Group Health Insurance for Freelancers?

Hello Rob, I do know if programs for organizations and have put them together before. There are many different options which depend greatly on the number of people in the organization and the interest by all members. One biggest misconception I run into as a health insurance consultant is that a large group gets a better deal than a small group or individual. This could not be further from the truth. large groups typically partially self fund their health insurance so the rates seem lower but the plans have typically been lasered so no two plans are the same. They take the money that was spent before on premium or price amd bank it to cover claims that occur before the health plan they bought kicks in. Also when you come together as a large organization you have to pay administrators to handle the billing and the eligibility, which all adds cost to the rate as well. Not to discourage interest in a organization plan I can set up a plan for your organization and I can make the rates favorable, however depending on the structure of the group I cannot gaurantee the rates would be what you expect. I would first ask what you have set up now. It has been my experience that small companies and individuals tend to get cookie cutter options from brokers as opposed to actual options. I would very much like to speak with you regarding this please feel free to call or email me Thanks, Robert

Hi Rob, I get my health insurance through the National Association of the Self Employed. I've been pretty pleased with it so far. You can check them out at nase.org, or you're more than welcome to send me a private message and I'll be happy to pass along the name and number of my insurance guy.

Good luck!! Katie :)

Hi Rob, It seems this is most pressing question most folks have throughout WA. Where can I get affordable health insurance. If you have two or more in your business you can get group coverage with several carriers. As a Freelancer, or as the State calls you, a sole proprietor, you only have individual coverage available. Many chambers of commerce have coverages available at a discount as a member. Unfortunately, most of the chambers don't offer a discount for individual coverages. Part of the freelancer or self employed's problem here is the definition of a small business, made my Olympia, which simply states a small business is 2-50. Many of my sole proprietor clients are taking advantage of the Health Savings Account programs to get coverage for medical, dental and vision and not necessarily send all their money to the insurance carrier. Feel free to ask your broker about the HSA programs of drop me an email and I can help you further.

I researched this issue for a small group client earlier this year. Many biznik members stepped up. Ron Copple was really helpful and extremely polite. Our state has that 2-50 level so it makes it difficile for solo entrepreneurs.

Both the larger and smaller chambers had expensive options. We did not go with a Chamber.

This issue comes around ever year, and every year I mention that my wife, Helen, would be willing to help Biznik members with their choice of health insurance coverage, for a reasonable fee.

As sole proprietors for 20+ years we've had to re-assess and make choices annually (we = she).

Because we are in health care professions and one of us uses the health care system on regular basis, we know a little about how things work.

I asked her about it again the other day when she re-capped this years changes and her pending choice along with the reasoning. She sees the picture more clearly and moves through the process much faster and easier now, so I asked her about helping other Biznik members.

She said that the time for you to approach her about it is November, but that she could come up with a check list of questions you could answer in preparation for getting together with her to go through it reasonably easily.

If you are interested contact her at ASINAC@aol.com

The biggest issue I see with small employers on the health insurance side is the underwriting for health issues. The associations plans and I cannot say all in every state underwrite. So this means that either you are going to pay through the nose if you have health issues. If you are healthy and young then the rates maybe good but if you stub your toe anytime through the year your renewal will reflect it. If your going to be underwritten make sure you are doing it where your dollars can be maximized. Another point to keep in mind is if the rates are way lower somewhere else then something is missing in the plan. There are many plans out there with lots of fluff but when you break then down they are junk and you will have wasted your money. Better to find out now before you have the claim. Find a broker you feel comfortable with and have them advise you on all the limits of the policy. If they cannot tell you then find another broker.

Robert makes the point that low rates don't equal decent coverage.

"Health" insurance is sold like everything else: they tell you what they want you to hear to buy their products. What you actually need to know you better already be prepared to ask because they will not answer unless you know to ask.

Someday it will be common knowledge that health insurance is predatory in the same way the real estate mortgage lending, credit card contracts and other corporate marketing industries are. In the same way taxes are.

Good luck.

