
Ask HN: Freelancers in the US: What do you do for health insurance? - patientfrog
Currently getting health insurance for my wife and me through my employer and plan to transition into freelance&#x2F;consulting. I&#x27;ll have to start paying for insurance and was curious what other freelancers on HN are using, what monthly costs are like, etc.<p>I am especially curious what freelancers in the NYC area are doing.<p>Thanks!
======
Beached
I just had to purchase health insurance two week ago in the state of MI(Just
turned 26).

I had 3 options:

1\. Obama Care - I qualified for a $16 subsidy...

2\. Individual plan from a health care provider in state

3\. Health Share plan (think Credit union for health care)

Obama care cost 2x as much as an individual plan, and almost 3x as much as a
health share plan, so even after the subsidy, this was not an option.

Health share plan was very affordable, however it only worked with the health
care providers on the east side of the state(I live on the west), it had a low
yearly deductible, much lower then the individual High deductible HMO, however
it had a 20% copay for all health services, including routine physicals and
checkups.

Individual Plan from an instate health care plan costs slightly more each
month, but all routine check ups, generic brand pharmaceuticals proscribe from
my doctor, and any specialist (Chiropractor, Knee Doctor, etc) visits are 100%
covered IF I am referred by my primary care physician.

I went with an individual plan for about $140/m and $28/m for dental coverage.

A political side note: this same exact coverage would have only cost me $84/m
before 2014 when Obama care went into play. (edit: Health Care cost, not Heath
+ Dental)

~~~
gwbas1c
The cost went up because of the pre-existing condition situation. Pre Obama
Care, if you had any kind of pre-existing condition, you wouldn't be able to
buy the $84 coverage.

(I got stuck having to get a normal job because of a pre-existing condition.)

~~~
Beached
Yes, Since I do not have any pre-existing condition, and have never smoked,
that $84 would have been mine. Because no insurer can decline someone, my cost
went up to make insurance for people with per-existing conditions more
affordable.

~~~
Aqueous
The fact that you didn't have to buy insurance until 26 is a result of
Obamacare too. Think of all the money you saved being on that insurance for
several extra years. You're welcome!

And maybe in part because you're spending that $84 now someone else who has a
pre-existing condition and no health insurance will be able to not die or go
bankrupt if they get something serious.

You have to buy insurance because our system now factors in the strain on the
system you would cause if something happened to you and you didn't have
insurance. Just think of it like a tax (or the tax penalty like a tax, and the
subsidy like a reward for responsible behavior.) That's how the Supreme Court
thought of it.

~~~
Beached
>The fact that you didn't have to buy insurance until 26 is a result of
Obamacare too. Think of all the money you saved being on that insurance for
several extra years. You're welcome!

yes i am aware that the 26 rule is an obama care result. However, if I am
nice, and I am, I pay my parents the extra cost per month to go from a spousal
plan to a family plan, which is $85/m, shocker.... However if my parents had
other kids younger then me that required a family plan it would have saved me
money, yes. in my response to another post, i noted that this was really the
only positive to Obama care that I experienced.

>And maybe in part because you're spending that $84 someone else who has a
pre-existing condition and no health insurance will be able to not die or go
bankrupt if they get something serious.

I dont think it is fair that I have to pay for someone elses health care
expenses. ESPECIALLY since that someone else doesnt take the time of day to
shop around for the best coverage for the cost, care to look at success rates
to avoid re-works, or heaven for bid, self diagnose themselves and go directly
to a specialist that can result in more expensive care. If people actually had
to pay for the coverage they used, they would take the time to shop around and
make informed decisions, and do things like exercise and eat well, avoid
smoking and recreational drugs, then people with pre-existing conditions, and
low incomes wouldnt have to pay so much for their care. Its called capitalism,
and the health insurance industry would look VERY different. Obama care only
gets us farther from where we need to be, and makes the entire situation
worse. I know I sound like a jack ass right now because some people would
suffer in the short term, but if you eliminated obama care, and the health
insurance industry, we would be better off in 10 years. keep medicare for the
poor, old, and disabled if you want, keeping it will have very little affect
as its an income tax and not a premium subsidy.

>You have to buy insurance because our system now factors in the strain on the
system you would cause if something happened to you and you didn't have
insurance. Just think of it like a tax (or the tax penalty like a tax, and the
subsidy like a reward for responsible behavior.) That's how the Supreme Court
thought of it.

