Freelancer’s guide to health insurance

Closeup Money rolled up with pills falling out, high cost, expensive healthcare

Deadlines, rejection letters, dead cable connections nothing strikes fear into the heart of a freelancer as much as the stratospheric cost of healthcare.



The Affordable Healthcare Act, at least for some of us, has made healthcare more affordable. For all of us, the ACA has, at a minimum, made compari­son-shopping for health insurance a bit easier.

That’s not to say that the shopping is easy; only easier than it once was. Comparing and contrasting premiums, deductibles, copays, coinsurance and such can still give you a hellacious headache.

Here are some pointers that might help lessen the confusion:


Unless your life is shaken up by a move to a new area, adding a child to your family or some such “qualifying life event,” you have until February 15 to choose a health-insurance plan for 2015. What if you don’t? You’ll probably have to pay the government a fine. Your only option for insurance for the rest of the year may be a crummy short-term plan. And, most importantly, you’ll be courting disaster should a medical emergency occur and you find yourself without insurance.


The Affordable HealthcareAct, at least for some of us, has made healthcare more affordable. For all of us, the ACA has, at a minimum, made comparison-shopping for health insurance a bit easier.


Yes, the federal website is now running just fine. It will refer you to your state’s website if you live in one of a handful of states that run their own insurance marketplaces. If you live in most of the United States, it will let you know which insurance companies offer coverage in your area, see the plans they offer and it will categorize them by level of coverage—bronze, silver, gold, platinum. The cheaper met-

als offer the lower monthly premiums, but you’ll find your ongoing, as-needed expenses, and often your out-of-pocket maximums, higher.


According to Katy Votava, Ph.D., RN., an expert in the intricacies of healthcare economics, you need to ask yourself the following four questions in choosing the plan best for you:

  1. If you have healthcare providers that you like, check with them first to see to which health-insurance networks they belong. If you want to see a doc who is out-of-network, you will probably be on your own.

  2. If you need regular medication, check to see if a plan will pay for it, and if so, how much.

  3. Consider a Health Savings Account (HSA)-eligible high-deductible plan. These (typically bronze or silver) plans can save you money if you wind up with modest health-care expenses over the year. Not only that, but you can bank as much as $3,350 ($4,350 for those over 50) a year in a Health Savings Account, which is like a healthcare IRA. If you don’t use the (tax-deductible) money you plunk in this year, you can use it for future healthcare expenses. But these plans usually require a lot of paperwork, and they can backfire and cost you more if you wind up spending a lot, especially on out-of-network care.

  4. Focus on the big picture. “Always consider the worst-case scenar­io, and take special note of a plan’s out-of-pocket maximums,” says Votava. (There is usually one out-of-pocket maximum for in-network care, and another out-of-pocket maximum for out-of-network care.) “These are your stop-losses…more important than your copays. In past years, back when most of us had company insurance, the copays were legitimately our biggest concern, because they were our biggest variable,” says Votava. “Copays are what we’ve been trained to look at,” she adds. “For that reason, people tend to belabor $5 or $10 differences in what they’ll pay each time they see the doctor, whereas what they really should be looking at are the potentially thousands of dollars of difference in out-of-pocket maximums.”

SEEK SUBSIDIES, IF YOU QUALIFY will also tell you if you qualify for a government subsidy based on your modest income. The current cut-off is $46,680 for an individual. That’s where the subsidies start. They get larger the less you make. If you are having a really bad year, with less than $16,105 in income, you’ll likely qualify for Medicaid and pay little to nothing.


One of the best things about the Affordable Care Act is the inclusion, at no extra cost, of preventive care. “These services are covered 100 percent, and many people overlook them,” says Votava. “Use them!” Such services include screening for blood pressure and cholesterol, diet counseling, colorectal cancer screen­ing (colonoscopy) for adults over 50, depression screening, STD prevention counseling, obesity counseling and various immuniza­tions, from the flu shot to chicken pox. Here is the full list:


A hypothetical 50-something freelancer in Pennsylvania who makes $46,000 a year (just under the government’s subsidy thresh­old) stands to get $2,031 back from Uncle Sam to help pay for cov­erage in 2015. That very same hypothetical freelancer, should his earnings climb to $47,000 a year, gets nothing back. You don’t need to be very good at math to see that if you’ve already made $46,000 by mid-December, you just might try to delay your final invoicing for the year…or consider a long holiday vacation.


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