So you’re a freelancer and you need to get health insurance. Now what?
Here’s a comprehensive look at how to find the health insurance plan that’s best for you -- from the people who know freelancers best. Freelancers Union is the nation’s largest non-profit representing the independent workforce.
We’ve been advocating for freelance workers nearly 20 years and we’ve been helping freelancers find health insurance for over ten of them.
You can find health insurance through our National Benefits Platform. If you'd like to see this post as a webinar, click here. If you like to read, keep on reading!
Do I really need health insurance?
Yes. It’s not only good for you, but, under the Affordable Care Act (aka Obamacare), it’s also required that everyone get health insurance.
The penalty for not having health insurance in 2015 is pretty significant -- it’s 2% of your yearly household income or $325 per person for the year, whichever is higher.
Where can I find health insurance?
You have three great options:
a. Freelancers Union’s National Benefits Platform, which provides a curated selection of health insurance options for freelancers across the country
b. Your state’s health insurance marketplace (you can see a directory of state exchanges and the federal exchange at healthcare.gov)
c. The websites of individual private insurance plans
What kind of plans are out there?
Under the ACA, insurance plans are basically offered at five metal tiers:
As you might guess, higher metal tiers (shinier metals!) are usually more expensive upfront but cover more of your medical expenses throughout the year. Lower tiers (catastrophic and bronze) have lower monthly premiums but cover a smaller part of your medical expenses throughout the year.
For example, in a Bronze plan, your plan will pay about 60% of the average cost of essential health benefits. A Platinum plan will pay about 90% of the average cost of essential health benefits, but costs more upfront.
I think I’m eligible for a subsidy. What can I do?
Under the ACA, if you make less than about $45,000 as an individual (or $94,200 for a family of four), you may be eligible for a subsidy or tax credit towards your health plan. This is great news for many middle- and low-income freelancers. You can get an estimate of what subsidies you might qualify for by using this great Kaiser Family Foundation subsidy calculator.
If you think you’re eligible for a subsidy, call Freelancers Union at 800-856-9981. You may be able to apply a subsidy to a plan in your state.
When can I enroll in health insurance?
Open enrollment for 2015 coverage begins November 15, 2014 and ends February 15, 2015. During this time, you can enroll in a new plan or change your current plan. To make sure you’re in the computer system of your carrier when the new year starts, you should pay for your plan by December 15, 2014.
Can I enroll at a different time?
Yes, but only if you have a special circumstance which makes you eligible for a special enrollment period. These special circumstances include:
a. Gaining or becoming a dependent
b. Losing existing health coverage (through job loss, separation from a spouse, etc)
c. Expiration of COBRA
d. Loss of eligibility for or expiration of a student health plan
e. A permanent move or relocation to an area with different health plans
f. Dramatic change in income that affects your eligibility for tax credits (which can make health insurance more affordable) or cost sharing reductions (a discount that enables you to pay less out-of-pocket for some medical expenses).
If any of these special circumstances sound like you, you may be eligible for a special enrollment period. And even if they don’t, it’s good to keep them in mind. Freelancing can be up and down, and if you find yourself needing new coverage, remember that you might be eligible to enroll outside of open enrollment!
Hold on, what do all these insurance terms mean?
Here’s a glossary of some health insurance lingo to help you through the enrollment process.
So how do I choose what plan is right for me?
Here are some questions to think about when trying to pick a health insurance plan.
What’s more important to you -- a lower monthly premium or lower out-of-pocket costs if you need care? You can’t have both.
What kinds of medical services do you typically need? If you have chronic needs, you’ll want to make sure your plan covers the specialist visits and prescriptions you need.
What kinds of prescriptions do you have? Some plans only cover generic drugs or cost a lot out-of-pocket. Pay attention to how drugs are paid for in your prospective plan.
It’s important to remember that even if something is covered by the insurance plan, that doesn’t mean it’s free after you pay your monthly premium -- it just means that the insurance company will pay for part of it. Insurance companies won’t pay for services that aren’t covered, or aren’t deemed medically necessary.
In general, if you know you don’t need much in the way of healthcare, you might be more likely to look at a plan with low premiums and a high deductible. You’ll pay less upfront, but if you do incur some expenses, you’ll have to take care of them on your own until you meet the deductible.
If you’re under thirty, you might also want to consider getting a catastrophic plan. This is a less expensive plan with low premiums and a high deductible that protects you from extremely high medical costs in the event of an accident or emergency. Of course, the risk is that if you are in an accident or receive a diagnosis of a chronic medical condition, you will have to meet that high deductible before your insurance benefits kick in.
Conversely, if you think you’ll have a lot of medical bills in the coming year (a surgery, a persistent injury that requires scans or tests, or planning on having a baby), you might want to get a plan with higher premiums and a lower deductible. Though it seems like more upfront, you’ll have lower out of pocket costs over the course of the year for the medical care you receive.
Lastly, if you have any important medical prescriptions that require certain drugs, check your plan to see what drugs are on their formulary list (the list of prescriptions they’ll cover in general).
What if I have a pre-existing condition?
The ACA made it illegal for insurance companies to charge you higher premiums for a pre-existing health condition or to deny claims for treatment of a pre-existing condition. No one is allowed to ask about your health and try to make you pay more.
Who can I call if I have questions?
If you have questions about how to get covered, email Freelancers Union’s member services team at firstname.lastname@example.org.
One last thing: you wouldn't happen to have this as a webinar, would you?
We sure do. You can check it out below:
Freelancers Union, Inc. (FU) is not a licensed insurance agent. Freelancers Insurance Agency, a wholly owned affiliate of FU, is a licensed health insurance producer in New York and New Jersey only. Freelancers Insurance Agency (FIA) contracts with HealthPlanServices,Inc. (HPS), a nationally licensed insurance producer. Other than in New York, HPS is acting as the insurance agent of record. In New York, FIA is the agent of record. HPS pays royalty fees to FU for the use of its intellectual property, which are used for the general purposes of FU. FU and FIA are not insurers. You should consider your needs when selecting products. FU does not make specific product recommendations for individuals. Each insurer has sole responsibility for its products.
The information on this Website about insurance benefits is a summary of applicable terms and conditions that is provided for general informational purposes only. The terms of any insurance products are governed solely by the applicable Member Contract or Policy Form. In the event of any inconsistency between information provided on this Website and the specifics provisions of the Member Contract provided by the carrier, the carrier's Contract shall govern.