Household in a benefits gap — recently laid off, between jobs, or early retiree not yet Medicare-eligible. COBRA, ACA marketplace, or short-term coverage decisions.
HC-03 is the coverage-transition archetype: households navigating COBRA versus ACA-marketplace choice under §1311 special enrollment, APTC subsidy reconciliation on Form 8962, and the HSA-eligibility disruption that follows almost every job-status change.
HC-03 exists because the coverage-transition surface is where benefits-admin, ACA marketplace, and tax-software products all fail at the same time. COBRA election under ERISA §601–608 gives a 60-day window from the qualifying-event notice, 18 months of continuation (29 if Social Security disability extends it, 36 for dependents on certain second qualifying events), and full premium plus 2% administration fee — almost always more expensive than ACA marketplace coverage with APTC. ACA Special Enrollment under 45 CFR §155.420 is triggered by the loss-of-coverage qualifying event with a 60-day window on either side, and APTC under IRC §36B is subsidized on a sliding scale tied to household MAGI against the Federal Poverty Level. Form 8962 reconciliation is the recurring trap: estimated income at enrollment versus actual income at year-end can swing the household between full subsidy and full clawback, with §36B(f)(2)(B) repayment caps for households under 400% FPL providing partial relief.
The structural story is a household at a financial inflection — recently laid off, between jobs, voluntarily transitioning, or an early-retiree pre-Medicare. Median income is $69k against median net worth $257k, but the income figure understates the volatility: pre-transition income may have been materially higher, and the year-end MAGI for APTC reconciliation depends heavily on the timing of any new job. HSA contribution eligibility almost always pauses during the gap; existing HSA balances remain spendable for qualified medical but new contributions stop when HDHP coverage ends. The COBRA-versus-marketplace decision turns on the dollar magnitude of premium plus deductible plus OOP-max — products that present only premium comparisons get this systematically wrong.
HC-03 differs from HC-01 (stable HDHP household) by the active coverage disruption, from HC-02 (active disability claimant) by being at the inflection rather than past it, and from S-02 (bankruptcy recovery) by being driven by job status rather than insolvency. The diagnostic is the active coverage transition and the choice point between COBRA, ACA, and short-term limited-duration plans.
Aggregated across the 11 HC-03 households in the shipped v3 corpus corpus. Numbers describe the corpus, not population claims.
Joseph and Hannah are the maximum-stress HC-03 file — a California domestic partnership where both partners work in healthcare, combined gross income is $69k, total liabilities are $664k, and liquid net worth has collapsed to $2,092. The diagnostic is the California state-individual-mandate exposure on top of the federal $0 penalty, plus the domestic-partnership tax-treatment asymmetry: California recognizes the partnership for state tax purposes, the IRS does not, and APTC eligibility under IRC §36B is computed on the federal-tax-household definition. This file finds bugs in marketplace-recommendation engines that treat all 50 states symmetrically and in tax-software that doesn't reconcile the federal-versus-state household definition cleanly.
Every HC-03 household ships with — at minimum — these JSON fields populated. The full schema is documented in the data set you purchase.
ACA marketplace operators and navigator products use HC-03 to test §1311 Special Enrollment qualifying-event logic, plan-comparison engines that surface total expected cost rather than just premium, and APTC estimation accuracy. Tax-software platforms use it for Form 8962 reconciliation including the §36B(f)(2)(B) repayment-cap tables and the lookback to actual MAGI versus enrollment estimates. Benefits-admin platforms use HC-03 for COBRA notice generation under DOL Model Notice timing rules, election-tracking, and the second-qualifying-event extension logic. HRIS and offboarding products use it for the loss-of-coverage notification cascade to dependents under ERISA §606. State-marketplace operators (Covered California, NY State of Health, Pennie) use it for state-mandate enforcement and state-specific subsidy stacking on top of federal APTC.
HC-03 is the active coverage-transition household. Stable HDHP enrollees in the HSA-investing posture belong in HC-01; active SSDI/LTD claimants with Medicare or Medicaid coverage belong in HC-02. Households where the coverage gap is part of a broader bankruptcy or insolvency workout belong in S-02. Medicaid-only enrollment without an ACA marketplace decision is not specifically modeled — that population overlaps U-01 / U-02 (unbanked / low-income working family) where the eligibility surface is state Medicaid rather than ACA APTC. Early retirees pre-Medicare who have voluntarily transitioned and have substantial financial assets to cover unsubsidized COBRA or marketplace premiums overlap with RE-01 / RE-02; if the financial-independence-driven posture is the diagnostic rather than the coverage gap itself, reach for those.
Income and asset bands during v3 synthesis were anchored to BLS Job Openings and Labor Turnover Survey separation-pattern data and KFF employer-health-benefits survey COBRA-cost benchmarks. State concentration in CA / NJ / AR reflects deliberate sampling toward two of the five state-individual-mandate jurisdictions plus a non-mandate baseline. The domestic-partnership representation in the corpus surfaces the federal-versus-state-tax-household asymmetry that affects APTC eligibility — a deliberate inclusion. Per CLAUDE.md §9 the corpus is FROZEN — priors above describe synthesis intent rather than auditable distribution fits. FPL bracket values reflect HHS annual indexing as enacted but year-specific snapshots are not asserted.
HC-01 is the stable HDHP household actively maximizing HSA contributions. Use HC-01 when coverage is stable and HSA strategy is the diagnostic.
HC-02 is the active SSDI / LTD claimant with Medicare-before-65 enrollment after the 24-month waiting period. Use HC-02 when disability income and the LTD-SSDI offset dominate.
S-02 is bankruptcy recovery. Reach for S-02 when the coverage gap sits inside a broader Chapter 7/13 workout rather than driving the household's primary planning issue.
RE-01 is the active early retiree managing pre-Medicare coverage with substantial financial assets. Use RE-01 when financial independence rather than involuntary transition is the diagnostic.
HC-03 — COBRA / Benefits Gap Household represents households in an active health-insurance coverage transition: recently laid off, between jobs, voluntarily transitioning, or early retirees pre-Medicare. It is the archetype for COBRA election workflows, ACA marketplace Special Enrollment under §1311, APTC reconciliation on Form 8962, and HSA-eligibility disruption logic.
The 11 shipped HC-03 households have a combined gross income median of $69,416 (25th–75th: $65,031–$70,601). Median net worth is $256,990 with $84,667 in liquid net worth — runway against the gap-period medical-expense spike and the COBRA premium load.
Yes. The household income profiles are positioned to exercise Form 8962 reconciliation across the FPL subsidy bands, including §36B(f)(2)(B) repayment caps for under-400%-FPL households and the cliff above 400% FPL when applicable. Specific subsidy amounts are downstream computations.
HC-01 households have stable HDHP coverage and active HSA contributions. HC-03 households are mid-transition with HSA contributions paused (though existing balances remain spendable). The diagnostic surface is the coverage choice — COBRA versus marketplace versus short-term — rather than HSA maximization.
Yes — state concentration includes CA and NJ, two of the five state-individual-mandate jurisdictions (with MA, RI, and DC). State-mandate enforcement is a downstream tax-software test against the household state attribute.
No. The shipped v3 corpus is frozen and not regenerable from current code (drift confirmed 2026-05-09). Improvements land in a future v4 release with per-archetype golden fixtures in CI.
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