Start now – if you haven’t already.
In this final post of a 3-part series on health reform for freelancers and sole proprietors, I’ll offer a suggested timeline to get ‘er done.
I’ll share key dates and resources. The rest will be up to you.
I hope you found the series helpful. If you missed the first two posts, the links are below.
- Step 1 – 3 Simple Health Reform Steps for Freelancers and Sole Proprietors
- Step 2 – What Freelancers Need to Know
Your 6-Week Plan
Step 1 got you started.
You learned the following.
- Most of you will be required to purchase health insurance for 2014
- You may have various options for coverage
One of those options may be your state’s health insurance exchange (or marketplace). Sign-up for the marketplace starts October 1, 2013. So, that gives us six weeks.
Weeks 1 -2
For the first two weeks, I recommend you figure out what your options are for coverage.
Note: This assumes you are among the majority of individuals who must have insurance or pay a penalty.
You can check the Kaiser Family Foundation flow chart to see if you are the exception who does not need to meet this requirement.
Let’s review some possible options (from the Step 1 post).
- Coverage under your spouse’s employer plan – As discussed, typically this is your best option in terms of what you pay for premiums, but be sure to compare plan options with your individual options (plans you purchase yourself)
- Coverage under an individual policy – You can purchase a policy through the state health insurance marketplace. In the Step 3 post, we shared the healthcare.gov link, which offers information on your specific state’s options, starting October 1, 2013.
- Coverage under government, association or some other plan - One of the provisions of health reform’s Affordable Care Act (ACA) expanded coverage for Medicaid; however, the Supreme Court ruling left it up to the states if they want to adhere to the expansion provisions. You can check your state’s Medicaid site for specifics.
- Medicare may be another government option for you if you’re 65 or older or meet other eligibility requirements.
- If you belong to an association, like Freelancers Union, you may be eligible for health insurance. Their coverage does not extend to those of us in the west.
Coverage for association plans isn’t as rosy as it once was – what is these days? But, if you have the option, be sure to compare coverage with plans in the individual marketplace.
If you already have coverage, check out all your options before signing on for another year.
Okay. This is where the rubber meets the road.
No matter how much you may want to avoid the discussion, you need to calculate what you can comfortably afford in monthly premiums.
Think about purchasing health insurance like you would any large investment.
- You may want the Lexus
- But, if you cannot afford those monthly payments
- You probably purchase a less expensive car
Knowing what you can afford helps you choose your plan design.
Generally, the more you pay out of your pocket for services, the lower your premium.
High deductible health plans are all the rage now.
- The design makes premiums more affordable
- Remember, ACA requires full coverage for certain preventive services
These plans are particularly popular with employers right now, and are often paired with a Health Savings Account.
There is additional information in Free Stuff about Health Savings Accounts.
In Week 5, you want to have your research organized so when the insurance marketplace goes live on Week 6, you can compare options.
As indicated in the Step 3 post, healthcare.gov will link you to the appropriate site for your state. However, you can research in the meantime to see if you are eligible for financial assistance with premiums.
- Kaiser Family Foundation has a Subsidy Calculator
- California’s health insurance marketplace, Covered California, also has one
I am sure there are others. I recommend you check to make sure the site is being regularly updated. If you work with a broker, he or she should also be able to help point you in the right direction.
Premium tax credit – FamilyUSA, a consumer advocacy group estimates that this year, individuals earning $45,960 (or less) or $94,200 for a family of four, will be eligible for a tax credit.
Navigators – ACA also has provisions for insurance Navigators, who are trained to guide you through the health insurance marketplace, including the following.
- The application and enrollment process
- Plan provisions and comparisons
- Tax credits or special programs (if eligible)
Their role is one of unbiased assistance.
Depending on your state’s requirements, insurance agents or brokers can also receive training on navigating the insurance marketplace and can be a resource for you.
Got It Covered
Let’s recap your 6-week plan.
- Review your coverage options
- Decide if you research it alone or work with a broker
- Calculate what you can afford
- Compare plan design options to cost
- Collect your research
- Explore what’s available through your state’s insurance marketplace (including financial assistance)
Get ‘er done.
May the force be with you.
Please leave your thoughts/questions in Comments.
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.