How To Get Health Insurance When Self-Employed
Health insurance for self-employed individuals can be a complex but vital aspect of managing one’s own business. Without the support of an employer’s insurance plan, self-employed people must navigate various options to find the right coverage.
Understanding and planning for health insurance when self-employed is crucial as it ensures financial protection against unexpected medical expenses. Knowing the available options, including government programs and private plans, can help establish a stable foundation for both personal health and business growth.
Types of Health Insurance for Self-Employed Individuals
Making sure you are covered is well worth the effort. Health insurance can help offset the cost of unforeseen medical emergencies as well as expenses related to chronic medical conditions and basic health maintenance, such as doctor’s appointments, vaccinations, and proactive treatment. These are the basic types of health insurance you can choose.
These are policies obtained through the government’s Health Insurance Marketplace or from licensed agents or brokers. They often come with potential subsidies. These plans comply with the Affordable Care Act (ACA), meaning policies follow federal guidelines for covered benefits, eligibility, and more.
You may enroll in an ACA-compliant plan yourself, or receive coverage through your spouse’s plan if they have employer-sponsored health coverage. Another option is to enroll in COBRA, which would extend your previous employer’s health insurance coverage, albeit typically at a higher premium.
Private, Non-qualifying Health Insurance
These plans may be purchased directly from insurance companies or from licensed agents or brokers. Non-qualifying health coverage plans do not have to comply with ACA guidelines, so they may offer limited benefits and have strict eligibility criteria.
These types of plans include specialized service plans like dental insurance as well as broader coverage plans like short-term health insurance, which is meant to provide temporary protection.
These options are programs like Medicaid or Medicare. They provide health coverage for those who meet specific criteria. For example, Medicaid is designed to help those with disabilities, pregnant people, and those with lower incomes.
On the other hand, Medicare is designed to provide health coverage for those 65 years and older, as well as those younger than 65 with certain disabilities.
Emergency and Catastrophic Coverage Options
For those who are self-employed, emergency and catastrophic coverage options can provide essential protection against significant health emergencies. However, these types of plans are limited in scope and so may be best suited for younger, healthier individuals or those with budget constraints.
- Catastrophic health insurance plans: Catastrophic plans are designed to provide coverage for worst-case scenarios, like serious accidents or illnesses. They typically have lower premiums and higher deductibles, covering three primary care visits per year and preventive services at no additional cost.
- Emergency coverage options: Some insurance providers may offer specific emergency coverage plans that cover unexpected illnesses or accidents but not routine care.
Before enrolling in these types of plans, ensure you understand how it can impact your health coverage. For example, while these plans offer lower premiums, they cover fewer services and can result in high out-of-pocket costs for non-emergency care.
Which Type Should You Pick?
The difference between these options lies in the providers, cost, coverage, and eligibility requirements of each type. For example, private insurance allows for more customization but might be more expensive, whereas marketplace plans offer a balance between cost and coverage with possible subsidies. Government-supported options, meanwhile, provide assistance based on specific criteria.
However, it is best to follow these steps to see which of these options you should select:
- Determine eligibility for government-supported options. Medicaid and Medicare can be the most comprehensive as well as affordable option for those who meet eligibility criteria. If you are eligible for one or both programs, it is generally a good idea to enroll. Self-employed individuals eligible for Medicare should explore options for Medicare Advantage, Medigap, or Part D drug plans to determine which Medicare plan best suits your needs.
- Determine if your spouse’s marketplace plan can meet your needs. Even if you are self-employed, you may join a spouse’s employer-sponsored health insurance plan. Doing so is typically more affordable than purchasing your own. If this is an option, evaluate the plan to see if the plan’s benefits and network will work for you.
- Determine if you are eligible for COBRA and whether it can meet your needs. You have 60 days after your employer-sponsored health insurance ends to enroll in COBRA. This can extend your existing plan for up to 36 months, though you may pay more for the same coverage. However, this can be a good option to ensure you retain your existing health networks and benefits while you search for a more long-term solution.