Dennis, I can see your frustration as well as most everyone else's regarding the costs of health insurance and true it is a product sold not provided. Most of the big carriers are non-profit and I know that does not constitute that they are trust worthy, however there are many factors that come into play when a health insurance carrier sets rates. So hopefully I can shed a little light on why the rates continue to climb at such a alarming rate and I will try and make this short. Because there are so many variances per state, and group size I will just use the WA small 2-50 group example. When the carrier sets the rates they have to take into account that in WA under 50 employer groups or not underwritten. This means that no matter what your health issue is they have to take you and cover the claims unless you have been without insurance for greater than 63 days in which they still have to cover you but they can deny the pre-existing condition claims for 9 months. So the carrier has to prepare for all kinds of claims and medical claims are the highest there is nothing else you can encounter that can sky rocket like health claims. With this figured, admin costs, staff to set up the network with doctors, customer service, Prescriptions, with all this factored in we all ready have a high cost and then WA state steps in and says for every dollar we have lost providing medical coverage for those who are uninsured and had a medical claim and they cannot pay it ( welfare, molina, DSHS) we are going to get it back by taxing your medical health insurance premium. This is a double digit tax and it is huge. So as in all other aspects of society we who pay and take care of ourselves pay for those who do not. Now I'm not sayin that government assitance programs are not needed, just that they are grossly abused. I see people all the time who drive around in $35,000 cars and are on government provided health insurance.
The tax alone is not the killer but is a big factor. Rx is another huge factor, the Rx companies spend 2-3 times on adverstising as they do research, because when we see an add on TV we buy that Rx no matter what the cost we want that brand not the generic. They take doc's on weekend retreats in hopes that they will push their product. You are correct that it is all sales, marketing and etc to get into our pockets, however I think that most of the actual sales are based around the health insurance carriers not the carriers themselves. Having worked on association plans, self-funded plans, HRA's, Partially self funded plans in several states I can tell you that trying to keep a lid on cost's associated with health care claims is a huge task. Just some food for thought Thank you,

Sorry, I don't read posts that are that long...

DD

That is unfortunate, Knowledge is power, Robert

only partial explainations from

Robert, I thought you did a good job of explaining the situation. Unfortunately some people are so tainted, they really don't want to see the forest for the trees. Many folks believe the cost of insurance is too high when in fact the cost of health care is too high and insurance must reach that cost. Thanks for taking the time to elaborate on the trials and tribulations of the cost of coverage.

I've found bizniks Kris Conway and Beth Cosker to be very helpful on this topic. Both will come to your location and explain the ins and outs to you. There are lots of good individual plans in WA. E-insurance is a place to start gathering data.

Kris did a good job of explaining that you shouldn't just look for a low premium and deductible, but also a low out-of-pocket maximum (that you pay) and a high per-incident and total payout (that insurance co. pays).

The catastrophic plans look enticing with their low premiums, but always check the max payout before signing on. A serious health issue can cost a lot more than some of those plans will cover.

Hopefully in the next couple years health insurance /health costs and many other things will change. We are ready for it!

Ron - you are right. One of the biggest reasons to have health insurance now is to get the discounts on retail fees that goes with it. Unfortunately, after the premiums, and the co-pays, and in spite of the discounted rates, that 20% or so that is not covered is still too much, which is why so many bankruptcies are due to medical conditions.

Karrie - also right on, and those max payout numbers are changing too so there is another factor to consider in dealing the the whole issue.

Innsurance companies play a vital role in our healthcare. Love them or hate them. They only respond to our behavior. We teach them how to treat us.

We love to blame the money hungry insurance companys rather than look at how we treat our own health.

How many of us don't keep our bodies healthy: Get adequate sleep, feed our kids healthy food, excercise regularly?

How many of us demand a drug fix for all of our health problems?

It takes a village to fix this problem. Right now the village is a big part of the problem.

Here is to your good health!

Kris Conway

Great words and great comments Kris. I used to be a chocolate-holic and of course that can screw up your cholestral. Well, instead of taking the drugs, I now do more exercise, moderate the chocolate and watch what I eat. I also take fish oil to assist in this preventive care. We all need to be more responsible for our own health care and remember, it is called the "practice of medicine" for a reason. Stay healthy everyone!! We are here to help you find good quality health insurance if you need us.

I like the "take care of your health first" idea, which I'd recommend following with naturopathic/holistic care, followed by insurance coverage for catastrophic health care. Consider if you need all the bells and whistles like RX (go to Costco!), or could you just get covered for the things that could wipe out your home, business, bank account and credit card limit, like emergency care, hospital stays, lab work, X-rays and other diagnostic tests. We tend to be insurance poor, but you don't want to become poor by not having any coverage.

As for NASE (National Assoc for the Self Employed), also referred to as Mega Life, my own experience with them was horrible. The premiums went up drastically every six months, and there were very few providers/doctors in the Portland area when I had their coverage. Perhaps they've improved, but please do your due diligence. Good luck with your search.

Great comments. I too had a horrible experience with NASE (Mega Life). My son chose that coverage and when he came down with cancer, they limited his coverage to the point he almost went bankrupt. From several people I have talked with that have had that coverage, they indicated when they started using the coverage, they had nothing but problems. Maybe not all people have that problem, but enough that wanted to change. It is always best to stay with a leader in your state and due your research on the kind of coverage you want and need.

