

Ask HN: Startups and independents, what do you do about health insurance? - lawnchair_larry

I am not working for a BigCorp for the first time in my life, and I have not had health insurance or benefits since leaving my last employer. Given that there are a lot of small startups and independent contractors on HN, I am seeking advice on the best options for insurance and benefits.<p>Who offers this to individuals or very small companies?
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tirrellp
I have an Anthem Blue Cross (California) family plan. It has a high deductible
(7500), and is attached to an HSA. Most normal routine preventative
maintenance is covered. My premium is $200/month. I treat this plan as 'major
medical' and sock away as much money as possible into the HSA, which I use for
EVERYTHING I CAN.

As an interesting side note. I was talking to my doctor, who happens to have
the same health insurance as me. He said that I am better off using my HSA in
most cases. For example, his practice charges $130 for a routine visit if I
pay directly from the HSA. If I charge it to my insurance, its more like
$1300. Why? 1, because dealing with insurance, by his own admission, is a
PITA, and 2, he will ALWAYS charge the maximum that will be covered by
insurance... its how business is done. But for cash (HSA) payments, the
administrative overhead is so low and the risk factors for nonpayment
(insurance denies the claim, etc) are so low and the A/P cycle is so short, he
would rather get paid $130 NOW (on my way out) than get $1300 90 days net IF
insurance approves the claim. He said a lot of doctors and dentists do it this
way and I should ALWAYS ask 'whats the cash price' because some have tiered
rates like he does. Most people don't care that its cheaper to pay cash
because for most people, their primary concern is out of pocket expense. Most
people would rather charge their insurance $1300 so long as they don't have to
pay anything than to pay $130 and not 'overpay' (albeit opaquely)

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lawnchair_larry
Interesting. I would have guessed the opposite - that the insurance companies
get a "volume discount" of sorts.

What about with prescriptions? Is it better to pay cash price via HSA, or can
you get a cheaper rate through your provider?

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tirrellp
As far as prescriptions, I have a couple cost effective choices: Compounding
Pharmacy and Mexico. The compounding pharmacy that my doctor referred me is
very reasonable and they can 'custom make' drugs. Mexico is a very good option
(I live in San Diego) because I can go get a generic equivalent for 1/5 to
1/10 of the price in the US, and I can use my HSA card to pay for drugs in
Mexico.

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nhangen
I bought a Blue Cross Blue Shield plan privately. For less than $500, I got
full dental and medical, including maternity, for my wife and 3 children.

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PonyGumbo
That's excellent - what state are you in (if I may ask)?

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nhangen
I'm in Florida, where I hear Humana has great plans as well.

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yummyfajitas
I'm taking my chances.

I've already moved halfway around the world (my startup needs cheap labor) and
run a much higher risk of death than in the US. Why should I worry about a
financial hit on top of death?

(Amusingly, my Mom worried about the Mumbai bombings 150km away from me. In
reality, she should worry about me looking the wrong way while crossing the
street.)

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badclient
You moved to my home city, Mumbai? :)

It's an awesome city though not always cheap. More likely you're somewhere
else in India hopefully!

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yummyfajitas
Pune, not Mumbai. But I described Pune to her as "a satellite city of Mumbai".

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veyron
If you are a US citizen, you have COBRA coverage. Which can get pricey, but at
least its something.

How old are you? My parents health/dental/vision coverage extends to all
children until 26, and I think one of the benefits of Obama healthcare
overhaul is that all health care plans must cover children until 26.

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jmtame
In SF here and just signed up for individual health insurance, HealthNet PPO
($70/month) after getting recommended to an agent through Dave Ramsey's web
site. It's a high deductible plan (around $7,500), but the premiums seem low.
I personally feel less at risk of being in the hospital; I don't commute right
now; I'm a fairly healthy individual. I would have signed up for the Health
Savings Account, but it was a bit more expensive. Maybe later.

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jbhelms
If you have a Tax ID and at least two people that want the insurance, you can
get a small business policy. Just do a google search for brokers.

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dlapiduz
I used to have an international insurance with bupa.com. They are very good
and not that expensive but I believe you need to have an address outside the
US

