Health insurance for those who are self-employed?

[SASM]

I posted this question last year and am, unfortunately, revisiting the topic again. Reposting in the hopes of getting more responses and possibly any new info. Thank you so much to those who responded last year!! Heading over the Marketplace now.

Last year's thread: http://windsorpeak.com/vbulletin/showthread.php?488469&p=4119456#post4119456

DH is seriously considering self-employment. I am looking into the healthcare options in this situation...a very foreign topic for me. I realize that insurance plans vary greatly - plans, regions, etc. All I have seen so far is that open enrollment has ended for two companies that I have checked out, however, it looks like we might be able to purchase if we have a "qualifying life event".

For those who are self-employed, can you offer any tips as I navigate this area?
Have you been satisfied with your insurance company/coverage, especially if you actually USE it?
Good customer service?
Good selection of providers?
Good websites to walk us through the process and help selecting a company??

I cannot think of anything else. It's just crazy overwhelming. Thank you for any advice/feedback!!!

[BunnyBee]

We have been self-employed for 10+ years. It's the same basic hassle you get from employer-provided insurance. ;)

We have bought through the Marketplace the past couple of years, though we aren't eligible for tax credits. Before that we used an independent broker. We usually check with both to see what's available. The expense is deductible for us on business taxes. (As far as I understand that...typically just sign the CPA-prepared returns and don't delve that deeply!)

Changing jobs is a qualifying life event. Open enrollment is also coming up in November.

[SASM]

Thank you so much for the response!!


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[saleenl]

Your options will *greatly* vary by state. In our state, there are far fewer individual plans offered than those to businesses. For example, as an individual I am unable to purchase a plan that includes out-of-network coverage, nor one with a high deductible. However, one person can qualify as a business in our state, so we are able to get around this. Also, our health insurance company offers different plans when purchased direct, as opposed to through the exchange, so be sure to check both.

Last, be sure to consider the total cost of each plan - premiums + medications + visits, etc. We originally had a HDHP and picked a carrier based on premium and plan features - I thought we were getting a great deal. We never spent as much as our deductible (as anticipated) so we paid the company's negotiated rates for doctor visits and medications. I became unhappy with the customer service of our first carrier, so we changed to what appeared an equivalent plan with a different carrier for a ~20% higher premium. I was shocked to find out that the second carrier's negotiated rates for everything from an office visit to medications were lower - sometimes as much as 40% lower. In the end, the total yearly cost of the higher premium plan was quite a bit lower than the lower premium plan. Also, don't forget to check the drug formularies for each plan to make sure all medications you are accustomed to are covered and verify the process for receiving an exception as well as any required step-therapies.

Of course, if you select a plan with copays this is not applicable, but I had no idea there could be such variation. I even researched plans and companies a ton!

[SASM]

Your options will *greatly* vary by state. In our state, there are far fewer individual plans offered than those to businesses. For example, as an individual I am unable to purchase a plan that includes out-of-network coverage, nor one with a high deductible. However, one person can qualify as a business in our state, so we are able to get around this. Also, our health insurance company offers different plans when purchased direct, as opposed to through the exchange, so be sure to check both.

Last, be sure to consider the total cost of each plan - premiums + medications + visits, etc. We originally had a HDHP and picked a carrier based on premium and plan features - I thought we were getting a great deal. We never spent as much as our deductible (as anticipated) so we paid the company's negotiated rates for doctor visits and medications. I became unhappy with the customer service of our first carrier, so we changed to what appeared an equivalent plan with a different carrier for a ~20% higher premium. I was shocked to find out that the second carrier's negotiated rates for everything from an office visit to medications were lower - sometimes as much as 40% lower. In the end, the total yearly cost of the higher premium plan was quite a bit lower than the lower premium plan. Also, don't forget to check the drug formularies for each plan to make sure all medications you are accustomed to are covered and verify the process for receiving an exception as well as any required step-therapies.

Of course, if you select a plan with copays this is not applicable, but I had no idea there could be such variation. I even researched plans and companies a ton!

Thank you so much! Taking notes. Very interesting...This is so overwhelming.


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[mom2binsd]

I buy my own, just for myself right now as my kids qualify for Medicaid.

I got my policy through the Marketplace, but I first went to a broker to help narrow down choices. There is a spot on the application where you put in the brokers id number so they get credit for helping you.

I have a 320 monthly premium for a HMO Public policy, it's a Silver level policy, I pay 20 per office visit, 40 for specialty. My ER copay is 500 though. I have about a 4000 deductible, but most routine things so far are covered. I've had very good customer service (I think it's specific to the actual carrier though), and have quite a few options for providers. Prescriptions so far have been 10.00 copays, although I don't take any regular meds and have only needed a few scrips. It doesn't include vision or dental.

[lmr1101]

Full disclosure, I'm a licensed health insurance broker... but currently not in the business.
Every state has different rules, ours requires at least two, non-married people to write a group plan.
As far as marketplace plans, there is only 1 carrier left selling in my state. There is no reason to buy on the marketplace unless you qualify for a subsidy. There are usually more options of the marketplace, but then you are paying the full price.
You may want to find a broker in your area, they can answer all of your questions. Good luck!


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[SASM]

Full disclosure, I'm a licensed health insurance broker... but currently not in the business.
Every state has different rules, ours requires at least two, non-married people to write a group plan.
As far as marketplace plans, there is only 1 carrier left selling in my state. There is no reason to buy on the marketplace unless you qualify for a subsidy. There are usually more options of the marketplace, but then you are paying the full price.
You may want to find a broker in your area, they can answer all of your questions. Good luck!


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Thank you :) Very good points. Will try to find one today. Have no idea where to look. Is there something that I need to look for in a reputable health insurance broker?? I didn't even know such a person existed before this thread. TY!!


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[BunnyBee]

Thank you :) Very good points. Will try to find one today. Have no idea where to look. Is there something that I need to look for in a reputable health insurance broker?? I didn't even know such a person existed before this thread. TY!!


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We got referrals from our CPA and other insurance agents.

[SASM]

We got referrals from our CPA and other insurance agents.
THANK YOU, BunnyBee!