by member premiums, advertising an unlimited annual maximum, cannot pay a catastrophic claim. The question you asked the broker — what pays a $500,000 claim? — is answered by the document itself: nothing does.
| Finding | Detail |
|---|---|
| Three state regulators | Named consumer alerts — Maine 24 Nov 2025, Tennessee 23 Feb 2026, Louisiana 21 Apr / 4 May 2026 — stating the sponsor, administrator, and captive are not licensed |
| Federal lawsuit | Elevance, Anthem, and the BCBS Association sued for trademark counterfeiting: "selling consumers an employee benefits health insurance plan that does not exist" |
| Second lawsuit | AIG sued the affiliated captive and its principal — the same individual is an officer of the claims administrator |
| Benefit caps | 30 inpatient days a year · 30 chemotherapy days · acute temporary dialysis only · no out-of-network transplant |
| Out-of-pocket limit | Excludes balance-billed amounts and a 50% preauthorization penalty — so it is not a limit |
| Precedent | Ohio's Thin Blue Line collapse (3,400 members, now in liquidation) and the Innovative Partners receivership, whose receiver states most claims "will remain unprocessed and unpaid" |
| Guaranty fund | None — not federal, not state. Enrollees become unsecured creditors and stay personally liable to providers |
Verify any agent and company before further contact: Ohio DOI agent locator and authorized company search, and Consumer Services on 800-686-1526. Nothing here requires assuming the individual agent knows what is behind the product — it does not change the answer.
| # | Question | Holder |
|---|---|---|
| Q1 | Exact date coverage terminates — the 3rd or the 31st? | HR |
| Q2 | Unspent FSA balance and the claim run-out deadline | FSA administrator |
| Q3 | Year-to-date deductible and out-of-pocket accumulation | Carrier / HR |
| Q4 | The actual COBRA rate on the election notice | COBRA administrator |
| Q5 | Hospital system and physicians in-network, per plan | Carrier directories, by phone |
| Q6 | Group life conversion versus portability terms | Life certificate |
| Q7 | Formulary tier, step therapy, and copay accumulator, per plan | Carrier pharmacy benefit |
Q3 is the one that decides August. Q2 has the shortest fuse. An adversarial verification pass on 28 July corrected four items in the underlying analysis: 1 September is the default marketplace effective date rather than the floor; gold costs ~$400/year more than silver rather than the same; the spouse-W-2 small-group route is unavailable under 29 CFR 2510.3-3(c)(1); and the FSA window likely ends on the termination date rather than month end.
Research and analysis only — not enrollment, tax, legal, or medical advice, and not an authorization to contact any broker, insurer, or employer. Figures labelled derived or estimated must be replaced with quoted numbers before they decide anything. Full sources in the accompanying briefing.