
Ask HN: Self-employed healthcare options? - wc-
I am making the leap back into self-employment, consulting, etc.  This question pertains to USA healthcare, although I welcome others asking the same question for other countries...<p>What do other self-employed consultants do now for healthcare?  Should I just wait and see what happens with the Obamacare repeal?  When I officially terminate my position at my current company can I sign up for Obamacare for a year?<p>Thanks everyone!
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chrisbennet
I'm a self employed consultant in NH. Things may be different in other states
so treat this as a data point. For a 2 person, 50+ year old couple, our bronze
policy premium is ~$800/mo I think.

The big difference between an employee health plan and going it on your own is
the very high deducible ($6K+, double that for a family). You get a break on
prescriptions and a once a year physical is included but for everything else
you're paying out of pocket for your health care unless you get very sick.

[https://www.healthpocket.com/healthcare-
research/infostat/20...](https://www.healthpocket.com/healthcare-
research/infostat/2017-obamacare-premiums-deductibles)

On a related note, you absolutely need to charge enough to cover the extra
cost or you are going to make less than if you worked for a company that pays
your health insurance.

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jweir
When life conditions change you can sign up for Obamacare – i.e. you move,
loose insurance

[https://www.healthcare.gov/glossary/qualifying-life-
event/](https://www.healthcare.gov/glossary/qualifying-life-event/)

Also look into COBRA [https://www.healthcare.gov/unemployed/cobra-
coverage/](https://www.healthcare.gov/unemployed/cobra-coverage/)

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wc-
Thanks, my current plan is to price out those two options.

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bsvalley
Here is what I'd do if I were you. You should look at how much your current
premium would cost if you were to switch to COBRA (when you leave your job,
your current employer is required by law to maintain your health coverage for
up to 18 months). Though, you would have to pay the full premium because your
employer would not participate anymore. Right now it's all accounted in your
paychecks and it's invisible to you.

So ask your HR how much it would cost per month to maintain your current
coverage under COBRA. If you can handle the payment, then I'd suggest to do
that for a few months and to not worry too much. You'd maintain your current
doctors, insurance card, coverage, etc. Settle down in your new position, look
at your monthly spendings, do some research, then eventually switch to a
cheaper coverage.

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cylinder
I've never seen cobra be worth a damn, always insanely overpriced and now ACA
exchange plans are usually better option.

~~~
bsvalley
It depends what you're looking for. In the tech industry, a lot of employers
offer top-notch health benefits. If you want to match that on the market,
prices are comparable.

If you're looking for a standard health plan then I'd say yeah... why would
you maintain an expensive health plan if you feel like you don't really need
it? Cobra is just a term used to maintain your employer's coverage, usually
when you lost your job on a short notice it protects you from any health
issues. That's why it's always good to request all the details from your HR in
order to get the exact premium cost under Cobra. Some people just want to keep
a similar coverage, in this case Cobra makes it easier.

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Mz
I will suggest you check out these previous discussions of Direct Primary
Care:

[https://news.ycombinator.com/item?id=13354383](https://news.ycombinator.com/item?id=13354383)

[https://news.ycombinator.com/item?id=13354383](https://news.ycombinator.com/item?id=13354383)

If you are under age 26, you may be able to get on your parents' insurance.

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karmajunkie
I am currently on a really good healthcare plan with my wife's employer (large
state university) after we got married last year. I'm based in Texas, so YMMV
depending on your state.

Prior to that, I was on an ACA plan since they were first available, and
before that on an individual policy. Despite its issues, I am a huge proponent
of the ACA—I would not have been able to continue being self-employed and have
reasonable access to healthcare without it. I am dreading seeing just how bad
the Republicans screw up its core tenets regarding preexisting conditions (my
wife is a cancer survivor) and subsidized access for the working class and
poor (I made too much to qualify for subsidies, which doesn't bother me, but
I've seen how much they help others.)

My silver plan in TX was pretty good—the network was a little smaller than I'd
like but I was able to work with it. Last year I paid about 575/mo for that,
which covered my son and I, and an additional 35/mo for dental. Deductible was
about 1800 per individual, IIRC, with $10/35 copays for PCP and specialists.
RX was a tiered plan with copays of $10/30/50/20% depending on the drug—most
of mine were either $10 or $30.

My insurer (Aetna) pulled out of TX this year, but I don't buy the market-was-
failing argument—it was pure retaliation for a rejected merger between Aetna
and Humana.

Having had an individual policy for years before the ACA was available, it
really was a night and day difference. Getting individual insurance was 3-6
months worth of tracking down medical records, dealing with hours of phone
calls to explain why I didn't provide whole pages worth of details about
medical visits I barely remember having (do you remember every doctors visit
for flu or minor injury for the last ten years? I sure as hell don't.) I am
dreading going back to that after the GOP finishes screwing this up.

If you're considering going off a group plan, I'd consider carefully whether
you want to do that until the healthcare law is settled, if you have a choice.
My guess is that what's going to happen is that preexisting conditions will
still not be grounds for rejection but your rates will skyrocket for them, and
the GOP will scrap requirements for minimum coverage, mental health,
maternity, and preventative care benefits. The only thing I've seen that I
think would be a net benefit is making HSAs available regardless of whether
the plan is a HDHP, but I'm betting that all individual plans are going to
either be an HMO/ACO or HDHP—PPOs will only be something you can get from a
large employer. Your costs for what you do get are going to go way up.

When you leave your employer now, provided you do it before the ACA
marketplaces are scrapped, you'll have about 30 days to get a new plan through
a marketplace because of a life-change event, so you should do your homework
ahead of time and pull the trigger on that as soon as you give notice. (The
ACA actually gives you something like 60 days, but I think the Trump
administration reduced that window as soon as they could, trying to cripple
the marketplace even further.) The plan should be in effect until the end of
the year, but all bets are off for 2018.

I'm normally the first one to cheerlead for going on your own, but I'd really
consider that move carefully right now.

