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Ask HN: Freelancers in the US: What do you do for health insurance?
65 points by patientfrog on July 15, 2015 | hide | past | favorite | 101 comments
Currently getting health insurance for my wife and me through my employer and plan to transition into freelance/consulting. I'll have to start paying for insurance and was curious what other freelancers on HN are using, what monthly costs are like, etc.

I am especially curious what freelancers in the NYC area are doing.

Thanks!




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)


> Obama care cost 2x as much as an individual plan

What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know.

> this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play

How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc.

EDIT: Remove something that I think was overly provacative, (even if not meant that way).


> What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know.

Ironically a plan through Priority health on the market place cost 2x as much as the same plan purchase through the same insurer individually. This is for a couple reasons:

On the market place, a qualifying plan must meet ALL ACA requirements. This includes a capped deductible, bundled Dental, vision coverage, prenatal coverage/birth control coverage. Also, ACA plans are held to a higher standard then individual plans purchased on the open market. I have fewer options to choose from, and those fewer options all come with lower deductibles and more coverage then I need/want. This means higher monthly premiums.

>Were you pricing insurance 2 years before you need it? Many years ago (before Obama was elected), when I was pricing individual insurance the price was several times more. Insurance companies seemed uninterested in individual consumers.

I had the wonderful experience of working at Priority Health from 2011-mid 2014. I got to see ALL sorts of chaos unfold as they tried to meet all the requirements and deadlines (They did just fine, but there certainly wasn't much cushion on time). This increase in coverage was literally over night, as in 12/31/2013 Individual Plan A (The actual name...) was $84/m, on 1/1/2015 Individual Plan A was $136/m (Priority Health did grandfather in the pre-ACA prices for anyone already on the plan for 1 year, however any new members paid the new price)

>How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc

Overall ACA has negatively affected my coverage and most people I know. However to be fair, I was in the Goldilocks zone for health care coverage. Young, white, healthy athletic male, no pre-existing conditions, never smoked, and located in a relatively low health care area when compared to LA, NY, Chicago, etc. Pre-ACA my health care costs would have been as low as low could be.

I do think that coverage until age 26 is a good additional, however I wish it was through the entire year they turn 26 in, and not just until the month they turned 26, (For me June and I had to find coverage within 30 days of my birthday).

I do like the fact that it give subsidies to the individuals who cannot afford even a $84-$150 monthly premium pre ACA, however I wish that they just expanded the medicare program to give these subsidies as these people only represent about 1/3 of 1% of Americans, and in many cases a large portion of this small percentage would have been covered under medicare anyways

I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums. (sounds harsh I know, but thats my opinion.)

I think it is stupid that my obama care plan purchased through the open market also includes Dental, Vision, Prenatal care, and Birth Control coverage. I think its a smart marketing move to bundle these together into one plan for certain females, however it is not possible to unbundle this. And yes that means all you males out there, and all you women after menopause have prenatal and birth control coverage...

I think its stupid that as a male i am REQUIRED to purchase prenatal care and birth control coverage for myself even though i will NEVER use this. why do i have to purchase this? All US Citizens are required to purchase a plan that meets the affordable care acts requirements, it does not mean i must purchase a plan on the open exchange, but yes that mean individual buyers must purchase coverage they will not use in an attempt to make health care for everyone good. If I dont purchase prenatal care, I will qualify for the penalty at tax season.


> a plan through Priority health on the market place cost 2x as much as the same plan purchase through the same insurer individually. ... On the market place, a qualifying plan must meet ALL ACA requirement

Doesn't the ACA require all insurance plans to meet its standards? If there wasn't that requirement, why would insurance companies offer ACA-compliant plans?

> I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums.

That isn't really subsidy, it is almost the definition and purpose of insurance. The total cost of medical care is the same, but we spread the risk (and therefore the cost) evenly over everyone in the insurance pool. Or another way of looking at it is we all subsidize each other; you are subsidized too, for your own unique risks and costs.

That way, when something bad happens and your costs spike, you will receive the medical care you need and won't go bankrupt. If we all simply paid for our own costs (and didn't 'subsidize' each other), we wouldn't be insured.


The problem is that in order to do true risk pooling, you need to be able to charge based on risk. The ACA (Obamacare) has eliminated much of that making the cost the same for everyone at a given level. And it turns out that many healthy people have continued to opt out and many of the new enrollees are people who couldn't get coverage elsewhere.

None of this is a judgement, just the raw math of the situation.

Here's one sample but the problem is nationwide:

"“Our enrollees generated 24 percent more claims than we thought they would when we set our 2014 rates,” said Nathan T. Johns, the chief financial officer of Arches Health Plan, which covers about one-fourth of the people who bought insurance through the federal exchange in Utah. As a result, the company said, it collected premiums of $39.7 million and had claims of $56.3 million in 2014. It has requested rate increases averaging 45 percent for 2016."

