Ask HN: What healthcare options exist for entrepreneurs?
Would like to know what are the best options for healthcare when working for yourself in California. How much should I expect to pay?
51 comments
This is a bit political; but relevant - vote for Universal Healthcare (Medicare for All), and this won’t even be a thought for you.
I’m from Australia and don’t need to ever worry about health care costs; and you’d never in my life get me to vote to have a system like yours here.
I say this not to rant, but to hope in my heart that America can deliver this level of care to its citizens, and free you and your family from this burden.
I’m from Australia and don’t need to ever worry about health care costs; and you’d never in my life get me to vote to have a system like yours here.
I say this not to rant, but to hope in my heart that America can deliver this level of care to its citizens, and free you and your family from this burden.
Also relevant if you want nationalized healthcare expect to pay a significant amount more in taxes. America is the third most populous country in the world with over 320M documented citizens + an unknown amount of undocumented citizens. Roughly half of the us population does not pay income taxes yet still need to be covered by healthcare. It’s probably much more affordable and of better quality to get a private insurance plan. So either be an entrepreneur who makes money so that you can afford that option or get healthcare through a company and moonlight your way to the top. Edit: also you can elect S-Corp and get a payroll system like ADP with a healthcare plan they provide
Fear, Uncertainty, Doubt.
Insured families pay $1200-1500/m for premiums with thousands of dollars of deductibles and annual limit on spending. And the. Have to fight for every cent the insurance companies do their damn best to not pay.
How will we pay for single payer? We take all the money that goes for healthcare right now, burn half of it and use the other half. Or less.
Insured families pay $1200-1500/m for premiums with thousands of dollars of deductibles and annual limit on spending. And the. Have to fight for every cent the insurance companies do their damn best to not pay.
How will we pay for single payer? We take all the money that goes for healthcare right now, burn half of it and use the other half. Or less.
I pay something like $430/month through Kaiser. My experience there is they are really good unless you need mental health stuff. I would especially recommend cancer—the views of SF from the chemo lounge are spectacular.
Kaiser is their own insurer/pharmacy, and works like a mini version of single payer. If you're younger than me (I'm 43) you may find some plans with them that are cheaper.
Another option is OneMedical, which is kind of boutique health care for wealthier people, but lets you do a lot more online than most medical services and may be worth a look. https://www.onemedical.com
Kaiser is their own insurer/pharmacy, and works like a mini version of single payer. If you're younger than me (I'm 43) you may find some plans with them that are cheaper.
Another option is OneMedical, which is kind of boutique health care for wealthier people, but lets you do a lot more online than most medical services and may be worth a look. https://www.onemedical.com
Also on Kaiser... they make you jump through hoops to get consistent mental health (regular weekly therapy). If you're persistent enough (call and be very direct about the kind of care you want) they'll hook you up with Magellan Health, the company they outsource to for mental health. Through Magellan, I was given a huge array of therapists to choose from in the Bay Area. If you shop around you can find someone you click with.
Thanks for inadvertently pointing me to this [1], it was so interesting!
https://idlewords.com/2012/09/no_evidence_of_disease.htm
https://idlewords.com/2012/09/no_evidence_of_disease.htm
Why do you say One Medical is for "wealthier people"? Outside of the $200 annual membership fee, it's no different than seeing any other physician if they are in-network for your insurance plan.
I had several doctors from One Medical and they were not the best. However, there were a number of things that made up for it. Setting up appointments was easy, the locations were convenient, and you could even talk to the doctors via messaging on the website. Viewing and downloading test results could be done via their website also, and I've had to jump through hoops to get test results elsewhere.
However, to call it a true concierge practice would be a joke, in my opinion. I've never had the money for one (10k+ per year fee), but a friend of mine did have one of these, and at least in his case they were able to cure a serious back problem of his through cutting edge and non-invasive therapies. I wouldn't expect to find anything close to that at One Medical.
Still would say the One Medical membership fee ($200) is worth it if you can find a decent doctor there and if you're not happy with what you currently have.
However, to call it a true concierge practice would be a joke, in my opinion. I've never had the money for one (10k+ per year fee), but a friend of mine did have one of these, and at least in his case they were able to cure a serious back problem of his through cutting edge and non-invasive therapies. I wouldn't expect to find anything close to that at One Medical.
Still would say the One Medical membership fee ($200) is worth it if you can find a decent doctor there and if you're not happy with what you currently have.
For me, the best thing about One Medical is that they have walk in labs and you can do your labs in their office without going to a Quest Labs or LabCorp office, which are not pleasant at all and usually have long waits.
The only people I've ever seen there are young techies, and their offices are in hip parts of town rather than Medical Gulch.
Folks who are living paycheck-to-paycheck probably aren't going to shell out an additional $200 fee.
