Self-Employed Health Insurance

Owning your own small business can get a little overwhelming especially if you have employees and are trying to manage finances. In such cases, it is essential to know about sef-employed health insurance.

Self-employment and gig economy workers are on the ascent. In fact, self-employment has reached the highest levels since 1957. In case you are among the 44 million self-employed Americans, you may worry about finding quality, affordable health insurance. Normally, you may meet all requirements to pursue another health insurance plan during the open enrollment time frame, which happens each November 1 through December 15. On the off chance that you have had a qualifying life occasion, you can likewise enroll. Qualifying occasions incorporate getting married, having a child, or losing your past health insurance. Keep on reading to learn all that you need to know about self-employed health insurance.

What Is Self-Employed Health Insurance?

Self-employed health insurance is any insurance plan bought as a self-employed entity or independent contractor where you are needed to cover the cost of your own employee advantages, including health insurance. You may have a couple of options for purchasing coverage, for example, directly buying health insurance from a provider or through your state’s exchange or Heathcare.gov. You may apply during open enrollment, which happens once each year every fall, or after a qualifying life occasion.

Contingent upon your income, you may meet all requirements for a discount through cost-sharing decreases, which may bring down the cost of your deductible, co-payments, or co-insurance. To qualify, you should sign up for one of the Marketplace plans. If your income is low, you may likewise check whether you fit the bill for Medicaid, which could offer free or affordable health insurance. You may apply for Medicaid through the Marketplace or through your state’s Medicaid agency.

Who Needs Self-Employed Health Insurance?

In case you do bring home taxable income without having an employer or employees, then you most probably need to find independent contractor health insurance via an individual or family plan. Some individuals who might need to enroll for self-employed health insurance are:

  • Independent contractor
  • Freelancer
  • Consultant

If you seem to fall under this category or description, then it is important to explore your options for self-employed health insurance. Getting coverage for yourself, regardless of your job status, might help you to stay away from paying a penalty for being uncovered. Keep in mind that if you have even one employee (apart from yourself), you may be qualified for small business group health insurance instead. This works well for individuals who are responsible for insuring their employees along with themselves.

Individual Health Insurance Marketplace

For the most part, if you maintain your own business and have no employees, or are self-employed, you will not meet all requirements for group coverage. You can buy qualified health coverage through the Marketplace for individuals and families. You can enroll through the Marketplace if you are a freelancer, advisor, independent contractor, or any other self-employed laborer who does not have any employees. In the event that your business has even one employee (other than yourself, a spouse, relative, or owner), you might have the option to utilize the SHOP Marketplace for small businesses to offer coverage to yourself and your employees.

With an Individual Marketplace plan, you can:

  • Access premium tax credits and other savings, if you are eligible
  • Find coverage for yourself and your family

The Individual Marketplace offers flexible, quality coverage for people who:

  • Are self-employed with no employees
  • Run their own businesses
  • Work as freelancers or consultants

All plans in the Individual Marketplace cover similar categories of fundamental health benefits and are restricted from excluding treatment dependent on pre-existing conditions. You can likewise pick between plans with lower premiums and greater cost-sharing when you need care, or higher monthly payments and lower cost-sharing when you need care.

You can only enroll in Marketplace coverage during the yearly Open Enrollment Period, except if you have a qualifying life occasion during the year. When you round out a Health Insurance Marketplace application, you would have to estimate your net self-employment income. Marketplace savings depend on your assessed net income for the year you are getting inclusion for, not last year’s income.

If you are searching for assistance with inclusion, find a broker or an agent in your region. Brokers and agents are specialists in health insurance and can help you find the inclusion you need if they have completed registration with the Federally-facilitated Marketplace, usually with no additional expense for you.

To get a premium tax credit or reduction of your out-of-pocket expenses, you will need to give an estimate of your family income to the Marketplace for the year you are getting inclusion. This can be difficult for entrepreneurs whose income may shift. You need to provide your best estimate. Get in touch with your tax professional and have a detailed chat with them for advice on the best way to estimate your family income.

If you meet all requirements for a premium tax credit or reduction of your out-of-pocket expenses and your family income changes during the year, you should get back to the Marketplace and update your assessed income quickly. Toward the year’s end, if you make more than what you told the Marketplace, you might repay a few or all of the premium tax credits. If you make less, you could get extra premium tax credits when you document your taxes.

Self-Employed Health Insurance Deduction

If you are self-employed, you might be qualified to deduct premiums that you pay for clinical, dental, and qualifying long-term care insurance coverage for yourself, your spouse, and your children or other dependents.

