
Ask HN: What healthcare options exist for entrepreneurs? - econti
Would like to know what are the best options for healthcare when working for yourself in California. How much should I expect to pay?
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plasma
This is a bit political; but relevant - vote for Universal Healthcare
(Medicare for All), and this won’t even be a thought for you.

I’m from Australia and don’t need to ever worry about health care costs; and
you’d never in my life get me to vote to have a system like yours here.

I say this not to rant, but to hope in my heart that America can deliver this
level of care to its citizens, and free you and your family from this burden.

~~~
lovetocode
Also relevant if you want nationalized healthcare expect to pay a significant
amount more in taxes. America is the third most populous country in the world
with over 320M documented citizens + an unknown amount of undocumented
citizens. Roughly half of the us population does not pay income taxes yet
still need to be covered by healthcare. It’s probably much more affordable and
of better quality to get a private insurance plan. So either be an
entrepreneur who makes money so that you can afford that option or get
healthcare through a company and moonlight your way to the top. Edit: also you
can elect S-Corp and get a payroll system like ADP with a healthcare plan they
provide

~~~
andrei_says_
Fear, Uncertainty, Doubt.

Insured families pay $1200-1500/m for premiums with thousands of dollars of
deductibles and annual limit on spending. And the. Have to fight for every
cent the insurance companies do their damn best to not pay.

How will we pay for single payer? We take all the money that goes for
healthcare right now, burn half of it and use the other half. Or less.

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idlewords
I pay something like $430/month through Kaiser. My experience there is they
are really good unless you need mental health stuff. I would especially
recommend cancer—the views of SF from the chemo lounge are spectacular.

Kaiser is their own insurer/pharmacy, and works like a mini version of single
payer. If you're younger than me (I'm 43) you may find some plans with them
that are cheaper.

Another option is OneMedical, which is kind of boutique health care for
wealthier people, but lets you do a lot more online than most medical services
and may be worth a look.
[https://www.onemedical.com](https://www.onemedical.com)

~~~
dawhizkid
Why do you say One Medical is for "wealthier people"? Outside of the $200
annual membership fee, it's no different than seeing any other physician if
they are in-network for your insurance plan.

~~~
Nuzzerino
I had several doctors from One Medical and they were not the best. However,
there were a number of things that made up for it. Setting up appointments was
easy, the locations were convenient, and you could even talk to the doctors
via messaging on the website. Viewing and downloading test results could be
done via their website also, and I've had to jump through hoops to get test
results elsewhere.

However, to call it a true concierge practice would be a joke, in my opinion.
I've never had the money for one (10k+ per year fee), but a friend of mine did
have one of these, and at least in his case they were able to cure a serious
back problem of his through cutting edge and non-invasive therapies. I
wouldn't expect to find anything close to that at One Medical.

Still would say the One Medical membership fee ($200) is worth it if you can
find a decent doctor there and if you're not happy with what you currently
have.

~~~
dawhizkid
For me, the best thing about One Medical is that they have walk in labs and
you can do your labs in their office without going to a Quest Labs or LabCorp
office, which are not pleasant at all and usually have long waits.

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kxyvr
Your best choice will likely be a plan from the ACA. In California, this is
[https://www.coveredca.com/](https://www.coveredca.com/). You can try and get
cute and find something like a MEWA, which have theoretically been cleaned up
from the disaster that they were in the past (bankrupt and not covering
claims.) There's also professional organizations that you can purchase
through, but I've never seen one that isn't just a gateway for the ACA.

As far as price, just check the market. There should be a way to see prices
without even creating an account. The total price to account for is premium*12
+ out_of_pocket_max, which should be between $11-15k for the year for a single
person regardless of what plan you have. For me, I'm at about $490/month for a
$7900 out of pocket max, which puts my total liability at $13780 for the year.
Though, it will probably be less than that given that I'm healthy. That said,
I'm not in CA.

Anyway, good luck! Running your own business is exciting and this is an
expense. Also worth noting that your premiums are completely deductible as a
self-employed person, which is normally not the case.

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corbet
We get group insurance (with BC/BS) through a local broker. One thing to have
a look at: we found that the high-deductable plans were so much cheaper that
we could put enough into everybody's HSA account to cover the deductible and
still come out ahead. I think it's one of the best moves we ever made, and
I've stress-tested the insurance pretty hard...

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bwb
I pay $1,050 for myself, my wife, and my son. It is crazy, that is with a $6k+
deductible per person... It is terrible insurance and just for catastrophic.

I hope we do Medicare for all. This system is so broken, it is time to learn
from Europe, Japan, etc. I don't get why we don't steal great ideas because we
are doing terrible.

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whalesalad
I am self-employed as a software contractor. I think my wife and I pay around
$500 combined for the two of us via Oscar. We had BC/BS for a while but as two
relatively healthy people we opted to reduce our monthly expenses a bit and
switch to Oscar when BC/BS raised their prices _again_ at the start of 2019.

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usaphp
Family of 4, I pay 1250$ for the cheapest Blue Shield CA plan. I got the plan
comparison on [https://www.stridehealth.com/](https://www.stridehealth.com/)
but the enrollment period is over already for this year, unless you qualify
for an event.