I have Kaiser through my employer and I like it a lot. Maybe they don’t have the shiniest and best but it’s solid, simple and predictable.
> I would especially recommend cancer
Umm...probably rephrase.
Umm...probably rephrase.
Your best choice will likely be a plan from the ACA. In California, this is https://www.coveredca.com/. You can try and get cute and find something like a MEWA, which have theoretically been cleaned up from the disaster that they were in the past (bankrupt and not covering claims.) There's also professional organizations that you can purchase through, but I've never seen one that isn't just a gateway for the ACA.
As far as price, just check the market. There should be a way to see prices without even creating an account. The total price to account for is premium*12 + out_of_pocket_max, which should be between $11-15k for the year for a single person regardless of what plan you have. For me, I'm at about $490/month for a $7900 out of pocket max, which puts my total liability at $13780 for the year. Though, it will probably be less than that given that I'm healthy. That said, I'm not in CA.
Anyway, good luck! Running your own business is exciting and this is an expense. Also worth noting that your premiums are completely deductible as a self-employed person, which is normally not the case.
As far as price, just check the market. There should be a way to see prices without even creating an account. The total price to account for is premium*12 + out_of_pocket_max, which should be between $11-15k for the year for a single person regardless of what plan you have. For me, I'm at about $490/month for a $7900 out of pocket max, which puts my total liability at $13780 for the year. Though, it will probably be less than that given that I'm healthy. That said, I'm not in CA.
Anyway, good luck! Running your own business is exciting and this is an expense. Also worth noting that your premiums are completely deductible as a self-employed person, which is normally not the case.
We get group insurance (with BC/BS) through a local broker. One thing to have a look at: we found that the high-deductable plans were so much cheaper that we could put enough into everybody's HSA account to cover the deductible and still come out ahead. I think it's one of the best moves we ever made, and I've stress-tested the insurance pretty hard...
I am self-employed as a software contractor. I think my wife and I pay around $500 combined for the two of us via Oscar. We had BC/BS for a while but as two relatively healthy people we opted to reduce our monthly expenses a bit and switch to Oscar when BC/BS raised their prices again at the start of 2019.
I pay $1,050 for myself, my wife, and my son. It is crazy, that is with a $6k+ deductible per person... It is terrible insurance and just for catastrophic.
I hope we do Medicare for all. This system is so broken, it is time to learn from Europe, Japan, etc. I don't get why we don't steal great ideas because we are doing terrible.
I hope we do Medicare for all. This system is so broken, it is time to learn from Europe, Japan, etc. I don't get why we don't steal great ideas because we are doing terrible.
Family of 4, I pay 1250$ for the cheapest Blue Shield CA plan. I got the plan comparison on https://www.stridehealth.com/ but the enrollment period is over already for this year, unless you qualify for an event.
Look at the MarketPlace, HealthSherpa, or ehealthinsurance.
I'm not sure the rules on posting links. I'm not associated with any of the above. But whenever I'm relocating and working a contract without benefits. I use those three sites to narrow down my options.
I'm not sure the rules on posting links. I'm not associated with any of the above. But whenever I'm relocating and working a contract without benefits. I use those three sites to narrow down my options.
I run a 1-person LLC in NYC. I initially used healthcare.gov for my coverage, but once my business started making money, I found that I was paying a lot for mediocre coverage. The providers I used also stopped offering coverage after 2016/2017, so I decided to switch to TriNet. They are an HR service, but also offer health insurance, which is all I use them for. I also looked at Gusto and JustWorks, but they required 1+ employees. I currently pay about $1500 for me and my family for pretty good coverage from Aetna (including dental and vision).
How did you get just the insurance? I reached out to them and was told I needed a full service plan ($500/mo before the insurance) with them to get the insurance. I have a 2-person LLC partnership, and we don't need the business services.
How'd you do what you did?
How'd you do what you did?
I pay for the full service plan (it is less for me since I am just 1 person), but I don't use any of the other services. Even with the fee, it is still a good deal.
I don't know how applicable it is, but if you are big enough to have an employee or two, check with whomever you contract with to handle payroll processing and see if they've got an offering. My wife's last gig was for a three-employee company and their payroll provider was able to offer group insurance rates that were pretty competitive.
In the US, if you are under age 26, you can still be covered by your parents insurance thanks to the ACA ("Obamacare").
If you pay yourself little enough you can get free or subsidised healthcare through Obamacare. There are no asset tests.
This is false and will likely get you into trouble. ACA uses your last year's income tax return in order to determine whether a subsidy should be awarded. While it is true that you do not send in your tax return while applying for coverage, your insurance company does send in paperwork through a 1095-A. In the past, 1095-A was used primarily to show that coverage was carried in order to avoid a tax penalty, so, yes, you may be able to get away with it, but you'd still be lying and there will be documentation that you are lying.
