If you’re a freelancer, chances are that you’re trying to figure out how to pay for healthcare insurance. It’s one of the biggest problems facing freelancers, who often need the same coverage that full-time employees get from their employers.
Still, if you want health insurance as a freelancer in the United States, it can be an expensive proposition. You have to consider deductibles and your penalty risk (the amount of money you’d have to pay if you were audited by the IRS and didn’t have health insurance).
But don’t fret! Here are my top 15 things I’ve learned about getting healthcare coverage as a freelancer:
| Takeaways |
|---|
| 1. Research and understand the different types of health insurance plans available for freelancers. |
| 2. Consider your specific needs and prioritize coverage that aligns with your health requirements. |
| 3. Take into account the cost of premiums, deductibles, and out-of-pocket expenses when comparing plans. |
| 4. Evaluate the network of healthcare providers associated with each insurance plan to ensure they meet your preferences and needs. |
| 5. Understand the limitations and restrictions of each plan, such as waiting periods, pre-existing condition coverage, and prescription drug coverage. |
| 6. Take advantage of resources and professional organizations that offer guidance and support in navigating freelance health insurance options. |
| 7. Review and compare the reputation and customer satisfaction of insurance providers before making a decision. |
| 8. Consider the financial impact of health insurance on your overall freelance income and budget accordingly. |
| 9. Keep abreast of changes in health insurance regulations and policies to make informed decisions. |
| 10. Seek professional advice from insurance brokers or consultants to ensure you fully understand the details of your chosen plan. |
1. Cost Of Premiums
When you’re looking for health insurance, the cost of your premium is one of the most important factors to consider. Premiums vary widely depending on a variety of factors:
Your age at purchase. Younger people tend to pay lower premiums than older people because they’re less likely to need expensive care.
Your smoking status and history (if applicable). Smokers pay higher premiums than non-smokers. This can be offset by deductibles and copays, but it’s still something you should keep in mind if you smoke or plan on starting in the future.
How much medical care you use over time. People who use more medical services pay higher premiums than those who don’t use as much care but again this can be offset by deductibles and copays that lower costs for certain services or procedures
Buying health insurance for the first time can be overwhelming. Make sure you consider all the important factors by following our comprehensive guide on 13 things to consider when buying health insurance for the first time.
2. Whether The Plan Covers Pre-Existing Conditions
If you have a pre-existing condition, the chances are that you’ll not be able to get insured. A pre-existing condition is one that you are already suffering from before purchasing your health insurance policy.
If an insurer finds out about your pre-existing condition, they will refuse to sell you a plan or charge higher premiums for it.
The benefits of having a plan that covers pre-existing conditions include:
- You can get insured at any time without worrying about whether your insurer will cover the costs of treatment for your pre-existing conditions;
- The premium rates will be much lower than those charged for plans that don’t cover preexisting conditions; and
- The waiting period before coverage kicks in may also be shorter (as compared to plans without such cover).
3. Whether The Plan Covers Essential Health Benefits
If you’re in the market for a new health insurance plan, you must make sure your policy covers essential health benefits. An essential health benefit is defined by the Affordable Care Act as a package of 10 types of health care services and supplies.
These include hospitalization, outpatient services, maternity and newborn care, mental healthcare, prescription drugs, and rehabilitative services.
Essential health benefits are meant to protect individuals from major financial losses if they get sick or injured while also ensuring that all Americans have access to high-quality care when they need it most.
If you have an employer-sponsored insurance plan (or group coverage) through an employer or union you probably already have essential health benefits covered under COBRA continuation plans after leaving an employer’s group coverage or job altogether.
You may also be able to purchase supplemental coverage on top of what your current plan offers through private insurers such as Blue Cross Blue Shield (BCBS) or Aetna if additional coverage is needed;
However, this can get expensive quickly depending on how much extra protection is needed beyond what’s already provided at low cost by employers who provide group plans for their employees.
If you’re self-employed, finding suitable health insurance options can be a challenge. Our article on how to find health insurance when you’re self-employed provides valuable insights and strategies to help you navigate this process effectively.
