

Ask HN: What to do about healthcare when working on a startup? - mrsmee89

I&#x27;m currently living off my savings.<p>What are my options as far as getting a high value healthcare plan?<p>To be clear I have no income as of now, not sure how that affects government subsidies.
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toomuchtodo
Have you checked [https://www.healthcare.gov/](https://www.healthcare.gov/)
(or [http://www.coveredca.com/](http://www.coveredca.com/) if you're in CA)?
If you're living off your savings and have little or no income, your monthly
premium should be heavily subsidized.

~~~
kurttheviking
Do this. Much of what the ACA is intended to do (we can debate its effect
another day) is address low-income scenarios. Also, consider COBRA (and
related state programs) as an intermediate step if available and necessary[1].
Dont' get a part-time job just for insurance...that's a distraction which will
sap your energy and focus.

[1] [http://www.dol.gov/ebsa/faqs/faq-consumer-
cobra.html](http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html)

~~~
bmmayer1
Is it ethical to take a government subsidy intended for low- or no-income
Americans if you have the savings to start a startup, and presumably the
thought capital to be able to work for a real salary if it doesn't work out?

~~~
Blackthorn
Yes. What do you think you paid taxes for while you were building those
savings?

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rdlecler1
I would love to see some kind of streamlined startup system. You apply, pay a
nominal fee, if accepted--you're then set up with a corporation, standard
offering documents, digital captable, vested founders agreements. The
government offers HC for companies with less than $1.5m funding and lifts all
of the legal overhead associated with employment/compliance issues--at least
for a short period of time. Starting a startup is hard, you give up a lot of
your life, opportunity cost, take on a lot of risk, mess with your health, and
then you have to deal with all of the legal and admin costs--it's a tax on
innovation.

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gumby
Just buy health care. Since you have no income you qualify for subsidies under
ACA/Obamacare (but even without those subsidies the plans available are much
better than the ones before the law passed).

The ACA is one of the most entrepreneur-friendly laws passed in my lifetime.
Big businesses don't like it because health care is one way to retain
employees, and so the lobbyists screwed it up a bit for medium businesses. But
while starting, it's a lifeline.

COBRA from your previous employer is probably more expensive.

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lambdaelite
It sounds like it's not viable at this moment, but later down the line you
could use a PEO (professional employment organization) for your startup. This
would give you health insurance in addition to a bunch of other benefits and
services.

Professional organizations (like IEEE) offer insurance plans. Another
possibility are shopping clubs like Costco. I haven't used either, but include
them as possibilities in case you weren't aware.

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caseyf7
I had a health insurance expert tell me with a straight face that she
recommends getting a part time job at Starbucks to her clients. Apparently
they give great health benefits to part time employees.

~~~
mrsmee89
Believe it or not I actually considered that!

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prokes
You may want to consider a High Deductible Health Plan (HDHP), which generally
offer lower monthly premiums for a higher deductible. This reduces your
monthly cost but should something happen, would require more paid out of
pocket before insurance contributes. The main benefit is a safety net in case
something serious happens.

Additionally, with an HDHP you may be eligible for a Health Savings Account
(HSA), which are tax advantaged savings for medical coverage, reducing your
cost of care.

If you're interested in HSA's I have blogged on their benefits[1] and wrote a
web app to track your HSA spending[2].

[1] [http://www.hsaedge.com/](http://www.hsaedge.com/) [2]
[http://www.trackhsa.com](http://www.trackhsa.com)

~~~
hamburglar
Absolutely consider an HDHP. I did a ton of analysis on how much I paid in
premiums versus how much was actually paid out on my insurance plan, and I
discovered that in a typical year on my old "gold" plan, I paid out twice as
much in premiums as the insurance company paid on my behalf. To put this in
real terms, I paid $12k in premiums and I needed $6k in care. My HDHP premium
is more like $1.5k, and although the idea is that I pay for everything out of
pocket, I've been surprised at the amount of stuff that's been covered as
"preventative". And the out-of-pocket maximum is capped on the HDHP to barely
more than the amount I paid in premiums on the "gold" plan. I encourage you to
run the numbers. It's really eye-opening.

~~~
lexicalscope
It's interesting to see different people have such different experiences. For
me, my wife and I both have chronic health issues, in her case more serious
ones, and so HDHP makes no sense for us. I can see how for people without
those issues it can make a lot of sense if you use your insurance less for
chronic treatment and more for preventative care and, as you said, a safety
net. On the plus side, you can generally switch from HDHP to a low deductible
plan at the next plan year start date should your situation change (as ours
did).

~~~
hamburglar
Yeah, that makes sense. The way it works out for me, even a year with
astronomical healthcare costs is only going to cost me a couple thousand more
because of the HDHP, and I saved nearly $8k last year due to the extremely low
premiums, even after considering the out-of-pocket healthcare costs for my
whole family. The way I look at it, that $8k has already paid for 2-3
hypothetical worst-case years sometime in the future.

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ams6110
Go without? What's the worst that can happen? You go bankrupt? Surely you've
accepted that possibility already, if you're living on savings, and knowing
that most startups fail.

~~~
whiddershins
This is horrible horrible horrible advice that may or may not have been
facetious.

The main reason, in my experience, for having health insurance is that you DO
NOT receive the same standard of care with it, even in emergencies.

I discovered this when I accidentally cut one of my digits nearly off, and had
no health insurance. I did not receive the same standard of emergency care,
even though I had the money to pay. I was scheduled for repair surgery over a
week after the injury and literally needed to show the money before any
procedures to save the digit because it was considered "elective" to do more
than just stop the bleeding.

So if you do not have the money to pay, you might be astonished at what
procedures are considered "elective" or "non-emergency."

Forget bankruptcy, insurance coverage influences quality of care, and access
to care, regardless of what popular conception is.

~~~
veidr
Can't upvote your comment enough. A lot of Americans have this (utterly
incorrect) idea that emergency room care is free and equal for everybody.
That's only (somewhat) true when it comes to _preventing you from dying right
now in this hospital_.

As a college student, I was studying abroad and came back on vacation. A buddy
crashed our car and I went face-first through the window. I went to the nearby
Alta Bates hospital in Berkeley. Maybe it was the privileged white vibe I
exuded, but I was immediately attended to by three different nurses, who
cleaned up the wounds and told me all about the stitches I was going to get,
and how Dr. So-and-so (forget the name) was so good and he would be with me
soon. Meanwhile, after stopping the bleeding, they asked me to fill out some
paperwork.

After I filled it out (listing "None" as my insurer) I never saw Dr. So-and-so
or even any of the nurses again. I got five packaged alcohol wet-napkins and
was sent on my way. I have a bunch of permanent scar tissue inside my mouth as
a result.

Still, in my case, I thought the experience was worth it to me personally as a
learning experience.

But I am old enough now to know lots of people in the USA who have gone up
against cancer. Some with good insurance, some with typical insurance, and
some with none. The people with no insurance didn't get anywhere near the
level of care that the others did.

If you are unlucky enough to contract a serious and dangerous disease,
following am6110's advice above will probably increase your chances of
suffering and dying prematurely, or even avoidably.