Also, sole-proprietorships and S-corps, LLC or not, are considered pass through and all company income is considered personal income as far as the IRS is concerned. There's no such thing as not paying yourself in this context to drive down your income.
Also, sole-proprietorships and S-corps, LLC or not, are considered pass through and all company income is considered personal income as far as the IRS is concerned. There's no such thing as not paying yourself in this context to drive down your income.
There is nothing false about his comment (maybe it was updated).
ACA is fully based on projected income for the year. Previous year's tax returns are one way of substantiating your projected income. But not required. If you are living off of savings and not making a profit yet on your business, you can pay yourself a small salary and qualify for full subsidies from ACA.
If you file as a C Corp (which you can do with an LLC), you could even hold profits in retained earnings and not pay them to yourself yet. You would of course have to pay corporate tax on those retained earnings.
ACA is fully based on projected income for the year. Previous year's tax returns are one way of substantiating your projected income. But not required. If you are living off of savings and not making a profit yet on your business, you can pay yourself a small salary and qualify for full subsidies from ACA.
If you file as a C Corp (which you can do with an LLC), you could even hold profits in retained earnings and not pay them to yourself yet. You would of course have to pay corporate tax on those retained earnings.
Yes, ACA is based on projected income:
https://www.healthcare.gov/income-and-household-information/...
However, for most people, the primary number to estimate this is your adjusted gross income, which they explicitly instruct to use line 7 on the 1040. It's not entirely clear to me who the regulatory authority is now that the tax penalty has been taken away for not carrying insurance, but I'm pretty sure it's going to look bad if you say that your income is near $0 to get a subsidized plan and your actual income is above the subsidy level and the IRS will have this information.
As far as holding the money in a C-corp, sure. However, then you're going to pay the corporate income tax rate for keeping the money in C-corp, file much more complicated paperwork than you would as a sole-proprietorship (depending on the state), and then likely have to pay additional taxes or play games once that money turns into income. All of this is to save on what's going to turn out to be likely less than $5k in premiums, which are already tax deductible as a self-employed person.
I'll still contend that the comment is largely false given the idea is to save money by pretending that there's no income. The IRS isn't dumb and they'll get their taxes eventually even if it requires an audit. It seems like a huge hassle and liability to play this game to save such a small amount of money. If this isn't a small amount of money, then the OP isn't in a position to start a business, unfortunately.
https://www.healthcare.gov/income-and-household-information/...
However, for most people, the primary number to estimate this is your adjusted gross income, which they explicitly instruct to use line 7 on the 1040. It's not entirely clear to me who the regulatory authority is now that the tax penalty has been taken away for not carrying insurance, but I'm pretty sure it's going to look bad if you say that your income is near $0 to get a subsidized plan and your actual income is above the subsidy level and the IRS will have this information.
As far as holding the money in a C-corp, sure. However, then you're going to pay the corporate income tax rate for keeping the money in C-corp, file much more complicated paperwork than you would as a sole-proprietorship (depending on the state), and then likely have to pay additional taxes or play games once that money turns into income. All of this is to save on what's going to turn out to be likely less than $5k in premiums, which are already tax deductible as a self-employed person.
I'll still contend that the comment is largely false given the idea is to save money by pretending that there's no income. The IRS isn't dumb and they'll get their taxes eventually even if it requires an audit. It seems like a huge hassle and liability to play this game to save such a small amount of money. If this isn't a small amount of money, then the OP isn't in a position to start a business, unfortunately.
I don't know why you latched on to the notion that I was suggesting something dishonest.
You might be prioritizing developing your product over making income, or reinvesting income rather than spending that income personally. Or you might have savings or existing investment funding. There are many common scenarios such as these and none of them involve fraud.
You can be building up a substantial asset and living frugally and it doesn't affect your eligibility because of the lack of an asset test and because any capital gains are not realized) or assessed) until the business is sold.
Also as a single person you can earn up about $12K and not pay any premiums under Obamacare, or get up to about $48K and still get a subsidy. If you have a family of 4 these figures and $23K and $96K respectively. So obviously you don't have to get your income down to $0.
You might be prioritizing developing your product over making income, or reinvesting income rather than spending that income personally. Or you might have savings or existing investment funding. There are many common scenarios such as these and none of them involve fraud.
You can be building up a substantial asset and living frugally and it doesn't affect your eligibility because of the lack of an asset test and because any capital gains are not realized) or assessed) until the business is sold.
Also as a single person you can earn up about $12K and not pay any premiums under Obamacare, or get up to about $48K and still get a subsidy. If you have a family of 4 these figures and $23K and $96K respectively. So obviously you don't have to get your income down to $0.