4. Number Of Covered Visits
Another important factor to consider is the number of covered visits. The number of covered visits determines how often you can visit a doctor or a health clinic.
A higher number of covered visits means that you can visit a doctor more often, while a lower number of covered visits means that you can visit your doctor less often.
In general, if this is your first time looking into getting health insurance, it’s not recommended to go with an insurance plan with fewer than 20-30 total visits per year.
If there are several plans available, try comparing their annual maximum allowed visits (AMAVs) before making a decision.
5. Cost Sharing
The amount you pay for certain services, known as cost-sharing, can be a flat dollar amount, a flat percentage of the allowed charges, or a combination of both. Some plans have no cost-sharing at all; others have low-cost sharing for specific services.
In addition to the total premium and any monthly payments, you are responsible for paying during your policy.
Some health insurance plans may require that you pay out-of-pocket expenses (known as co-pays) when visiting doctors or getting prescription medication.
These co-pays typically range from $10 to several hundred dollars per visit depending on how much work was done by your doctor or if he/she prescribed medications for you.
Cost-sharing may also be subject to limits based on your plan’s deductible (the amount of money paid before coverage begins) which could mean lower out-of-pocket costs later on down the line if certain services aren’t used often enough during coverage periods.
Such as yearly renewable policies versus short-term nonrenewable policies with little flexibility available beyond annual open enrollment periods unless applying directly through individual providers like Anthem Blue Cross/Blue Shield/Health Net etc…
Are you a freelancer in need of health insurance? Explore the various options available to you by reading our informative post on what health insurance options are available to freelancers.
6. Out-Of-Network Costs
Out-of-network costs are costs you will have to pay if you go to a provider that is not in your plan’s network. They can be very high and often mean that you’re left with only emergency health care as an option.
For example, if your child has been in an accident and breaks his or her leg, he/she may need emergency surgery done at the hospital.
If the hospital is out of network for your health insurance company, then they’ll likely bill these services at much higher rates than their actual cost.
This means that even though the cost of this procedure might only be $1,000 or so when done by someone who is within your plan’s network, it could end up costing several thousand dollars if done by an out-of-network provider!
Don’t forget about annual benefits caps either. If you have a serious illness like cancer or heart disease that requires intense treatment over an extended period (which could last months).
Then it’s possible that these treatments will use up all of your annual benefits caps very quickly and this would leave no money left over for other medical costs incurred during those same months before needing another year’s worth of coverage on top!
7. Cap On Annual Benefits
Annual caps on benefits: Many health insurance plans have an annual cap that limits the amount they will pay out in a given year.
For example, if you have a plan with an annual maximum benefit of $50,000 and need more than that amount in care during the year, you’ll be on your own for paying for the rest of that treatment.
The same goes for families; if one member needs more than $50K in treatment in any given year and a family is insured under the same policy, all members are responsible for paying out of pocket any costs above this threshold.
In some cases (like HMOs), this can also apply per member per month it depends on what type of plan you have and whether or not it includes co-pays or deductibles (see below).
8. The Insurance Company’s Financial Strength Rating
A strong financial rating is a must. You want to make sure that the insurance company has been in business for many years and can pay out when it needs to.
This means looking for an A+ rating from A.M. Best or Standard & Poor’s, as well as a stable outlook from Moody’s Investors Service or Fitch Ratings on their financial strength ratings.
These are all leading organizations in their fields and will give you the best information on whether or not the company you’re considering is reliable.
Freelancers in the USA face unique challenges when it comes to obtaining health insurance. Don’t miss our detailed article on the top 15 things to look out for when getting freelance health insurance in the USA, which provides essential information and tips to help you make informed decisions.
9. Health Insurance Exchange Plan Versus Off-Exchange Plans
When you shop for health insurance, you will come across two types of plans: the exchange and off-exchange. Here are a few things to consider before choosing which one is right for you:
Exchange Versus Off-Exchange Plans
The main difference between these two options is that an exchange plan comes through a state marketplace where individuals can purchase private coverage. Off-exchange plans are purchased directly from an insurance carrier, not through an exchange or any other entity.