  • This health insurance discount is entered on page 1 of Form 1040, which implies that you are at an advantage whether you itemize your deductions.
  • In contrast to an itemized deduction, this deduction treatment is useful because it brings down your adjusted gross income (AGI).
  • Having lower AGI can diminish the chances that you will be impacted by unfavorable phase-out rules that can cut back or eliminate different tax breaks.

Remember that this deduction treatment additionally implies that you cannot deduct the premiums when you calculate your self-employment tax liability. The deduction cannot surpass the earned income you gather from your business. For instance, if your self-employment activity is sole proprietorship that produced a tax loss for the year, you are not permitted to claim the deduction because the business did not generate any positive earned income.

On the off chance that your business has employees, and you pay health insurance premiums for them, these sums are deducted on the relevant tax form and line for employee benefit program costs. For instance, if your business is a sole proprietorship, you deduct premiums paid to give health inclusion to employees on Schedule C.

What Is The Average Cost Of Self-Employed Health Insurance?

Five factors may have an effect on the expense of self-employed health insurance for Affordable Care Act-consistent plans: age, location, tobacco use, individual versus family plans, and plan category. A few states have rules about how much these elements may affect your monthly premiums.

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Premiums might be up to three times higher for older workers, and tobacco users may pay up to 50% more. You may likewise pay more in a state with less competition among suppliers. However, the good news is organizations cannot charge more based on your gender, your present health status, or clinical history.

Utilizing Healthcare.gov, if you run a couple of quotes, you will see that geography can tremendously affect your premiums. The plans available in your region and the level of competition are vital factors in deciding your costs. All things considered, somebody’s premiums can change by hundreds every month based upon where they reside.

Cost-Saving Health Insurance Alternatives For Self-Employed People

Keep in mind that you will not get all the benefits and securities that you would with an ACA-compliant individual health insurance plan. However, if you want to save money, you could consider some alternatives to Obamacare. Usually, people consider these individual health insurance alternatives as temporary solutions that will fill the gap in permanent individual health insurance coverage:

  • Short-term health insurance for individuals and families: You can purchase short-term health insurance for up to a 12-month term in a lot of states. You also have the option to renew this sort of inclusion for up to three years. About half of the respondents to an eHealth survey said they most likely would not have been unable to afford individual health insurance if they could not purchase short-term coverage.
  • Medical packages: You can also combine coverages such as short-term health insurance, dental insurance, prescription discounts, and emergency indemnity policies to give you and your family various health benefits.

These alternatives to individual health insurance ensure that your pocketbook is secure if you have an accident or face an unexpected health issue. Unlike Obamacare individual health insurance policies, these alternatives will not provide coverage for some health issues like maternity, mental health, or routine care for pre-existing conditions. They cannot exactly replace an ACA-compliant major medical plan, but they can assist self-employed people to get important protection at a generally lower cost.

Best Health Insurance Companies For Self-Employed In 2021

Blue Cross Blue Shield

Blue Cross Blue Shield (BCBS) is an association of 36 free Blue Cross Blue Shield companies across the United States. Since 1929, the organization has set up a solid reputation, and a lot of its companies have high AM Best ratings. The companies have scored 2.5 to 4.5 on a scale of 1 to 5 from the National Committee for Quality Assurance (NCQA). Blue Cross Blue Shield companies additionally procured high rankings in the J.D. Power 2020 U.S. Commercial Member Health Plan Study.

Blue Cross Blue Shield offers coverage to 107 million individuals in each of the 50 states, including Washington, D.C., and Puerto Rico. The companies have a broad network, including 96% of the nation’s hospitals and 95% of specialists and doctors. Expatriates may also have access to health coverage through the organization’s worldwide network. Contingent upon the state, Blue Cross Blue Shield companies may offer various products. You may likewise get health and wellness discounts like gym memberships and fitness products through Blue365.

You may analyze and compare plan quotes and apply for health insurance through your local Blue Cross Blue Shield company’s website. Moreover, you can likewise call or sign up through your state’s health insurance exchange or Healthcare.gov. With 36 different companies, costs may differ by area, plan type, age, tobacco usage, and the size of your family.

After getting healthcare, visiting a hospital, or getting a prescription, the supplier presents a claim to Blue Cross Blue Shield. You may get to a claim summary, including the amount you owe, by logging in to your online portal or via mail. Self-employed laborers may like Blue Cross Blue Shield’s information-driven methodology, similar to the organization’s National Health Index, which maps health status by county. Blue Cross Blue Shield also utilizes nationwide information to resolve significant issues like the increasing expense of healthcare.