Ref: http://www.witn.com/home/headlines/-Health-Insurance-Compani...


> The problem is that in order to do true risk pooling, you need to be able to charge based on risk. The ACA (Obamacare) has eliminated much of that making the cost the same for everyone at a given level.

Why is that a problem? I'm not sure why a less diverse risk pool is inherently better than a more diverse one. Certainly I want very ill people to receive medical care, and it seems as broad as possible a risk pool facillitates that.

> it turns out that many healthy people have continued to opt out and many of the new enrollees are people who couldn't get coverage elsewhere.

Don't opt-outs have to pay the fine, which funds medical care regardless (or do those funds go elsewhere)? The fines might be less than insurance payments, but I'd assume they are all profit. The opt-outs consume generate zero claims and costs from insurers.

The paragraph you quote doesn't say healthy people are opting out; it says the insurance company is claiming higher costs than they expected and wants a rate increase. Their expectations could have been wrong, or they simply might want to raise rates and are making a case for it (or their claim could be legitimate, of course); I'd guess reality is some mix of the three.


Pre ACA for a 30 year old non smoker with zero heath problems my plan was over 500$/month. Granted, VA health costs are probably higher, but that's a long way from 84$/month. Can you give details such as a link to the actual coverage?


https://www.priorityhealth.com/plans/individual-family/mypri...


Ok, zero coverage for out of network health care that’s a great way to end up bankrupt if you have an accident on vacation. Add in the 6,400$ deductible it's really not a good deal IMO, but I can see why someone might chose it.


"however I wish that they just expanded the medicare program to give these subsidies"

This would have been a much better overall option vs entire ACA mess. Is the issue access to health insurance or access to health care service? I feel like the two got mixed together quite often (not sure how much was actual intentional deception vs truly not grokking the difference) but... insurance is not the same as care, and moving towards universal health care vs universal health insurance... I don't know when we'll ever get to the former. :/


You are required to buy prenatal care because it wasn't fair for young women to have much higher insurance costs then young men just because they get pregnant more often...you know it takes two to tango.


I am happy to pay for prenatal care IF AND WHEN my wife/partner and I decide to have a child. and in that instance, yes I would be paying for prenatal care, however I do not think it is right for the government to force me to purchase ANY SERVICE that I may not want or may not use, such as prenatal care.

Those young women who made the decision to have sex not knowing if the individual they "Tangoed" with would help with any costs or work will soon learn that it was a poor decision. Sheltering the consequences of ones actions is not an affective way to direct behavior for the masses. That young girls friends will see that it was hell, and their parents will learn it was an expensive decision, and then those other girls and their parents will do a better job being responsible citizen. I shouldnt have to pay for coverage that is ultimately needed because of poor parenting.

And yes, with any statistical examination there will be a small percentage of people that statistics work against, IE. the less the 1% of pregnancies due to rape.


And I'd be happy to pay for car insurance IF AND WHEN I get in to an accident in my own car. You don't get an insurance discount for naively believing that you won't make mistakes, or for believing that undesirable things won't happen to you.


What Beached is saying is that he's not driving a car yet. You don't have to pay for car insurance when you don't have a car.


This^


I guess the main problem is that pregnancy is considered a health insurance thing at all: it's going to come and birth, like schools, benefits society as a whole. But who pays for it?

If you are a single guy with no kids, do you also complain about property taxes funding public schools? After all you have no kids, you are paying for something you don't use. If you go single or DINK, then it is something you will never use.

Really, this is why I think single payer or just full-on nationalized health would work better in the end. Insurance is just another tax now, and there is no point to put private companies in the middle of it.


Prenatal care like vaccinations more than pay for themselves at the societal level. I can see the argument for keeping the government out of healthcare, but this really does fall under moral hazard.

Also, if a female can go from no prenatal care to prenatal care then there going to swap from one to the other when they decide to have kids which would distort the market. In the end it's the same reason you can't get insurance with and without support for specific diseases.


Unintended pregnancies exist, and people have sex. But you're not going to get pulled over and cited for sexing without a license, because it tends to happen in private. So how should an insurance company verify that someone isn't having sex that could result in an immediate need for prenatal care? What happens when you're allowed to opt out, but your contraceptive fails and you have a kid anyway? The risk of ectopic pregnancies and/or miscarriages is high pretty early on, and many of those present in the ER where it's ludicrously expensive to even breathe the air.

How about diabetes or mental health care, should you be allowed to opt out of that coverage it you're sure™ it's not going to happen to you? Can women opt out of most everything to do with the prostate?

