by Katherine Braden
Open Enrollment for 2019 is already here, and it’s time to start thinking about a necessary (but not-so-favorite) thing… health insurance! Specifically, health insurance for freelancers and the self-employed.
We get it. It’s a complicated and confusing topic. And it becomes even more complex when you’re running your own small business or are your own boss. Throw in many yoga teachers’ needs for preventive care (think: chiropractor!), and health insurance can seem like a dismal topic to dive into.
Not to worry — Illumine’s got you covered! We’ll start with your options, so you’ll feel well prepared for Open Enrollment (Nov. 1 to Dec. 15).
Health insurance for freelancers 101
First: the government’s Health Insurance Marketplace. If you’re self-employed (you have a business that takes in income but doesn’t have any employees), look into buying insurance from the Individual Health Insurance Marketplace.
If your business has even one employee (other than yourself, a spouse, family member or owner), you might be able to offer coverage to yourself and your employees through the Small Business Health Options Program (SHOP). If you qualify, look into this option. You could save on your monthly premium, lower your deductible and qualify for tax breaks.
Chicago’s marketplace options are Blue Cross Blue Shield, Ambetter and Cigna. If you’re going this route, plug in your household income, your age, gender and zip code. You’ll find a wide range of options and will need to pick your preference based on your need of EPO, PPO or HMO (check out our refresher on the differences between these plans) as well as how high your deductible and out of pocket maximum are. Individual plans range from bronze (average monthly premium of $434) to platinum (average monthly premium of $709). Take note: pay careful attention to your income and tax situation so you stay within the threshold of getting a discount on the premiums.
If you’re under 30 and relatively healthy, take a look into the Affordable Care Act’s “catastrophic insurance.” This plan is built to protect you if you get into a medical emergency that costs thousands of dollars. Monthly plan premiums tend to be lower (an average monthly premium of $206), and you’re guaranteed three primary care visits a year as well as preventive services such as immunizations. You’ll typically pay for all other health-care costs out of pocket until you reach the plan’s annual deductible. Unfortunately, the annual deductible is at least a couple thousand dollars.
Overwhelmed? The Health Insurance Shoppe offers plans for small businesses, individuals and families. For $125, they’ll provide quotes and proposals on your available options. For an additional $375, they’ll enroll you and your employees in the best insurance plan and provide annual customer service support. They work with United Healthcare, Aetna, Blue Cross Blue Shield and others.
What’s your plan?
Taking control of your health (plan) is a major decision — and sometimes it helps to ask other business owners and self-employed professionals about the coverage they’re working with. (For an explanation of the difference between an EPO, PPO or HMO, see below.)
Susan A. Lipshutz, LCSW, owner of Everyday Medicine Woman, uses Blue Cross Blue Shield HMO. “I did an exhaustive search when my individual plan was no longer viable in Illinois for 2018 and there was only one option,” said Susan. “There really is no other option if you are insuring yourself as an individual that I could find.”
Owners of ACM School of Music, Maria Boustead and Seth Boustead, head to the healthcare marketplace for insurance. Both of them have chronic diseases that require regular visits and medicine. “Since the ACA passed, we’ve changed our insurance every year to find the cheapest plan for us,” says Maria. “That means our doctors switch every year too, which is definitely not ideal, but what can you do?”
Seth and Maria’s bronze level status on their Cigna of Illinois HMO plan means they pay the first $12,000 out of pocket.
“Seth and I each go to a doctor and a specialist about twice a year and pay out of pocket about $200 a pop, or roughly $800 per year,” says Maria. “We could opt for a better plan that (partially) covered doctor visits, but those were about $200 more per month, so it’s less to pay out of pocket. We would still be covered if something really bad happened that would cost us more than our deductible.”
The cost of preventative maintenance
“For yoga teachers and fitness professionals, maintenance care and self-care are a must,” says Dominika Hertsberg of Balanced Flow Wellness.
However, similar to the way your car insurance doesn’t cover gas, health insurance doesn’t cover maintenance, notes Dr. Meggie Smith of Chiropractic First.
Most plans cover the cost of chiropractic care for short-term conditions or exacerbation, according to Dr. Jodi Kirsch of West Loop Spine and Stability.