UnitedHealthcare

UnitedHealthcare is a subsidiary of UnitedHealth Group, the largest health insurance provider in the country. Founded in 1977, the provider has an A rating from AM Best. UnitedHealthcare did not procure a top ranking in any region in the J.D. Power 2020 U.S. Commercial Member Health Plan Study. The organization offers wide health coverage with benefits in all 50 states and 130 countries. In 2020, the provider network included 1.3 million doctors and other healthcare professions and more than 6,500 hospitals. The organization offers various products including health insurance, Medicare, Medicaid, short-term insurance, vision, dental, and supplemental coverage.

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However, UnitedHealthcare has not always offered solid mental health or substance abuse coverage. In 2020, a federal judge rules that the organization was discriminating against individuals who required these services. From that point forward, the organization has made one of the largest virtual mental healthcare services through the purchase of a company in that field. You may get a quote and apply for health insurance through the company’s website, via telephone, through your state’s exchange, or Healthcare.gov. UnitedHealthcare plan pricing changes by state, your policy type, your age, whether you smoke, and your family size.

The UnitedHealthcare claims process is basic: If you utilize the organization’s provider network, you will not have to present a claim. Be that as it may, you may have to do it for your flexible spending account, upfront billing, or out-of-network providers. You may submit a claim through the online portal or by its claim via mail service. Ground-breaking entrepreneurs may see the value in UnitedHealth Group’s way to deal with innovation and technology. The organization utilizes solid information to address healthcare imbalance, developing telehealth amid the pandemic, digital therapy for managing type 2 diabetes, or utilizing artificial intelligence to further develop member engagement.

UnitedHealthcare, part of the country’s greatest health insurance organizations, offers the most strong network. With coverage in each state, UnitedHealthcare may make it simpler to find a health insurance plan with your preferred providers, so self-employed people do not need to hold back on medical care.

Kaiser Permanente

Kaiser Permanente is another health insurance organization with a solid reputation. The organization was established in 1945, and it does not have a rating with AM Best. It procured high scores of at least 4.0 and up to 5.0 with NCQA alongside standout rankings from the J.D. Power 2020 U.S. Commercial Member Health Plan Study. However, Kaiser Permanente has faced some questions from the state of California. The organization has been dependent upon several state sanctions and fines for holding back on behavioral healthcare. A few individuals still trying to get care toward the end of 2019, as per the Los Angeles Times.

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Kaiser Permanente offers health insurance in Washington, D.C., and eight other states — California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington — for 12.4 million individuals. The organization’s network incorporates 39 hospitals, 719 medical officers, 23,271 doctors, and 63,306 nurses. You may have access to various health plans that include Medicare, Medicaid, high-deductible health plans, health savings account eligible plans, and catastrophic plans. Plan availability relies upon where you live.

You may get a quote or apply for inclusion through Kaiser Permanente’s website. If you need monetary help, you may apply through your state’s exchange or Healthcare.gov. Like other suppliers, pricing may depend on where you live, plan type, age, smoking status, and family size. The claims cycle may rely upon your health plan and should be within a year of the date of your service. There are some extra steps to submit a claim for a crisis or urgent care visit away from home.

As a self-employed or gig economy laborer, you may have restricted assets for spending additional cash on healthcare and may profit with Kaiser Permanente’s emphasis on preventative care. The organization’s record-keeping and system of updates make it simpler to catch the beginning phases of an illness. Subsequently, the organization leads the country in preventative cancer screenings and keeping a cap on high blood pressure.

Cigna

Cigna is the oldest health insurance organization, with a history that can be traced back to 1792. The organization has acquired an A rating from AM Best and rankings of 2.5 to 4.0 from NCQA. Cigna additionally procured high marks, including one regional first place, in the J.D. Power 2020 U.S. Commercial Member Health Plan Study. Cigna offers worldwide inclusion to 180 million clients in 30 countries, which includes 1.5 million providers and facilities. In the United States, the organization works with more than 67,000 pharmacies, over 500 hospitals, and more than 175,000 mental and behavioral health providers, becoming 70% since 2016.

Cigna offers individual plans in 10 states: Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee, Utah, and Virginia. Contingent upon where you reside, you may have access to Cigna’s different products like Medicare, Medicare supplemental plans, dental insurance, vision insurance, or international health insurance.

You may search for quotes or purchase inclusion online or by telephone. You may likewise buy inclusion through your state exchange or Healthcare.gov. The pricing may differ depending on factors like where you reside, the type of plan you bought, your age, smoking status, and the size of your family. Most providers will directly send a claim to Cigna and you can see your clarification of benefits through the organization’s online portal. You may have to record a claim with out-of-network providers, however, which includes downloading a form, filling it out, and sending it via mail.