~~~
econti
I assume that is per month?

~~~
usaphp
Yes

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soulnothing
Look at the MarketPlace, HealthSherpa, or ehealthinsurance.

I'm not sure the rules on posting links. I'm not associated with any of the
above. But whenever I'm relocating and working a contract without benefits. I
use those three sites to narrow down my options.

~~~
econti
Have you tried healthcare.gov?

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eappleby
I run a 1-person LLC in NYC. I initially used healthcare.gov for my coverage,
but once my business started making money, I found that I was paying a lot for
mediocre coverage. The providers I used also stopped offering coverage after
2016/2017, so I decided to switch to TriNet. They are an HR service, but also
offer health insurance, which is all I use them for. I also looked at Gusto
and JustWorks, but they required 1+ employees. I currently pay about $1500 for
me and my family for pretty good coverage from Aetna (including dental and
vision).

~~~
rcalafato
How did you get just the insurance? I reached out to them and was told I
needed a full service plan ($500/mo before the insurance) with them to get the
insurance. I have a 2-person LLC partnership, and we don't need the business
services.

How'd you do what you did?

~~~
eappleby
I pay for the full service plan (it is less for me since I am just 1 person),
but I don't use any of the other services. Even with the fee, it is still a
good deal.

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rootusrootus
I don't know how applicable it is, but if you are big enough to have an
employee or two, check with whomever you contract with to handle payroll
processing and see if they've got an offering. My wife's last gig was for a
three-employee company and their payroll provider was able to offer group
insurance rates that were pretty competitive.

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DoreenMichele
In the US, if you are under age 26, you can still be covered by your parents
insurance thanks to the ACA ("Obamacare").

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nutjob2
If you pay yourself little enough you can get free or subsidised healthcare
through Obamacare. There are no asset tests.

~~~
kxyvr
This is false and will likely get you into trouble. ACA uses your last year's
income tax return in order to determine whether a subsidy should be awarded.
While it is true that you do not send in your tax return while applying for
coverage, your insurance company does send in paperwork through a 1095-A. In
the past, 1095-A was used primarily to show that coverage was carried in order
to avoid a tax penalty, so, yes, you may be able to get away with it, but
you'd still be lying and there will be documentation that you are lying.

Also, sole-proprietorships and S-corps, LLC or not, are considered pass
through and all company income is considered personal income as far as the IRS
is concerned. There's no such thing as not paying yourself in this context to
drive down your income.

~~~
jjeaff
There is nothing false about his comment (maybe it was updated).

ACA is fully based on projected income for the year. Previous year's tax
returns are one way of substantiating your projected income. But not required.
If you are living off of savings and not making a profit yet on your business,
you can pay yourself a small salary and qualify for full subsidies from ACA.

