Health Insurance for self employed

amother

Lilac

Mon, Jan 10 2022, 9:48 pm

I don't think there are any other options...it's one of the reasons I stick with my job even though I do not really like it. Employer insurance has much better networks. And my employer doesn't even pay part of the premium, I pay the full premium myself but I need to have access to top doctors/surgeons for my condition

Amarante

Mon, Jan 10 2022, 10:05 pm

There is private health insurance which you can get other than through the "marketplace".

If you are not receiving a subsidy for your premium there is no particular reason to use the marketplace. You should determine what your premium subsidy would be as the premium might be reduced by quite a bit but that depends on your income. The premium subsidy is what makes health insurance more affordable through the marketplace but unless you get the subsidy there isn't any particular reason to purchase through the marketplace.

Find a good insurance agent in your location who is familiar with all of the plans and network providers. If you have a doctor that you want to continue seeing find out what their insurance networks are pay for a visit if it is worth it or find another doctor. Depending on how often you see a doctor it might not be a bad way to go since you would still be covered for major expenses AND you could go to specialists within the network. My friends pay for office visits to their long term PCP but any other expenses are covered so the cost is just for the visit itself.

My deal breaker was having Cedars Sinai on the list of hospitals because it is convenient and because every decent doctor in the area has privileges so I eliminated any plan that didn't have it in my network.

amother

Emerald

Mon, Jan 10 2022, 10:07 pm

Amarante wrote:

This is not true in New York

jd1212

Mon, Jan 10 2022, 10:22 pm

I am a health, life, and disability insurance broker and I sell an individual health insurance plan that’s sold through a business owner union. It has an excellent networks of doctors. If you receive a subsidy, it’ll be way cheaper on the Marketplace, but the networks there are very poor.

The only catch is that the union has a health questionnaire to join the union for major medical conditions (which is legal for some technical reasons if anyone cares I can explain). Anyone who joins the plan (parents and kids) needs to clear those. But otherwise they’re quality plans. You need to have your own business to apply- minimally being a 1099, so even a contract worker counts.

Please PM me if you’d like and happy to discuss more.

amother

Tanzanite

Mon, Jan 10 2022, 11:34 pm

Amarante wrote:

What part isn't true?

Does every person in the state have to purchase through the marketplace?

The policies available to people without a commercial plan aren't good. We had a great commercial plan through an employer, but the year that didn't work out there weren't any good/comparable options. (It could be there was a comparable plan for double the price, but that's not comparable anymore imo)

Amarante

Tue, Jan 11 2022, 11:02 am

amother [ Tanzanite ] wrote:

If by commercial you mean a health plan that is through a large corporate employer, you are not comparing apples to apples in terms of premium costs.

Large corporations generally pay all or a significant portion of the premium for their employees as well as subsidizing costs for their spouses and children to some extent so the actual amount of the premium is not known by the employee which is why people get "sticker shock" when they have to purchase their own health insurance in the private market.

Also the cost for employees is shared over a large number of people which includes younger employees with lower costs. Private insurance plans are grouped into age categories and it can be a huge shock when one moves from one age group to another age group. With a corporate policy your costs are the same whether you are 45, 60 or 25 but in the private market your premiums would be significantly different.

Corporations offer good benefits because they want to attract people. Many people stay with their jobs because they don't want to lose their great health insurance. Also corporate plans are a great tax benefit to employers and employees. Employers get to deduct the cost of premiums. They don't have to pay FICA on it. Employees get a huge financial benefit and they don't have to pay income tax on the value nor do they have to pay FICA on the value of the benefit.

amother

Tue, Jan 11 2022, 11:07 am

Amarante wrote:

I was on cobra until now snd paying $845 a month. It was worth it to me to stay with a United healthcare (Oxford ), which I found was acceptable to all the doctors and providers I needed. I’d be ok paying something comparable. It’s just like I said, many doctors don’t take ANY marketplace (Obamacare ) insurance.

amother

Maroon

Tue, Jan 11 2022, 11:10 am

amother [ OP ] wrote:

Right when you’re on cobra you are not getting any employer discounts. Are you NY or NJ?
I did a search last night in NJ for 1 male adult in a household of 6 enrolling and household making 150k a year. They showed some non marketplace plans including Oxford.
Have you tried reaching out to a broker?

Amarante

Tue, Jan 11 2022, 11:13 am

amother [ OP ] wrote:

Not to belabor but your $845 payment was still lower because of the lower cost of the insurance employer was paying that amount per employee. He was also paying that amount for a 25 year old guy who would be able to get insurance in the private sector for $250 per month. The larger risk pool with all ages evens it out so that your premium is less. But it was "artificial" in the same that you were paying much less than if you weren't in a pool with younger people who were lowering the amount your employer had to pay for insurance.

When I went off Cobra I also got sticker shock and that was in the bad old days when you also could be denied any health insurance because of any pre-existing condition - and if you were middle aged you could pretty much guarantee you had some kind of pre-existing condition even if it were minor. And if you once had a serious disease like cancer or a chronic disease you couldn't get any kind of health insurance. Back then people would work at at place like Starbucks just because you could get some type of insurance if you worked at least 20 hours per week.

amother

Tue, Jan 11 2022, 11:21 am

Amarante wrote:

I get it. I’m just trying to figure out where to go from here.

amother

Tue, Jan 11 2022, 11:22 am

amother [ Maroon ] wrote:

NY. No haven’t spoken to a broker yet. Figured I’d reach out here first for advice. I have until May/June on my current plan.

amother

Thistle

Mon, Feb 14 2022, 4:19 pm

amother [ OP ] wrote:

Are there any freelance groups that let you band together for this purpose?

There used to be so-called affiliation groups years ago before there was Obamacare and the issue was much more of actually being able to get insurance if one didn't get it through one's employer. I can't stress enough how big a factor that was prior to Obamacare since you literally couldn't obtain insurance on the open market.

What happened was that the "affiliation groups" and "trade groups" entered into what is known as a "death spiral". Essentially their membership started to consist only of people who were desperate to obtain any form of health insurance and so premiums rose because the pool consisted of older and less healthy people and so it continued until eventually it became untenable. I received health insurance through the Bar Association but they stopped offering it at a certain point because of this.

Large corporations offer great health insurance for the most part because it is part of the compensation package AND because they have a large pool which consists of young healthy people. Essentially when you work for a corporation you are forced into their pool because you can't go to HR and say pay me $1000 per month instead of giving me health insurance.

Not all plans obtained through the marketplace are identical in terms of networks so it is not too early to start researching. Also if you aren't eligible for a subsidy, then there is no particular benefit to purchase through the marketplace. Whatever option you are well advised to use a knowledgeable health insurance broker who can advise you on the best option for you.