Cigna offers various alternatives for busy self-employed workers. You may fit the bill for $0 virtual care (except forIf Arizona and Colorado). Self-employed laborers may likewise adore the comfort of Cigna’s Express Scripts Pharmacy — which offers home delivery for 90-prescriptions — alongside 247 access to licensed pharmacists. Cigna as of late added Talkspace, a well-known digital therapy service, to its behavioral health network. This provider has worked hard in these fields to make care as convenient as could be expected.

Molina Healthcare

Molina Healthcare is a health insurance organization focused on those getting government help. Established in 1980, the organization does not have an AM Best rating. Albeit the organization’s Moody’s credit score is not high (B2), the most recent report gives indications of improvement. Molina Healthcare has had some regulatory issues including fines for enrollee complaints in California and administrative issues in Texas. But the organization has been putting in the effort to work on its reputation. Molina Healthcare had 3.6 million members as of June 30, 2020. The organization offers Medicaid and Medicare plans in California, Florida, Illinois, Michigan, Mississippi, Ohio, Puerto Rico, New Mexico, New York, South Carolina, Texas, Utah, Washington, and Wisconsin. Medicaid covers a wide range of services, and research shows that access to care to mind is similar to private inclusion.

You may get quotes or apply through Molina Healthcare’s website, or by calling their support group. You may likewise apply through your state’s healthcare exchange or Healthcare.gov. However, you may have to make a partial payment for the service when you check-in, and the provider will charge you for the remaining balance. If a provider does not send a claim to Molina, you may need to submit it yourself for repayment.

In August 2020, the organization declared an underlying $150 million in funding for the MolinaCares Accord, a project committed to filling health inclusion gaps for disadvantaged populations. This further sets it as the best for underserved groups. Some key points of focus are racial disparities in access to care, narcotic use disorders, rural healthcare access, and other financial issues.

Molina Healthcare centers around affordable healthcare for lower-pay families. In case you are self-employed and finding it hard to get by, you may fit the bill for Medicaid, which offers comprehensive advantages through Molina. Qualified Illinois occupants may likewise enroll in the Molina Dual Options plan that facilitates the advantages of both Medicare and Medicaid.

Oscar

Oscar is a technology-driven health insurance startup and is the youngest organization out of the companies mentioned up till now. Established in 2012, Oscar has been getting popular and popular with its extraordinary way to deal with customer service. The organization currently does not have a rating with AM Best and has acquired rankings of 2.5 to 3.0 from NCQA. Although the organization has restricted availability — Arizona, California, Colorado, Florida, Georgia, Iowa, Kansas, Michigan, Missouri, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and forthcoming administrative endorsement, North Carolina — it does have plans to expand in 2021. As of now, the organization offers health insurance and Medicare plans to 420,000 individuals.

You may get quotes or pursue an arrangement through Oscar’s website or by telephone. You may likewise shop through your state’s exchange or Healthcare.gov. The pricing will fluctuate dependent on where you reside, the type of plan, age, tobacco usage, and family size. The claims process is like that of other organizations. Your provider will present a claim to Oscar and the provider will share an explanation of benefits covering the amount you owe. The organization commonly does not cover out-of-network claims since it usually offers HMO plans.

Oscar has a couple of novel features that might be helpful for self-employed or gig economy laborers. The organization’s Doctor on Call feature offers free, unlimited, 27/4 access to a provider. The Concierge is additionally a champion element, with a committed team of guides and nurses to respond to your inquiries and help you save money. This degree of customer service is unbeatable among the providers audited.

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In case you are tired of mediocre customer service, Oscar might merit a look. As a member, you may utilize Doctor on Call or Concierge through the organization’s mobile application alongside simple access to your records, lab results, deductibles, and more. The organization’s white-glove service might be especially appealing to self-employed people exploring health insurance on their own and that too for the first time.

Conclusion

Since you are in business for yourself, your health care costs have an effect on your main concern. The right health insurance plan can help you get a good deal on out-of-pocket expenses. At the point when you visit in-network providers, you gain access to the lower rates that they have negotiated with your health plan. At the point when you see an out-of-network provider, your expenses are usually higher. That is the reason why you should pick a health plan with in-network health care providers and hospitals in your space.

Time is valuable when you are maintaining your own business. It can help if you picking a policy with a customized, simple to use online website and smartphone application, so you can manage your health at any point, and at any place you are. Get health data, find in-network providers, pay your health insurance charges, see your health care claims, and print temporary ID cards. Also, when you have a health issue on your mind, you need answers. It helps with having a health data line to call. Get in touch with a nurse to get data and to get help in finding answers to your health-related inquiries.

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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