On top of all of this, as another commenter explained, the marginal cost of prenatal/pregnancy/postnatal coverage isn't even all that high. The cost of managing the opt-out would probably destroy any savings you were hoping to realize.


As a female who will never have children, I'm even more angered by the new coverage. Being self-employed, I went from a $5k deductible for around $80/month to a $10k deductible and $230/month (and my new plan doesn't have good coverage all over the country, which sucks because I travel a lot).

I have never used my health insurance for any reason in the last 15 years, I eat well, exercise, get plenty of sleep, etc. - so the whole situation makes me mad every time I see the bill.


> I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums. (sounds harsh I know, but thats my opinion.)

The problem is that insurers try to deny claims based on a patient having a pre-existing condition that they weren't paying for.


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.)


Interesting. I know a freelancer couple whos cost when down dramatically with the OC plan. Could the federal prices be different per state?


they're all different per state, because there's no real 'federal pricing' or 'federal policies', AFAICT. The fed govt gives subsidies to insurance companies for low-income folks who sign up to the plans in their individual states/locations. There's no 'federal health plan' (more's the pity, imo).


And it's illegal for companies to sell plans across state lines. Remove that restriction and the situation would change quite a bit.


They are all differant per state, and if he/she is poor with a pre-existing condition/smoked/smokes, over weight, its very likely that his costs went down.


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.


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.


>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.


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


> Since I do not have any pre-existing condition, and have never smoked, that $84

I'm almost 40 and never had use of my health insurance - if you are like me you can save 124$ per month !

Think of all those years I would have been able to save. Same thing for my car (never stolen, no accident), house insurance (no theft), professional liability insurance, travel insurance (no problem so far), life insurance (still alive), payment protection insurance (still employed), critical illness insurance on the mortgage (thanks god).

Don't be bitter about it. I don't regret it for a second all that money spent. I feel lucky every day if the little premium I pay prevent me to see a friend in misery. And by the time you get my age, you will have seen a lot of stuff happening around you (to me it started around age 28, shit happening somewhere is sadly too common nowadays).


I do not regret paying for health insurance, or car insurance for that matter. It would actually be cheaper for me to pay the penalty and not have coverage, however i still have it because it is what I consider a good investment, even at the increased rates. I will say I am a little bitter, since I actually worked at a health insurance company that worked to reduce health care costs instead of just upped the premiums when costs rose, I see how the health industry triad is just making it worse. The ACA on top of that has made it so that the free market will not be able to correct itself and effectively ruined capitalism from working for the health industry.

ACA had good intentions, just very poor execution.


I'm quite sure they appreciate it, thanks. :D


I'm also in Michigan and curious about the specifics of options 2 and 3. Would you be willing to share the details?


Certainly, 2. The individual plan is from Priority health, it is their individual High deductible HMO HSA plan with a annual deductible of $6300. The entire spectrum health network is covered in the plan, (Spectrum health pretty much owns all of west MI and the Grand Rapids area).

3. http://www.healthshareplan.org/ When I contacted them, they only paid out to UoM and Mercy Health networks, not spectrum health. Since I live in Spectrum health land, this wouldnt work well for me. however if you live in East MI, you may consider this.


The HSP looks really interesting, and I'm currently living in Ann Arbor so UofM is practically within walking distance. Thanks for the information!


no problem, i will also say that PH insurance has some of the BEST customer service. Both public facing and internal. They actually have an internal department that the public is unaware that does some amazing things that help reduce cost for both them and you as a customer. This department also help make sure the care you receive is the best available for you, as well as thoroughly completed to avoid complications and repeat visits, which also help reduce costs but improve quality of life.

I cant say much more then that because im pretty sure its what they would call a trade secret... I am only aware of it because I worked for them and was involved in supporting this from an IT perspective.

On a side note for all of you people looking for a change of pace. Health care is IMO the most fascinating place to be as far as IT is concerned, I would have never left the health care industry except that I wanted the benefit of working from home full time. When I left, I told my boss and a few other managers to let me know if a full time work from home position became available.


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.


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.


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


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.


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


Does that $650 per month include subsidies from the government for low income? Because that is far cheaper than what I received as a quote on healthcare.gov. For my wife and kids it was $1,100 per month with a $12,000 deductible. With that plan my out-of-pocket expenses would be $25,000 per year before the insurance paid a nickel!

86% of people who sign up with Obamacare received a subsidy1 from the government for low income. Without that, I don't understand how anyone could afford the rates posted there.

---

1 http://www.nytimes.com/2015/03/11/us/11-7-million-americans-...