If the government allowed care providers to go after uninsured individuals
assets and not eat the costs. AND if the government allowed back charging for
care given to qualified medicare/medicaid individuals, there would be no need
to increase the burden on me to help pay for everyone else who goes in for
care un covered. over 75% of the uncovered costs pre-ACA are people treating
the ER like their PCP anyways. If we allowed capitalism to work, those
individuals who go to the ER for a cold would eventually go to a PCP and only
pay $25 for the visit and $15 for the generic meds.

~~~
lentil_soup
I'm sorry dude, but not every pre-codition is because people don't exercise or
don't eat well.

------
shiro
I became a freelance 13 years ago. On COBRA for a while. Looked for IEEE group
insurance but HI wasn't covered then. The insurance company (HMSA) offered a
switch to individual plan. It wasn't too bad initially ($350/mo for me and my
wife, HMO, $500/$1000 ded.) But then the premium soared and also we had a kid;
at peak it was $1050/mo without drug, vision and dental. I learned antibiotics
are pretty expensive.

After ACA, it got a lot better. Currently we have PPO through HMSA in HI.
About $650/mo for me, my wife and one kid. Kind of high ded ($1500/$3000), but
drugs are covered and also with basic vision and dental.

~~~
logfromblammo
You should visit your local pet store, in the aquarium fish section, and check
out the products available for maintaining the health and well-being of your
fish.

And you should also learn the generic drug names or IUPAC chemical names for
the commonly prescribed antibiotics.

I'm not saying those two suggestions are in any way related, other than the
possibility that doing both could save you a great deal of money, in certain
situations. Otherwise, grocery stores and big-box stores with embedded
pharmacies often sell generic antibiotics at prices below your drug co-pay,
but you would still need a prescription, and therefore an office visit co-pay.
It pays to shop around.

~~~
welshguy
I have an unhealthy fish. What brand would you recommend?

~~~
logfromblammo
I can't recommend anything, as I am not a veterinarian. You need to do your
own research. Fortunately, the web makes this rather easy. Try searching for
"aquarium antibiotics" and refine your search terms as necessary.

~~~
b_t_s
Fishflex FTW....for fish of course. It's even better than fishmox :P

------
asciimo
The Freelancers Union now offers health insurance
([https://www.freelancersunion.org/benefits/](https://www.freelancersunion.org/benefits/)).
NY was their pilot state.

~~~
colinbartlett
I don't really understand why Freelancers Union is useful anymore. I thought
the point of those "unions" were work-arounds to the old system where group
rates were drastically cheaper.

But with the Affordable Care Act, individual plans are no longer medically
underwritten, so how are those groups helpful?

------
bradwschiller
Oscar is great in the NYC / NJ area
([https://www.hioscar.com/](https://www.hioscar.com/)). They do a good job of
lveraging technology and are less confusing than other insurance companies.
They even have a program with Misfit where you get $1 per day for reaching
your steps goal. Lowest premiums I've found. I'm paying less than $1,000 per
month total for myself, my wife, and my kid.

~~~
colinbartlett
Second vote for Oscar here. My wife and I pay north of $1,000 but have
something of a Platinum plan and it covers _everything_.

The Affordable Care Act has really taken the pain out of insurance when
working for yourself. Things like Freelancers Union were almost a necessity
before the ACA. Now individuals can buy insurance at competitive rates and
without worrying about "pre existing conditions".

------
silentbob46
Like others have mentioned...if you're in NY, just go to
[https://nystateofhealth.ny.gov/individual](https://nystateofhealth.ny.gov/individual)
to research and enroll in an ACA-compliant individual health plan.

Personally, I went with a plan from Oscar
([http://hioscar.com](http://hioscar.com)). Oscar offers reimbursements for
gym memberships, free unlimited access to Teladoc
([http://www.teladoc.com/](http://www.teladoc.com/)), and Amazon gift cards if
you take enough steps per day (tracked by a free Misfit Flash).

Pre-2015, I had insurance with Freelancers Union
([https://www.freelancersunion.org/](https://www.freelancersunion.org/)).
Their plans are not subsidized, but with some of them you get free, unlimited
access to doctors at Freelancers Medical
([https://www.freelancersmedical.org/](https://www.freelancersmedical.org/)).
They have two offices, one in Downtown Brooklyn, and one in the Financial
District.

------
eibrahim
Don't listen to politics in the comment. Here are some real life examples:

I am married and have 2 kids. I got a gold plan through the marketplace for
$1250 a month. I got no subsidies since I make more than is required. It's a
pretty good plan but expensive.

My last job which was pre-obamacare they were deducting $450 a month every 2
weeks for just my wife and I. So nothing really changed for me.

On a sidenote my cousin is low income and she got a killer plan through
obamacare for 75 a month. So now she can afford to go to the doctor and not
"walk it off" :-)

