Health for Solopreneurs

Are you a solopreneur looking for health benefits? Or just trying to understand your options?

Here’s your guide to getting affordable health benefits and coverage options for yourself and your family.

There are a lot of perks to being a solopreneur. You set your own hours. You’re your own boss. And you choose who you work with and how you work. 

The downside though is, you’re the boss.  

You’re responsible for all those things that an employer would typically handle: health benefits, retirement fund, life insurance, even sick days. It can get a bit overwhelming, especially if you’re new to running your own business. 

There’s only so much time in the day for stuff like researching and buying a health insurance plan, especially after you’ve been juggling clients and sales all day. To help you out, we’ve built this simple guide on choosing the right type of benefits and links to where you can find them.

Why should I even get health insurance?

Before the Affordable Care Act(ACA), a lot of solopreneurs chose to go uninsured. The Affordable Care Act (ACA) was created to help provide affordable health care and give you a lot more options like a traditional employer. 

Pretty much every health plan includes the essentials: free annual checkups with a primary care doctor, free screenings, vaccines and labs. The basic plans can be great if you’re generally healthy. 

If you have a chronic condition, get routine care, or take medications it’s worth considering the higher coverage levels. Sure, your monthly premiums will be higher, but they also provide more flexibility and potentially higher levels of care and coverage. 

Where can I get health insurance?

Let’s get this out of the way…health insurance can be one of your highest monthly expenses as a solopreneur here in the U.S. We’ll explain the basics on the two most common sources of coverage and ways to take some of the sting out of the costs below.

The two most common sources for private health insurance are the ACA Marketplace and an Employer COBRA plan..  

The ACA Marketplace: This is your most direct route is the HealthCare.gov marketplace.

You will find a large selection of providers and plans available to your state. You can choose based on your budget, the level of care and whether you want to keep a specific doctor associated with a specific provider. 

Fair warning, the costs can be shocking if you’ve never had to pay them before. That said, there are ways to reduce these costs. Your accountant or tax advisor can confirm whether you’re able to deduct this as a business expense against your taxes. You may be eligible for financial aid based on certain income standards. Or, you might be eligible for government-assisted insurance like Medicaid or Medicare when you sign up through a marketplace.

Employer COBRA Plans: COBRA health insurance extensions via a former employer are another common source for coverage. COBRA coverage can last up to 18 months after you have left your job as long as you pay your monthly premium on time. COBRA is often a more expensive option, but it allows you to continue care with doctors you like and are comfortable with. Make sure you talk to your HR representative about their process and timelines. 

Wherever you get your insurance, make sure you’re taking full advantage of whatever aid and discounts are available and deducting the expenses against your business when eligible based on guidance from a tax professional. 

What type of plan should I buy?

Buy what you need and what you’ll actually use. The best way to avoid buying a plan with unnecessary features is to understand the cost-sharing components of a health care plan.

Health insurance plans typically come on tiers based on precious metals like bronze, silver and platinum. The higher the metal, the higher the monthly premium, features, level of care and lower annual deductibles.

Choose a plan based on your age, family size, general health and desired level of care.

If you’re young, healthy, single and under 30, you likely don’t need more than the basics. Consider a “catastrophic plan” that gets you basic annual checkups and covers you for major accidents or sickness. Your monthly premiums will be lower with these plans, but you’ll pay a higher cost if something major happens.

If you see a doctor regularly,  have a number of year-round prescriptions or need to cover a family, should consider a higher tier gold or platinum plan.

These are questions you should ask when choosing a plan: 

1. Do you want to stay with a specific doctor? 
2. Are they in the coverage network? 
3. Will the insurance plan pay for my existing medications? What are those costs?
4. Does the plan include extras like telemedicine, prescription discounts or patient advocacy?
5. Do I need referrals for specialists or things like x-ray and lab work?
6. Is there an online portal so I can skip the phone calls and hold times? 
7. Can I get coverage for my whole family? 

How can I get the most out of my coverage? 

Now that you’re covered you’ll want to get the most value out of your plan.

Here’s a few ways to reduce cost and frustrations, and get the most out of your plan: 

1. Use telemedicine. 

Skip the lines or trips to your doctor’s office. More and more health plans offer telemedicine services for free or for a small extra fee. Telemedicine can help treat minor conditions like skin issues, colds, sinus infections, or get refills on routine prescriptions like birth control.

Check with your health insurance company before you get care to make sure that the doctors are in your network and take your plan.

2. Use Rx delivery by mail. 

Insurance companies now offer mail-order Rx programs. Skip the trip to the farmacy for common maintenance prescriptions.

3. Go generic. 

Brand names are more expensive and typically not covered by insurance companies.

Go for the generic options instead. Insurance companies prefer generic versions and are more likely to cover them fully, or with a lower copayment. 

4. Max out your freebies.

All insurance plans now cover annual physicals, well-woman exams, preventive vaccines and lab work, certain types of birth control, and routine screenings like colonoscopies and mammograms. 

As long as you stay in-network, your health insurance company will pick up the tab.If you need care immediately but it’s not an emergency, try an urgent care clinic before making a trip to the ER since hospital visits are generally more expensive.

5. Pick a primary care doctor. 

If you haven’t yet, it’s time to build a relationship with a primary care doctor. They’ll get to know your health history and can make referrals to specialists when needed. They may also help you navigate the complex insurance system to avoid some other expenses and hassles. 

What else should I consider? 

No health insurance plan is perfect when you’re paying out of pocket and trying to keep costs down. Some plans won’t have benefits like telemedicine or Rx discounts. 

What about dental insurance? Glasses? Braces? These are typically add-ons and wholly separate plans with high out of pocket expenses. These are major coverage gaps. 

But, there’s options that can close these gaps. 

The Alliance Health Package was built specifically to help close these gaps for solopreneurs.

For less than $20/month, Alliance members get free, or heavily discounted, access to 24/7 telemedicine, local dentists of your choice, discounted prescriptions-by-mail, discounted glasses and checkups, discounted lab tests and diagnostic imaging like x-rays and MRIs.

And our memberships always cover you and your immediate family. 

That’s medical, dental, vision, Rx discounts and a whole lot more for less than $20/month. 

If you’re a solopreneur looking for health benefits and better coverage, check us out.