Those minimum/maximum rates are different depending on if you state has medicaid expansion or not.
But I think the rates you posted are federal poverty level for a family of 4. Obamacare coverage kicks in at 138% of FPL all the way up to 400% of fpl.
Below 138% FPL disqualifies you for obamacare because you would qualify for state medicaid coverage.
But I think the rates you posted are federal poverty level for a family of 4. Obamacare coverage kicks in at 138% of FPL all the way up to 400% of fpl.
Below 138% FPL disqualifies you for obamacare because you would qualify for state medicaid coverage.
He didn't imply you should lie about your income.
Most early businesses don't make much profit if any. Mine did not and so we kept our income right in the sweet spot to get max subsidies.
We paid ourselves that small salary and plowed every bit of the remainder into growing the business. In other words, there was no profit at the end of the year.
We had absolutely excellent coverage for around $100 a month total for a family of two. In one year we had $70,000 in expenses from a broken ankle that needed major surgery. And the next year a complicated pregnancy that cost $40k. We paid our max out of pocket those two years of $1500 each year.
Most early businesses don't make much profit if any. Mine did not and so we kept our income right in the sweet spot to get max subsidies.
We paid ourselves that small salary and plowed every bit of the remainder into growing the business. In other words, there was no profit at the end of the year.
We had absolutely excellent coverage for around $100 a month total for a family of two. In one year we had $70,000 in expenses from a broken ankle that needed major surgery. And the next year a complicated pregnancy that cost $40k. We paid our max out of pocket those two years of $1500 each year.
I'm not 100% sure, but afaik this is true in some states if you are living off of capital gains - I've seen people on the FIRE forums saying, "I feel actually bad taking advantage of subsidized healthcare, but because state law is written poorly and only considering wages, I am being opted in". In CA this loophole is not a thing, and capital gains are considered as part of your income for insurance purposes.
You’re looking for network healthcare plans? It was news to me to learn about ‘sliding scale’ pricing at many county hospitals. Same for clinics.
If you’re young and in good overall health, this might be a choice to consider.
If you’re young and in good overall health, this might be a choice to consider.
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Use the exchange.
I pay $150/mo using a health sharing service called Christian Healthcare Ministries. There are others not religious in nature like Liberty Health Share. Would be $450 for entire family.
I vouched for this dead comment. I know a few self-employed consultants or business owners who use this kind of mutual expense sharing for their insurance. (I learned about the concept from my auto insurance agent several years ago.) It seems like something entrepreneurs actually use and may be more viable than high deductible insurance for people who would actually use their insurance (but more expensive than Medicaid.)
It is worth highlighting the major difference: these products are not at all health insurances, and they cannot be labelled as such.
When you have a contract with an insurance company, that service provider has to pay up or you can sue them if they don't. Sure, there might be a co-pay or a high deductible, but if you draw an unlucky card with cancer / heart / cardio disorders, they will fork out six-seven figure sums to get you better.
"Christian Healthcare Ministries" and the like have no obligation to pay out and you are gambling on their goodwill, which can be revoked at any moment with no recourse. Further, they often have _lifetime_ caps of ~$100k per diagnosis/condition, and in case of any serious illness this will be chewed up in 3-4 months, then you are on your own.
When you have a contract with an insurance company, that service provider has to pay up or you can sue them if they don't. Sure, there might be a co-pay or a high deductible, but if you draw an unlucky card with cancer / heart / cardio disorders, they will fork out six-seven figure sums to get you better.
"Christian Healthcare Ministries" and the like have no obligation to pay out and you are gambling on their goodwill, which can be revoked at any moment with no recourse. Further, they often have _lifetime_ caps of ~$100k per diagnosis/condition, and in case of any serious illness this will be chewed up in 3-4 months, then you are on your own.
Yes, that all is important to consider. My understanding is that this was especially true before the ACA, when certified continuous coverage was a big deal.
The lifetime limit is more complicated than that as they seem to have separate programs for up to a maximum and everything beyond that. For example, Samaritan Ministries (one of these programs) costs ~$500/mo for a family for everything up to $250,000 and about $500/year to cover $250,000 with no limit. I’m guessing that’s done because they have members who live in inexpensive countries, but it seems like the extra annual cost should just be rolled into the monthly so no one makes the wrong choice about how much to cover.
The lifetime limit is more complicated than that as they seem to have separate programs for up to a maximum and everything beyond that. For example, Samaritan Ministries (one of these programs) costs ~$500/mo for a family for everything up to $250,000 and about $500/year to cover $250,000 with no limit. I’m guessing that’s done because they have members who live in inexpensive countries, but it seems like the extra annual cost should just be rolled into the monthly so no one makes the wrong choice about how much to cover.