~~~
UnoriginalGuy
Can you clarify this:

> deducting $450 a month every 2 weeks

That is confusing/doesn't make sense.

~~~
potatosareok
$450 a deducted per paycheck. Paycheck every two weeks?

------
midnightmonster
I am male, early thirties, married with children. We have a high-end ACA-
compliant plan purchased directly from Florida Blue. At almost $1600/month,
it's really freakin' expensive. But we have various health issues between us
that make us uninsurable for any reasonable amount via individual plans, and
that also mean we use a lot of health care.

Prior to ACA, we had my wife and kids on a COBRA plan out of Maryland from
when we lived there (God bless Maryland for making COBRA last as long as you
want, and making it last even when you leave the state) and me on a separate
individual policy. Together they were about as expensive as our current plan,
and they had higher deductibles/OOP max and poorer coverage.

Still grateful for the Maryland coverage, though, as I would have had to have
a normal job once we moved to FL otherwise.

~~~
colinbartlett
This is very interesting to me. It was my understanding that the rates were no
longer jacked up, even if you had "various health issues". This is called
Medical Underwriting and I thought it was forbidden by the ACA. It could be a
state-by-state issue. Perhaps Florida is different?

When you applied for insurance, did they acquire your medical history?

1\. [http://kff.org/health-reform/perspective/how-buying-
insuranc...](http://kff.org/health-reform/perspective/how-buying-insurance-
will-change-under-obamacare/)

2\. [http://blog.rmhp.org/2013/12/sticker-shock-obamacare-and-
the...](http://blog.rmhp.org/2013/12/sticker-shock-obamacare-and-the-death-of-
medical-underwriting/)

~~~
midnightmonster
I implied a slightly scrambled chronology. To clarify, we kept the expensive
COBRA coverage from my wife's old job in MD, because prior to ACA there were
no good individual insurance options for her and the kids. Now, with ACA, we
have an individual plan purchased from Florida Blue. It is very expensive, but
not much more so than the two separate plans we had, and the better coverage,
less confusion from the insurance being out of state, and having everyone on
the same deductible and OOP max make it worthwhile.

------
mgkimsal
We've got precious few choices in NC - our county has had only one insurance
company providing ACA-compliant insurance for the last few years, and premiums
have basically doubled in 3 years ($275/month to $530/month). It'll go up
again next year no doubt. This is with the highest deductible available as
well.

Some areas of the country seem to have been better served with the passage of
ACA, but much of NC seems in the dark ages. I _think_ we've got one other
company that's now serving our county this year, and they're ... 20% more
expensive, IIRC.

~~~
tanglesome
That's because the NC state government refused to have anything to do with
ACA.

------
zrail
PPO through HAP in Michigan. $798/mo, $1500/$3000 deductible for my wife and
I, no kids. I dug around on the exchange and then ultimately bought directly
instead of through the exchange because we're not eligible for subsidies.

ACA has basically made this a non-issue. Figure out how big of a deductible
you can absorb, walk through your state's exchange and find something
reasonable. Then (this is the most important part), raise your rate to
compensate for your newly legitimate business expense.

------
dangrossman
Shopped at the healthcare.gov federal exchange, now paying $223/month for a
PPO plan with Aetna. Large network, no PCP election required, no problems with
it the past 2 years. Don't forget that you can deduct insurance premiums on
your taxes when you're self-employed.

------
dragons
I'm in the Boston area, YMMV. I left my job in 2011. I did a few months of
COBRA, which I found unreasonably expensive. I'm currently paying about
$380/month on a BCBS individual plan with a $6K deductible (costs have risen
about $5-$10/mo per year since I joined). I don't think my experience will
help you much (single), but I'm putting this out there for others who might be
interested. BTW I have never met the deductible and usually spend less than
$1K/year on medical expenses. Knock on wood.