Pros & Cons Of Each Type
The advantages of an on-exchange plan include having access to lower premiums and out-of-pocket costs as well as tax credits if eligible based on your income level;
However, these policies usually have limited provider networks (meaning fewer doctors and hospitals) than off-exchange plans do.
On top of that, most exchanges also have limited coverage options available so make sure they’re compatible with your needs before committing yourself!
Offering more flexibility than their counterparts does come at a price though – namely higher premiums but also higher deductibles (how much money must be paid out before benefits kick in).
Plus there may be restrictions such as age limits or preexisting conditions preventing certain individuals from obtaining certain types altogether.
10. Your Current Coverage
If you are currently covered by an employer-sponsored health plan, you may be eligible to keep your current coverage.
If you do not have employer-sponsored coverage and choose not to enroll in a new plan, you may be eligible for federal subsidies that can reduce your monthly premiums and out-of-pocket costs.
You can find more information on federal subsidies here: https://www.healthcare.gov/lower-costs/.
11. Federal Subsidies And Tax Credit Qualification
If you are a low-income individual or family, then federal subsidies and tax credits may be available.
The amount of the tax credit depends on your income, which is determined by factors like your household size, insurance premiums before any discounts offered, and whether or not you’re eligible for other government programs such as Medicaid or Children’s Health Insurance Program (CHIP).
The credit is paid in advance to your insurance company to lower your monthly premium cost. This means that if you don’t keep up with these payments, there could be serious consequences for your finances later on down the line!
If this sounds like something that may apply to you or if it just seems like a good idea.
You must contact an agent right away so they can help make sure everything goes smoothly when signing up for health coverage across different plans during the open enrollment period (usually around November 1st until December 15th).
Curious about freelance agencies and whether they are a good option for you? Discover more about this topic by reading our article on what is a freelance agency, and is it a good thing. Gain insights into the pros and cons, and make an informed choice for your freelancing career.
12. Deductibles And Copayments For Generic Vs Brand Name Medicines
If you are looking for a good health insurance plan for your family, one of the most important things to look out for is whether or not it covers generic drugs.
Generic drugs are essentially brand-name drugs that have been around for quite some time, and they tend to be cheaper than their brand-name counterparts.
However, it’s worth noting that some people may feel better on certain types of medicines, while others might get sicker if they take them.
For example, if you suffer from hypertension and need medicine to control high blood pressure then your doctor will likely prescribe a specific type of medication that works best for you.
In this case, your physician may recommend that you buy a brand-name drug over its generic counterpart because it has been proven effective in treating hypertension patients like yourself (as well as other conditions).
On the other hand though if we were talking about erectile dysfunction instead then there wouldn’t necessarily be any difference between taking Viagra or going with Levitra because both medications do exactly what they promise:
Increase sexual desire among men who suffer from ED problems due to low testosterone levels (among other things).
13. Medical Underwriting Process For Individual Plan Applications For Pre-Existing Conditions
Medical underwriting is the process of determining whether an individual or group policyholder is eligible for coverage.
Underwriting is a process that determines whether the insurance company will cover a person with a pre-existing condition. Pre-existing conditions are conditions that existed before the effective date of the policy.
The following information may be used in evaluating whether you are eligible to purchase coverage:
- Your age, gender, and other personal characteristics;
- The state where you live; and
- Whether you have been diagnosed with any medical condition (including mental health).
14. Network Of Providers You Can Use For Your Medical Needs And Prescriptions
When considering a health insurance plan, you will want to check out the network of providers that are covered by your plan. A narrow network means that there are fewer doctors and hospitals available to you.
The upside is that it can save you money since there is less overhead. However, this can also restrict your access to care if there aren’t any in-network specialists or physicians near where you live or work.
Wide networks offer more options but cost more because they have bigger networks of providers to pay for and maintain.
If your primary concern is getting affordable health insurance coverage with wide access, then these plans may be ideal for you but keep in mind that higher premiums usually mean lower deductibles or co-pays (how much money gets paid before coverage kicks in).
