Imagine this scenario.  We have two couples.

Couple #1: Sick Sally retired a while ago; she’s married to Sam. Sam is still working and carrying the family medical insurance.

Couple #2: Working Wanda is approaching 65, but doesn’t plan to retire yet.  Working Wanda’s husband Wayne is turning 65 in less than a week, happy early birthday Wayne!  He’s also not retiring yet, but Working Wanda carries the family medical insurance, and plans to continue to do so, both until retirement and afterwards through retiree medical.

Sam comes to talk to Working Wanda, with a tale of heartbreak and woe – after much back and forth, including documentation via email, Human Resources has told Sam that Sick Sally can no longer be on Sam’s employee medical insurance because Sick Sally is now Medicare eligible.  Instead Sick Sally will have to go on the healthcare exchange.  Since Sick Sally has a lot of medical bills, that means the couple will hit their out of pocket maximum for both the employee plan, and the healthcare exchange plan, for 2020.  Also, because of Sick Sally’s medical care needs, only the most expensive plan on the Exchange will give her access to her current health care providers (who she wants to be able to continue to work with).

Working Wanda has developed a full blown migraine listening to Sam’s story.  She knows Sam is usually very good at getting all the details, and coming to the right conclusion.  But Working Wanda has always heard that a spouse can be carried on your medical insurance in the situation that Sick Sally and Sam are in, which parallels her own situation with Wayne.  After hours on the internet, she can’t find a definitive answer.  While she trusts Sam, she decides to call Human Resources benefit specialists herself.  She can’t wait to find an answer, remember Wayne is turning 65 (the magic Medicare enrollment age in many scenarios) in less than a week!  Wayne has expensive health care needs and specific provider access issues too, and Working Wanda would feel like a very irresponsible spouse if she was inadvertently dropping him into some health care coverage gap.

Working Wanda calls HR.  The representative Working Wanda speaks with soothes Working Wanda’s stressed feelings, it’s all okay, Working Wanda had the right ideas in her head before Sam’s visit. Indeed, Working Wanda and Wayne can both be covered through employee medical until Working Wanda retires.  “But then what about my friends, Sick Sally and Sam?”, Working Wanda asks HR, and lays out their story.  HR says to have Sam call HR and ask to have their case reviewed.

Working Wanda relays the advice to Sam, who jumps on it. By the end of the week, Sick Sally and Sam are happily back to coverage through Sam’s employee medical insurance!  Everything worked out okay, but only after Sam was prodded to go back to find a better contact in the same office.

What a stressful story. And it’s what I was witnessing last week.  The internet doesn’t tend to have the specifics for your exact employer scenario. Having the right expert in your corner is invaluable, in terms of your emotional well-being, your money, and your physical health. And if you are suddenly hearing something that is completely the opposite of what you think you’ve known for years, it’s okay to stick to your guns about needing explanations and education about where you were wrong – because not only do you deserve to know, it’s also possible you weren’t wrong.