- Determine if you are eligible for a Special Enrollment Period. If you are eligible for a Special Enrollment Period or within a reasonable timeframe for the annual Open Enrollment Period, an ACA-compliant marketplace plan may offer you the most comprehensive coverage. Be sure to see if you are eligible for subsidies to further save on costs.
- Determine if a short-term, non-qualifying health plan can provide temporary protection. If the other types of health insurance plans cannot meet your needs for budget, eligibility, and timing, a non-qualifying health plan can still offer protection against major medical expenses.
Tips for Choosing the Right Plan
In addition to the overall type of plan you select, you also have options when it comes to the specific insurance company and plan you can enroll in. Here is guidance on assessing individual health needs and financial boundaries for self-employed individuals seeking health insurance.
Tip #1: Assess Your Individual Health Needs
Consider you and your family’s specific health needs, including any chronic conditions, preferred doctors, or anticipated medical treatments. Look at past and current health conditions, regular medications, and any anticipated surgeries or treatments.
Identify your must-have coverage based on your health history, such as mental health services, maternity care, and chronic condition management. Also decide if having specific doctors, specialists, or hospitals in-network is vital, which might lead to choosing a PPO or EPO over an HMO.
Tip #2: Set Your Budget
Understand what you can realistically pay monthly for your insurance premium, taking into account both business and personal finances. This can help you immediately eliminate all health insurance options that exceed that budget.
For the remaining options, compare out-of-pocket costs, such as deductibles, co-payments, and co-insurance to see what you’d pay before insurance starts covering costs. Also note how often you think you would need out-of-network care and use that to inform whether or not you need a plan that provides coverage for that care.
Tip #3: Look Over Provider Networks
Even though some health insurance plan types cover out-of-network care, it is always more affordable to seek in-network care whenever possible. Check if your preferred healthcare providers are in network, including your preferred pharmacies and facilities. If not, consider whether you would be willing to find new doctors within the plan’s network.
Tip #4: Evaluate Covered Services
After you have already assessed your needs, you should have a good idea of which benefits are crucial for your health insurance plan to cover. Every qualifying health plan must cover the Affordable Care Act’s list of essential health benefits, which includes preventive care, prescription drugs, mental health support, and maternity care.
However, insurers may interpret coverage differently, so it is critical to look at the specific services covered. Match them with your family’s needs. For example, if you have a family history of heart disease, you may seek an insurance plan that has generous coverage for heart disease screenings and treatment.
Tip #5: Seek Professional Advice If Needed
Consult with licensed insurance brokers, agents, or financial advisors specialized in healthcare to get help and ensure your chosen plan aligns with your unique situation. You may also seek help before choosing a specific plan, as a professional can help clarify which benefits you need, which plans could be a match, and answer any questions you might have.
Tip #6: Review Your Coverage Annually
Health needs and financial situations can change. Make a habit of reviewing your plan annually to ensure it continues to meet your needs. All in all, choosing the right health insurance plan requires careful consideration and comparison of various factors, including premiums, deductibles, network restrictions, and covered services.
It’s vital to read the plan details thoroughly and understand the terms, ensuring that the plan aligns with both health needs and financial constraints. Seeking professional advice, when necessary, can help you make the best decision for yourself and your family.
How to Enroll in Health Insurance
- Determine your eligibility for government-sponsored health insurance. Check requirements and options based on income, family size, and location. As requirements can differ for Medicaid by state, it’s best to check your state’s Medicaid department for more information.
- Gather all the necessary documents and information. Prepare documents like proof of income, social security numbers, and information about current health coverage. Even if you are not enrolling in Medicaid or Medicare, you will likely need this information to enroll in a plan from the Health Insurance Marketplace.