Just as a heads up - many of the insurance carriers here in the Sate of WA are no longer writing or are looking to write "Assocotation" plans. The issue we have with BizNik as a whole is that many of the members happen to be a company of 1. I too have worked in the insurance business for over 15 years and have pulled together many association plans. In fact, I have tried this with this group and the carriers are just not interested due to the size (1 employee) of most of the businesses.

The best option for many small group businesses happen to be the individual market. There are some really smart ways in which you can establish an individual plan for both you and any employees and have those cost covered by the comapny money and thus a write off for tax purposes. I have worked with a ton of small business and always look at group plans vs. individual plans and it seems that almost 99% of the time, the small biusiness goes with the individual route.

I too had a horrible experience with NASE and Megalife many years ago. (The agent misled me about what was covered and signed me on for a plan I had to prepay for a year--so I was quite stuck with terrible insurance that did not cover what I needed)

I think it's a waste of money to be a member of NASE as I saw absolutely ZERO benefit from membership. I felt it was just a hook to reel people into the health insurance plan.

If you are looking for health insurance, I suggest reading profiles of some of the knowledgeable people who replied to this thread who are in the business of guiding people through the various plans. I've seen plans ranging anywhere from $75 to $250 per month and they are all different. It's good to get someone to help you.

By the way, whether you go with e-insurance or one of the agents who have replied above, your cost is the same for the same plan--wherever you get it. Wouldn't you rather give the commission (always included in the price) to a small biz owner rather than a big corporation?

Nicely stated Karrie!!!

The way I see it is that my job is to help my clients through the muddy waters of health insurance and help you pick the best plan that fits your specific needs.

The really nice thing about individual plans as oppose to group plans is that you are able to build plans that fit the individual needs of each person in the family. Not a one size fits all approach.

Thank you Karrie, very well stated. The same goes for the medical plans offered by Costco and Sams Clubs. The plans available are generally the same that your broker offers and the cost is the same. The big difference is you don't have anyone knowledgeable to help you through the mess. Keep in mind if you have two in your business or a spouse working in your business drawing an income, you can qualify for a group medical plan without association membership. You have a wide range of choices in coverage with a group plan from as low as a $250 deductible to the HSA. Most individual plans as of January 1st will have a minimum of $1,000 deductible. Be in the driver's seat of your health insurance, let your broker help you help yourself!!

Great points, You cannot replace the services that you get form having a licensed, trained, broker versus having to go through an association. The associations do not care wether your bill was paid correctly or if you need to get a new employee on the plan mid year. They tell you to call the carriers 800-customer no service line.

There is over 48 million a year lost in the U.S. on incorrect billings by doc's and carriers alike. A good broker can keep you from contributing to that fund. Now in the state of Washington they will not allow any associations to form self-funded plans and that takes away the whole power of a big group. So now most the Association plans are just slight modifications of the plans outside of the association. The carriers operate on a 3.5% to 4% profit margin so there is no room to give a break on group size. It looks to me that any Biznik Indie here has several qualified, well informed, and licensed advisors to choose from.

Great comments. I wanted to invite you all to an Obama/ Biden event . They are looking for input on improving healthcare.

December 27th 2:00 at Marie Calendars near northgate. You need to RVSP immediately. Send me an e-mail if you want to participate.

Kris Conway

Kris,

I am really interested in the Obama/Biden health care event. Who is sponsoring it and is it advertised anywhere?

Karrie, you hit the nail on the head. I would so like to support a small business person while purchasing health care.

Health care for ourselves and employees is a very important challenge in being a small business. When I had more employees, it was really a struggle to provide health care and a really good wage base. Now that I am a smaller business, just thinking about what I spent on health care astounds me.

I am so hoping that we can help Obama change our health care services to serve everyone.

This might be common knowledge to some, but I have really valued the education that an independent health insurance broker in my BNI group has given. He told us that if you and a spouse are both listed on your business license, you can actually be eligible for group benefits. He sells many options for those who think that they can't get health insurance-including small businesses. If interested, I can get anyone in touch with him. With so many people getting laid off and so forth, it's good to know that there are sometimes better options out there than COBRA. One scenario is that a person can be on COBRA and their spouse on another plan. It's all about quality and saving money. Healthcare is the most ridiculous, unnecessary problem in our society.

I would always suggest a large amount of PIP and uninsured motorist coverage through your auto insurance.

I'd be glad to give anyone this broker's name and I know that he educates first and sells second. No high pressure sales. I've had friends say that they really appreciate that. My heart goes out to those of you who don't have health insurance, it's bad enough even with insurance, believe me, I know--thanks to a drunk driver almost 3 years ago and we had insurance, but the bills are still horrible.

Hope this can help anyone out there!!! If so, look up www.healthsolutions4u.net. The broker's name is Nick Metcalf and tell him that Janis Flagg told you about him.

Until a better days comes...if this helps just one person, it'll make my day.