PS I haven't noticed much effect due to ACA, except that some services that
used to require a co-pay became free. It will be nice not having to worry
about pre-existing conditions, too.

~~~
eropple
$380/month sounds kind of high. I have similar coverage via MassHealth for
$225/month (+$25 for dental). YMMV, of course.

------
kaypro
Did this 3 years ago when I broke out on my own. I'm in Boston. MA has a
decent portal through their MA Health Connector site. For my family (Wife, son
and myself) I pay $760 on a high deductible plan for health and $99 for dental
for my wife and me. Once my son needs dental it'll most likely go up by about
$40 for the dental. My only advice is to really sit down and determine what
you're going to need for coverage and depending on that choose a high or low
deductible. We started out on a low and realized we really would be better off
on a high one so switched at the next enrollment. Good luck.

~~~
slickwilli
Is that per month?

~~~
kaypro
Yes per month.

------
explorigin
Expect to pay more (relative to group plans). If you want to see what plans
are comparable without entering all your data into healthcare.gov, try
[https://www.healthsherpa.com/](https://www.healthsherpa.com/)

------
batoure
Yeah thanks to the ACA this is really not a problem any more... shop around
and buy a plan...

------
jwolgamott
Step 1: know your medical expenses. Your total cost per year is either a) You
are healthy are it is the sum of your premiums or b) You (or a family member)
is not and it becomes the sum of premium payments + deductible. In ObamaCare
plans, this is basically the OutOfPocketMaximum.

I am firmly in the (b) camp, and see yearly medical expenses as the deductible
plus premiums. And so, I pay $1500 a month in health insurance premiums, but
have a $1500 deductible and $4000 out of pocket max. Yearly cost: $22,000.

So, depending on your health and tolerance for rick, go for a high deductible
cheap premium plan OR a high premium low deductible plan.

As a freelancer, premiums CAN be tax deductible (see a CPA to make sure).

------
netman21
Blue Cross Blue Shield of Michigan. When we started out it only cost about
$500/month. Jumped to $890 and deductible went to $23K with the affordable
healthcare act. Basically, now we pay all of our health care out of pocket.