- Check for the upcoming enrollment period as well as your eligibility for a Special Enrollment Period. Note the Open Enrollment Period usually runs from November 1st to December 15th in most states, while Special Enrollment Periods are triggered by life events.
- Search for a plan and enroll. Look for plans through an insurance broker or agent, on your state or federal platform like Healthcare.gov, or directly through an insurance company. Utilize tips for comparing your options and selecting the best match for your needs. You can usually enroll directly with an agent, broker, over the phone, or online.
Utilizing Tax Benefits and Deductions
Understanding the tax benefits related to health insurance for the self-employed and properly claiming deductions can result in significant savings.
Tax Benefits for Self-Employed Health Insurance
- Self-employed health insurance deduction: Self-employed individuals can typically deduct premiums paid for medical, dental, and long-term care insurance for themselves, their spouse, and dependents. This deduction is an adjustment to income and can be taken even if you do not itemize deductions. Generally, you claim the self-employed health insurance deduction on Form 1040, Schedule 1.
- Health Savings Accounts (HSAs): Contributions to a health savings account paired with a qualifying high-deductible health plan (HDHP) are tax-deductible. Earnings and distributions for qualified medical expenses are tax-free. Contributions to an HSA are typically reported on Form 8889.
- Potential additional deductions: Depending on your situation, you might also be eligible for other healthcare-related deductions, such as medical expenses exceeding a certain percentage of your adjusted gross income.
Resources for Self-Employed Tax Guidance
- IRS Guide to Self-Employed Health Insurance Deduction: Publication 535, Business Expenses
- IRS Guide to HSAs: Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
- Your state’s tax department website: State tax rules may also apply, so consult your state’s tax department website for additional information.
Planning and Future Considerations
Health insurance is not a one-size-fits-all decision, nor is it a set-and-forget aspect of financial planning. Proactively considering future health needs, regularly reviewing and evaluating coverage, and emphasizing adaptability ensures that your health insurance can keep you covered for both your immediate and long-term care.
Consider Future Health Needs
- Family status changes: Anticipate potential changes in family size or structure, such as marriage, divorce, or having children. Ensure your plan can be adjusted to include new dependents or other family members.
- Potential health conditions: Consider your family’s medical history and any known risk factors. Plans with broader coverage might be suitable if you anticipate significant health needs.
- Career transitions: If you expect changes in your income level — such as if you plan to expand your business —, understand how these could affect eligibility for subsidies or other insurance options.
What to Evaluate Every Year
- Network and coverage changes: Check if your preferred healthcare providers remain in network and if there are any significant changes to covered services or medications.
- Cost changes: Check if your premiums, copays, deductibles, and other cost factors change. You may also want to see if you are newly eligible for any new subsidies or breaks.
The Importance of Long-Term Planning and Adaptability
It is critical to think beyond your immediate needs. Choose a health insurance plan that aligns not only with current needs, but also anticipated future changes in health, family, and career.
As business can change quickly when you are self-employed, consider options that allow for adjustments in coverage, such as flexible spending accounts (FSAs) or health savings accounts (HSAs), to adapt to changing circumstances.
In addition, regularly update yourself on changes in health insurance laws, marketplace options, and available resources to ensure your plan remains relevant and effective.
Putting It All Together
Self-employed professionals may struggle finding affordable health insurance without employer-sponsored options. Fluctuating incomes add uncertainties, making it vital to research and select flexible insurance plans that meet eligibility criteria and provide inclusive coverage for their unique needs. But there are options available for those who are self-employed.
Whether you opt for a comprehensive health insurance plan from the Health Insurance Marketplace, government-sponsored coverage, or another type of health plan, you can still ensure you and your family are protected against high healthcare expenses.
Navigating the health insurance enrollment and coverage process as a self-employed individual involves understanding the steps for enrollment, utilizing various platforms for purchasing insurance, managing ongoing coverage, and addressing any issues or appeals. Careful consideration can provide you with a plan that aligns with both your health needs and your budget.