Individual and Self-Employed Healthcare – Je

Individual and Self-Employed Healthcare – Jessica Headrick

  • 02 Mar 2016
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Individual sunder the age of 65, not covered by an Employer-Based plan at work, can shop for health insurance plans online using the Health Insurance Marketplace, on Insurance Company websites, or through an insurance agent. If you already have a plan, you should still take a look due to changes from one year to the next. These changes may affect your coverage, providers, deductibles, co-insurance or premium. Aside from variations to existing policies, brand new plans may be available, creating new choices to make for which plan is currently your best option. Since the rollout of the Affordable Care Act is not considered complete until 2022, it is recommended to stay current with any modifications in the law and coverage.

Self-Employed, freelance, and entrepreneurs, are a rapidly growing group that has always had to deal with their own insurance coverage. If they are working solo then all individual plans can be considered. If they are contracting help, again, individual plans will apply to them and their contractors. Self-employed people with limited groups of employees will want to look at (SHOP) Plans designed for small business.

All qualified Affordable Care Act plans have a minimum of 10 services to offer including doctor visits, prescription drugs, hospital visits, maternity and newborn care, and preventative care. A few will offer vision, dental, or medical management programs, but those additions are not generally included.

The following is a list of 10 categories you will see in every plan:

  • Children’s healthcare with vision (occasionally dental)
  • Emergency Care
  • Hospitalization
  • Laboratory Services (like X-rays)
  • Maternity and Newborn Care
  • Mental Health and Substance Abuse Care
  • Outpatient Care (Doctor Visits and Outpatient surgery)
  • Prescription Drugs
  • Preventative services (like Immunizations and Cancer Screenings)
  • Rehabilitative Care (Physical and Speech Therapy)

Reasons you may find yourself shopping for insurance as an individual may vary. You may have lost a job, and therefore, the insurance that came with it, you may be a commission based contractor with an income that is hard to predict, self-employed with a small income or starting your own new business. Whether you go to the Marketplace, an insurance agent, or directly to an insurance company website, know the ACA law and find a qualified plan or face a penalty at the end of the tax year. Qualified plans must be purchased during Open Enrollment November 1st through January 31st.

There are some exceptions to Open Enrollment where you may not be regulated by the dates such as canceling a non-qualified plan and coinciding dates with a qualified plan for replacement.

If you have lost or left a job

Regardless of the reason, you are no longer employed, you are allowed to purchase a plan outside of the Open Enrollment dates. COBRA plans are notoriously expensive but have to be offered by the employer by law. The less expensive decision would be to have a letter from your employer explaining the circumstances around your job loss and subsequent loss of coverage, allowing you 60 days to enroll in a Health Insurance Marketplace plan.Learn what to do if you lose job-based health insurance

If you have a contract job and your income varies

You are able to apply with the best estimate of your income for the coming year. You will need to be as accurate as possible because savings is based on that figure. If your income changes, you need to update the information with the plan carrier to make the adjustment. Whatever savings you qualified for will go up or down when you have your year-end numbers ready for Federal Taxes.Learn about health coverage if you’re self-employed

Self-employed ambitions have yet to produce substantial income

There are ways to qualify for low-cost and free coverage through Medicaid. Adjustments can be made later when your income increases allowing you to change coverage to a Health Insurance Marketplace plan when you are ready.Learn about Medicaid & CHIP

Starting a new business

This is an exciting but hectic time. If you are a sole proprietor, you will be shopping for an individual plan.If you have some employees on the payroll, you may be able to get your coverage, as well as that of your employees, through the Small Business Health Options Program (SHOP). Depending on the number of employees, you could qualify for tax credits for up to 50% of your premium costs.Learn about Small Businesses

Jessica Headrick is a professional writer, Executive Advisor at Boardroom Advisory Group and Founder of Scribe Syndicate. Jessica has an extensive library of published articles including Technology, Human Resources, Travel and Tourism among many others. She provides topic research, initial draft concepts to complete article and blog productions, all dependent on the client’s individual needs. Jessica is available for project-based and al la Carte work throughout the United States and can be reached at jessica.headrick@boardroomadvisorygroup.com.

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