If you file as a C Corp (which you can do with an LLC), you could even hold
profits in retained earnings and not pay them to yourself yet. You would of
course have to pay corporate tax on those retained earnings.

~~~
kxyvr
Yes, ACA is based on projected income:

[https://www.healthcare.gov/income-and-household-
information/...](https://www.healthcare.gov/income-and-household-
information/income/)

However, for most people, the primary number to estimate this is your adjusted
gross income, which they explicitly instruct to use line 7 on the 1040. It's
not entirely clear to me who the regulatory authority is now that the tax
penalty has been taken away for not carrying insurance, but I'm pretty sure
it's going to look bad if you say that your income is near $0 to get a
subsidized plan and your actual income is above the subsidy level and the IRS
will have this information.

As far as holding the money in a C-corp, sure. However, then you're going to
pay the corporate income tax rate for keeping the money in C-corp, file much
more complicated paperwork than you would as a sole-proprietorship (depending
on the state), and then likely have to pay additional taxes or play games once
that money turns into income. All of this is to save on what's going to turn
out to be likely less than $5k in premiums, which are already tax deductible
as a self-employed person.

I'll still contend that the comment is largely false given the idea is to save
money by pretending that there's no income. The IRS isn't dumb and they'll get
their taxes eventually even if it requires an audit. It seems like a huge
hassle and liability to play this game to save such a small amount of money.
If this isn't a small amount of money, then the OP isn't in a position to
start a business, unfortunately.

~~~
nutjob2
I don't know why you latched on to the notion that I was suggesting something
dishonest.

You might be prioritizing developing your product over making income, or
reinvesting income rather than spending that income personally. Or you might
have savings or existing investment funding. There are many common scenarios
such as these and none of them involve fraud.

You can be building up a substantial asset and living frugally and it doesn't
affect your eligibility because of the lack of an asset test and because any
capital gains are not realized) or assessed) until the business is sold.

Also as a single person you can earn up about $12K and not pay any premiums
under Obamacare, or get up to about $48K and still get a subsidy. If you have
a family of 4 these figures and $23K and $96K respectively. So obviously you
don't have to get your income down to $0.

~~~
jjeaff
Those minimum/maximum rates are different depending on if you state has
medicaid expansion or not.

But I think the rates you posted are federal poverty level for a family of 4.
Obamacare coverage kicks in at 138% of FPL all the way up to 400% of fpl.

Below 138% FPL disqualifies you for obamacare because you would qualify for
state medicaid coverage.

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xtiansimon
You’re looking for network healthcare plans? It was news to me to learn about
‘sliding scale’ pricing at many county hospitals. Same for clinics.

If you’re young and in good overall health, this might be a choice to
consider.

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sjg007
Use the exchange.

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greggeter
I pay $150/mo using a health sharing service called Christian Healthcare
Ministries. There are others not religious in nature like Liberty Health
Share. Would be $450 for entire family.

~~~
1123581321
I vouched for this dead comment. I know a few self-employed consultants or
business owners who use this kind of mutual expense sharing for their
insurance. (I learned about the concept from my auto insurance agent several
years ago.) It seems like something entrepreneurs actually use and may be more
viable than high deductible insurance for people who would actually use their
insurance (but more expensive than Medicaid.)

~~~
e1g
It is worth highlighting the major difference: these products are not at all
health insurances, and they cannot be labelled as such.

When you have a contract with an insurance company, that service provider has
to pay up or you can sue them if they don't. Sure, there might be a co-pay or
a high deductible, but if you draw an unlucky card with cancer / heart /
cardio disorders, they will fork out six-seven figure sums to get you better.

"Christian Healthcare Ministries" and the like have no obligation to pay out
and you are gambling on their goodwill, which can be revoked at any moment
with no recourse. Further, they often have _lifetime_ caps of ~$100k per
diagnosis/condition, and in case of any serious illness this will be chewed up
in 3-4 months, then you are on your own.

~~~
1123581321
Yes, that all is important to consider. My understanding is that this was
especially true before the ACA, when certified continuous coverage was a big
deal.

The lifetime limit is more complicated than that as they seem to have separate
programs for up to a maximum and everything beyond that. For example,
Samaritan Ministries (one of these programs) costs ~$500/mo for a family for
everything up to $250,000 and about $500/year to cover $250,000 with no limit.
I’m guessing that’s done because they have members who live in inexpensive
countries, but it seems like the extra annual cost should just be rolled into
the monthly so no one makes the wrong choice about how much to cover.

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sergiotapia
saving thread

~~~
jotjotzzz
(and loans.. hopefully not student loans)