~~~
zrail
That's atrocious. We're in Michigan and only pay $798/mo for a $1,500
individual /$3,000 family PPO through HAP for my wife and I. Individual
deductible for ACA plans is limited to $6,600 individual and $13,200 family,
so you may want to shop around for a new plan during open enrollment this
year.

~~~
Beached
The deductible cap is only applicable to plans purchased through a health care
exchange. He is likely on a family plan and purchased his insurance
individually. similar ACA coverage would certainly carry a lower yearly
deductible, however would likely double his monthly premiums. This was the
case for me on my individual plan.

If he has a healthy family who does not need coverage outside of basic
physicals, then its likely he purchased this plan to only cover catastrophic
events, I know I would rather purchase the $500/m with 23k deductible rather
then the $1000/m 13k deductible if I only planned on using coverage in the
event of a horrible catastrophe.

------
gervase
Jesus, I thought we had it bad, but some of these other comments are making me
rethink that. We're paying ~$640/mo for a $0 deductible, 0% coinsurance ACA
Gold HMO, purchased off CoveredCalifornia. That's without any subsidies - like
most on HN, we're just not eligible. That's covers me, my wife, and my infant
daughter, and includes maternity coverage.

It's still about double what we were paying before the ACA, but it's a far cry
from the $1500+ premiums some others here are paying.

------
schlagetown
I'm in NYC, recently turned 26 and signed up for the cheapest Oscar plan
available. It's only around $180 a month — fairly high deductible (~$6,000)
but includes free preventative care and a couple free primary care visits per
year. I believe this "catastrophic plan" is only available for people under 30
yrs old, otherwise the cheapest is more like $300. Also doesn't cover
prescriptions, but I don't have any so it seemed the best option for me right
now.

------
bmj
It's been awhile since I've looked into it, but my local tech council
([http://pghtech.org](http://pghtech.org)) offers a coverage group to provide
health insurance options to member organizations. I knew a few folks that have
leveraged this in the past, but I'm not sure how rates have changed due to the
ACA.

It may be worth seeing if such a program exists in NYC, and if it would be
worth the membership costs.

------
codegeek
I did exactly this as a freelancer even though not anymore. It will cost you
more out of pocket to buy insurance compared to a "group" plan through an
employer.

My first suggestion: Keep the health insurance through your wife if you can
and if she is still working. It is hard to beat the plans sponsored by
employers as they get subsidized group rates to offer to employees.

But if you absolutely need to buy your own, you have 2 options:

Option 1: Use Obamacare [0] and see your options. You can try healthsherpa.com
[1] which is a unofficial wrapper on top of obamacare and you can compare the
various plans.

Option 2: You go and buy health insurance directly from an insurance company
without the extra layer of obamacare in between. You can use sites like
ehealthinsurance [2] to get some quotes.

Option 3: Use an insurance broker. Find someone locally in your area.
Sometimes brokers can get you good deals.

All options have benefits and problems. I personally hated obamacare as it was
too much bureaucratic crap to deal with and now you have 2 layers to work
with. The only advantage of obamacare is that if you are considered poor by
obamacare standards, you can get subsidy on your premiums if you enroll
through obamacare. But if you don't care about these things or are not
applicable to you, then just go buy insurance directly and not even bother
about obamacare.

Monthly Costs depend on a few factors:

In-network vs Out-Network: Very important factor. You can only go to certain
doctors/hospitals etc that are "in-network". Some plans only allow in-network.
Some plans have both but have higher premiums. Also, out of network coverage
is very limited usually.

Co-Payment: This is the amount (usually $10-$30) that you will pay for _every_
visit to a doctor. Some plans have no co-payment while most have the range as
I mentioned.

Deductible: This is the amount that you will pay _first_ for any medical
expenses _before_ your insurance company pays anything. So if you go for a
plan with "high deductible", then your premiums may be lower and so on.. I
will say that for a family specially with kids, I personally prefer zero
deductible as it can save you more over a year since kids visit doctors
frequently. But if you think you won't visit the doctors as much in a year,
then go for high deductible. Again, just a choice and no right answer here.

Co-Insurance: This is the portion that you will pay _after_ your insurance
company has paid the remaining portion. For example, if your co-insurance is
30%, then the insurance company will pay the 70% for the medical expenses and
you take care of the rest. Again, to get here, you will have met your
deductible first.

Out of Pocket limit: This is the _total_ amount you may pay for an entire
year. Anything over this, the insurance company pays regardless. For example,
lets say your deductible was $500, co-insurance 30% and out of pocket limit is
$5000 for the family and you end up with a bill of 14,000 on your very first
visit during a calendar year. In that case, you will pay upto the total of
$5000 (including deductible+co-insurance) and insurance company will pay the
remaining balance of $9000. After that, you will not pay anything for that
whole year (except copays). Plans with higher out of pocket limit may have
lower premiums by logic.

PCP (Primary Care Physician) required: THis may not affect cost but important
factor to know. Some plans require you to choose a PCP and only use that PCP
as your well, PCP. You have to let the comnpany know if you change PCP.

Specialist Referral required: Some plans require you to get referral from your
PCP before you can visit a Specialist. This is critical as you cannot go to a
specialist on your own in that case.

Hope this helps. Happy to give you more inputs if you need.

[0] [https://www.healthcare.gov](https://www.healthcare.gov)

[1] [http://www.healthsherpa.com](http://www.healthsherpa.com)

[2] [https://www.ehealthinsurance.com](https://www.ehealthinsurance.com)

~~~
zrail
> The only advantage of obamacare is that if you cannot buy insurance yourself
> that easily with things like pre-existing conditions etc.

Medical underwriting is no longer a thing industry-wide and hasn't been since
the beginning of 2014. No matter where you buy your plan, they will not ask
about pre-existing conditions.

It's true that the only reason why you'd actually buy through an exchange is
to get the subsidies, even if you don't it's worthwhile to check. They offer a
pretty comprehensive survey of the companies that offer insurance in your
state and roughly how much you'll pay, and you can go to those companies
separately and check into their plans they don't offer on the exchange.