They also tend to have higher copayments (a fixed amount per visit) than narrow networks do as well as an annual deductible amount which must be met before any benefits kick in
15. A Short Guide On The Factors To Consider When Purchasing A Health Insurance Policy
Cost Of Premiums
The main factor to consider when purchasing a health insurance policy is the cost of premiums. It is important to look out for the annual premium, co-insurance, and deductibles.
The higher your deductible, the more likely you will have to pay out-of-pocket for any medical expenses that exceed this amount.
When comparing different plans, it’s also important to consider how much each plan covers in terms of deductibles and co-insurance costs as well as what types of services are covered by your plan.
Pre-Existing Conditions
You should make sure that any health insurance policy you purchase covers pre-existing conditions before signing up for it. This can be done by requesting a list of exclusions (what’s not covered) from the insurer before buying a policy so that there are no surprises later on down the road when trying to use your coverage at an inpatient hospital or urgent care center.
While traveling overseas without being able to afford treatment costs upfront because they’re too expensive at local facilities where people usually go instead due to lack of availability within geographic distance limitations.
Even though few providers may offer discounted rates depending on income bracket level but aren’t guaranteed unless receiving subsidies through Medicaid/Medicare programs;
Therefore being careful about whether or not accepting free services would put them into debt rather than help them get better faster.
Since most physicians don’t want anyone else knowing how much money was spent treating someone who didn’t pay anything back except if getting paid under Medicaid/Medicare programs due to having low-income levels necessitating assistance from government agencies.
These are like UNOS (United Network Of Organ Sharing) which operates nationally collecting donations from donors across America who want their organs donated after death along with tissue donation options available through various organizations based upon location type (rural vs urban).
Conclusion
We hope that our top tips for finding the right freelance health insurance in the USA will help you protect your family and finances. Please leave a comment if you have any questions or would like to add anything to our list!
Further Reading
Here are some additional resources for further reading on freelance health insurance:
Best Health Insurance for Self-Employed People: Forbes Advisor provides insights into the best health insurance options specifically tailored for self-employed individuals.
The Freelancers’ Guide to Health Insurance: Freelancers Union offers a comprehensive guide that covers various aspects of health insurance for freelancers, including finding affordable options and understanding coverage.
Freelance Health Insurance Guide: ZenBusiness provides a detailed guide on freelance health insurance, offering information on available options, eligibility criteria, and tips for choosing the right coverage.
FAQs
What are the key considerations when choosing health insurance for freelancers?
When choosing health insurance as a freelancer, it’s important to consider factors such as affordability, coverage options, network providers, and any specific needs or pre-existing conditions you may have.
Can I get health insurance if I’m self-employed?
Yes, self-employed individuals can typically obtain health insurance coverage. There are various options available, including purchasing insurance through the marketplace, joining a professional organization for access to group plans, or exploring private health insurance providers.
How do I find affordable health insurance options as a freelancer?
To find affordable health insurance options as a freelancer, consider researching and comparing different plans, evaluating your eligibility for subsidies or tax credits, exploring professional associations or unions that offer group plans, and considering high-deductible plans or health savings accounts (HSAs) for potential cost savings.
What is COBRA and how does it relate to freelance health insurance?
COBRA (Consolidated Omnibus Budget Reconciliation Act) allows individuals to continue their employer-sponsored health insurance coverage for a limited period of time after leaving their job. It can be an option for freelancers who recently left a traditional employment situation but want to maintain their existing health insurance coverage.
Are there any government programs that provide health insurance options for freelancers?
Freelancers may be eligible for government programs such as Medicaid or the Children’s Health Insurance Program (CHIP) if they meet certain income and other eligibility criteria. It’s advisable to check the specific guidelines in your state to determine if you qualify for these programs.
Costantine Edward is a digital marketing expert, freelance writer, and entrepreneur who helps people attain financial freedom. I’ve been working in marketing since I was 18 years old and have managed to build a successful career doing what I love.