Services covered through insurance (though often requiring a copay, ranging on average from $10 – $30, and a deductible to satisfy prior to reimbursement) at her practice include adjustments, manipulative therapy, spinal decompression, physical therapy (exercises for strengthening and mobility) and acupuncture. Not covered by insurance: cupping (both fire and pneumatic), dry needling (sometimes acupuncture depending upon the specific policy) and kinesiology taping (using a therapeutic, elastic tape to treat athletic injuries and physical disorders).
“Overall we see the best policies with Blue Cross Blue Shield PPO,” says Kirsch, “but pay close attention to deductible amounts. Regardless if a service is covered, insurance will not pay anything on the claim until the deductible is satisfied.”
Smith agrees. Blue Cross Blue Shield is the only insurance policy accepted in her office. “Blue Cross tends to cover chiropractic care pretty well and [they] are relatively easy and nice to deal with,” she says. “It tends to be the most common company accepted by health care practitioners in the Chicago area.”
Dr. Nolan Lee of Balanced Flow Wellness also notes that the best coverage he’s seen is through Blue Cross Blue Shield’s PPO plan. According to Lee, most plans cover exams, rehab, soft tissue manipulations and chiropractic manipulations, but many do not cover acupuncture. “I’ve seen BCBS cover acupuncture much more often than other insurers,” he notes. Aetna, he says, is next in line for wellness coverage.
Looking for reimbursement on soft tissue work, rehab, chiropractic manipulations or acupuncture? Those services can be covered as long as a doctor orders the work and there’s a valid diagnosis proving the treatment is a medical necessity. “That’s not as complex as it sounds, as even pain or stiffness are official and valid diagnoses,” Lee says. “We can order all of the mentioned work and diagnostic procedures such as x-rays and MRIs. We cannot and do not order drugs or medical procedures like injections, but our nurse practitioner on staff can.”
Invest in yourself
“For people who want to be proactive about their health, find good practitioners and invest in [yourself] by paying for services,” says Smith. “Don’t let your health insurance company dictate how and when you care for your body. Research has found that people who get chiropractic care spend 66% less on health care. So by paying for chiropractic care (even though preventive care isn’t covered by insurance) most people save a ton of money on health care.”
Mimi Bosika, co-founder of Delos Therapy, advises for self-insured individuals: find an insurance with some discretionary spending by the client built in (think: Flexible Spending Account (FSA) or Health Savings Account (HSA)). “This allows [you] to have control over [your] wellbeing and invest in care that gets [you] results rather than having a third party dictate what they do,” says Bosika.
Whatever freelance health insurance plan you choose to pursue in 2019, remember to read the fine print. Also remember that all insurance plans are personal and you’ll need to find a policy that will provide the best care for your current situation.
“If you have something like a chronic condition and need regular care or expensive prescriptions, that’s something to consider,” says Anne Holub, self-employed freelance writer and editor. “If you’re looking to have a baby in the coming year, check out coverage and costs for that. If you tend not to use much healthcare but want to be taken care of in case of accidents, that’s another thing to consider.”
What’s the difference between an EPO, PPO or HMO? And which one do you need?
HMO (Health Maintenance Organization)
- Health plan that offers a local network of doctors and hospitals for you to choose from.
- Lower monthly premiums than other plans.
- Right for you if: You’re comfortable choosing a primary care provider to coordinate your health care and you’re willing to pay a higher deductible to get a lower monthly health insurance premium.
PPO (Preferred Provider Organization)
- Health plan that offers a larger network so you have more doctors and hospitals to choose from.
- Out-of-pocket costs are typically higher with a PPO than with other plans.
- Right for you if: You’re OK with paying a higher monthly premium to get more choices and flexibility with your health care options.
An EPO (Exclusive Provider Organization)
- Health plan that offers a local network of doctors and hospitals for you to choose from.
- Usually more pocket-friendly than a PPO, however, if you choose to get care outside of your plan’s network, it’s typically not covered except for emergencies.
- Right for you if: You’re looking for lower monthly premiums and willing to pay a higher deductible when you need health care.
Katherine lives in Chicago’s Uptown neighborhood and just recently finished her M.S. in Journalism from Northwestern University. She enjoys writing about a wide range of subjects, petting fluffy dogs and riding her neon green bike.
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