No, it doesn't include subsidies (ED: I mean, we don't get subsidies). I signed up directly with the provider. Your number looks egregious. I wonder how that kind of plan works, though, with ACA's 80/20 rule.


It's non generic prescription drugs that are expensive. See for example the generic antibiotics available for $4:

http://www.target.com/pharmacy/generics-condition

http://www.walmart.com/cp/4-Prescriptions/1078664

(you have to click around more to get the list on Walmart)


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


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?


I have a very good friend who has had terrible experiences with getting reimbursed for legit claims via FU. He pays for the most expensive plan, too.

Based on his experiences I'd rather go directly to an insurer like Oscar.


Oscar is great in the NYC / NJ area (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.


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".


Like others have mentioned...if you're in NY, just go to 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). Oscar offers reimbursements for gym memberships, free unlimited access to Teladoc (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/). Their plans are not subsidized, but with some of them you get free, unlimited access to doctors at Freelancers Medical (https://www.freelancersmedical.org/). They have two offices, one in Downtown Brooklyn, and one in the Financial District.


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" :-)


I forgot to add that one thing that benefited me from obamacare is that my wife was pregnant at the time and we didn't get penalized for a "pre existing" condition and the plan covered a lot of the pregnancy cost. Without it I would have been in the whole for $10k or more.


$15,000 a year for insurance ... plus all the taxes we already pay. Wow. Is this in NY? I'm guessing it's a low deductible plan.


Can you clarify this:

> deducting $450 a month every 2 weeks

That is confusing/doesn't make sense.


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


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.


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...

2. http://blog.rmhp.org/2013/12/sticker-shock-obamacare-and-the...


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.


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.


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


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.


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.


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.


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


Do you have an HSA?


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.


Is that per month?


Yes per month.


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/


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


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).


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.


TLDR; the current situation sucks, and is not sustainable. Save your pennies.

I started freelancing in 2012 with BCBS of MI. Being young-ish and healthy with no kids, just a spouse, I was paying something around $200/mo for a PPO with an HSA (side note: get an HSA and save - it's your best option for not being screwed as a freelancer). 3 years later and the AHA has left me at $400 a month for a HMO (downgrade), higher deductable (downgrade), but thankfully I still am allowed to use an HSA (HSA compatibility is complete bullshit, BTW).

Everything is out of pocket except some bare minimum prevention stuff. Everything trip to the doctor involves me wondering if it's really worth the money and the hassle (thanks to the HMO I can no longer see my old family doctor).

Those of you bound to say that I should shop around using the marketplace - yup, I did. This was the best deal. Insurance is dependent on geography. I'd love to see an app that told me which address would give me the most reasonable insurance. Any takers?

My suggestion - budget something like $500/mo/person. Half for insurance and half for saving in the HSA. As a freelancer you'll likely make too much money to have any of your insurance covered by the government. It's outrageously expensive, but if you have serious health problems, a $12.7k deductible is way less than potentially ten times that in hospital bills.

As an aside - I do believe the AHA did some good. I had friends in states without a non-profit insurance provider like BCBS who simply could not leave their jobs due to pre-existing conditions. That no longer happens, thankfully. However - we can do better. It's insane that I have to weigh the monetary cost of going to the doctor in my decision to go. Of course we all go for an acute illness, but I believe there are millions with minor chronic illness that are simply not getting treated because they cost of even the most common diagnostic tests is astronomical.


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.


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.


Something's wrong here, because the out of pocket max for a year (which for BCBS of MI is not the same as the deductible) cannot exceed $13,200 a year for a family. By law.

See https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

I had a BCBS/MI family plan through the marketplace up until last month. (Silver Multi State) It cost $1,000/month and had a $6,000 (family) deductible, after which BCBS pays 80% of all costs until you hit that out of pocket max. It also allows you to bank $6,500 a year in an HSA pre-tax, which basically covers the deductible.

[edit] Forgot to mention that this plan included medical, dental, and vision.


Have you looked at other plans since the ACA exchange went live? I've never seen an ACA plan with a deductible that high...


Briefly. In the old days you just called an insurance provider and a helpful person would come to your home and explain all the intricacies. Now you have to devote a couple of days to research on infuriatingly obtuse websites. As a free lancer time is really money.


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.


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.


It's been awhile since I've looked into it, but my local tech council (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.


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

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

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


> 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.


"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?


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.


you are right. I edited that part. I did this a couple of years ago so a lot has changed since then.


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.


600$/month pretax is not that bad, but I suspect you can do better. 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.


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.


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.


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


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.


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.


Obamacare/BCBS is working great for us.


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


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


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


live in canada.


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.


If I weren't married to a teacher who has great health benefits, I'd probably have moved out of the country to get away from the ACA into a single payer system.


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.




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