Another idea is to find a local insurance broker in your area. They're free to
you (the insurance companies pay them) and they'll find you a good plan that
fits your needs.

~~~
marincounty
"The only advantage of obamacare is that if you cannot buy insurance yourself
that easily with things like pre-existing conditions etc."

It has vastly improved the health care the poor receive.

I'm not a huge fan of Obamacare, but it is all he could get past the
Rebublicans at the time. He tried to push for a sensable solution, but
Republicans fought it. I am waiting for anyone to propose a better solution to
Obamacare, but keep bill's core requirements.

As to what how for-profit insurance companies have explioted us, while blaming
Obamacare; I hope there's a special place in hell for these heathens! In the
original Obamacare bill there were measures that would limit rate increases,
and out of pocket fees--the Republicans got rid of all of them. I recall them
saying, 'Get ride of this language/requirement and we might pass it?"

What I am trying to say is get rid of Obamacare, but replace it with something
better. I haven't heard any real alternative plans proposed by the
Rebublicans? I though the the Rebublican Doctor(Bobby Jindal) would have a
thoughtful, pragmatic plan--yea, he has a plan, but it just sounds like
basically going back to the free market system we had before? That worked so
well?

~~~
nsxwolf
I don't think what we had before could really be described as a "free market
system". It was an employer-based healthcare system that shut individual
buyers out of the only good deals, enacted by the government via the tax code.

The new system is the same, except now there's no pre-existing conditions and
the individual is forced to buy a plan. The plans themselves are the same
crappy plans with a few tweaks.

The consumer of healthcare is still completely disconnected from the price of
the goods sold, completely screwing up market signals and making sure prices
stay astronomically high. This is not a free market by any measure.

------
tanglesome
I set up a Type C corp for my business. With it, the company can pay for all
my employees (just me and my wife) medical expenses. For health insurance, in
NC, I pay out the nose: $1,200 a month. It's a good, but not great, Blue Cross
plan. In NC, that's really the only company that will look at you.

~~~
Retric
600$/month pretax is not that bad, but I suspect you can do better.
[https://www.ehealthinsurance.com/](https://www.ehealthinsurance.com/) has
lots of plans starting at $264.45 /month for a 35 year old.

Granted the deductibles look high, but unless you have ongoing heath issues
your generally better off using a higher deductible and putting the difference
into a savings account.

PS: Don't forget the high ROI part of health insurance is simple negotiating
power, the risk mitigation part is less useful.

------
ojiikun
I elect to have none, and pay a yearly penalty to the federal government as a
result. I earn and save money on my own to cover medical expenses. I view
payments to a 3rd party who then bank their business model on my _not_ needing
payouts as a form of gambling on human welfare, which I deem immoral.

~~~
peacemaker
While I agree the whole system is immoral, I have to ask what will you do if
you have a critical injury or disease? Lots of things can happen outside of
your control and healthcare is an insurance against going bankrupt.

------
rch
I haven't used them myself, but I've always been curious about the group plans
available to IEEE members:

[http://www.ieeeinsurance.com/us/home.aspx](http://www.ieeeinsurance.com/us/home.aspx)

------
dnm
When I was contracting (pre-Obamacare), I joined my local Chamber of Commerce
and that made me eligible for their group plan with the local BCBS (family
plan). Started with a PPO. Eventually downgraded to an HMO due to costs.

------
hellofunk
When I was in NYC I joined the Freelancer's Union which provided health
insurance. That was a few years ago, but it was quite helpful.

------
orasis
Obamacare/BCBS is working great for us.

------
daxfohl
Ask HN: What is the best subject to invite trolls rather than subject matter
experts into the conversation?

------
jedanbik
I pay $228/month for a personal silver plan down here in NC through the
marketplace.

------
bsdadmin
I went to a health insurance broker who helped find the best plan for IRS
section 105.

------
x5n1
live in canada.

~~~
smutticus
Seriously, as a Dutch/American dual citize I'm debating moving back to the NL
simply for this reason. From what I can tell I would pay close to a quarter in
NL for better insurance than in the USA. The US is a complete ripoff.

------
rwhitman
Self employed health insurance in New York is ludicrously expensive, or at
least it was prior to Obamacare. I've been on my wife's employer's plan but
before that, I used Freelancer's Union which is NY only. I'm a big fan of
their organization and everything they offer. The health insurance itself is a
group plan and more or less provides what an employer's plan would. They also
offer other types of benefits you'd expect from an employer.

