Health Insurance as an IC

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emergentmd

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So I am full locums now and do just IC work. All 1099, plus ownership in FSED. I also have alot of rental properties if that even matters.

I am currently on Cobra that has a decent plan but will only last for 18 months.

I have an LLC and am the sole owner.

How is everyone getting their insurance as an IC esp in Texas?

I have looked into the Obamacare exchange and all of the plans are terrible and our docs are not on the plan.

The Christian ministry plans comes across as not true insurance, but maybe someone who is on it can educate me.

I have heard that if I hire one employee, then I can shop the small business group plan through Obamacare which may have better options. I have not researched this to be sure.

Are there any good options? I am currently paying 1300/mo for Cobra with a High High High Deductible plan which serves its purpose but seems crazy at 1300/mo premium.
 
Physician Solutions, LP | Independent Contractor Benefits

You become a partner, pay into the partnership and receive refunds of overpaid premiums. They send you a K-1 each year.

You get a high-deductible health plan that's a nationwide Blue Cross/Blue Shield of Tennessee policy. There are three options available. All are HSA compatible. You get reduced monthly fees if you use Health Equity as your HSA custodian.

They charge $90/month administrative fee, which is a bit pricey but for some states, this is the only way you can get a BC/BS policy that is widely accepted... plus it's an employer-sponsored plan and not an individual policy.
 
I have never heard of this. So is this something like a dummy company where you become a member by paying a monthly fee so you can access their group plan? Very interested if so
 
I know a lot of Physicians who own their own practice and go the way of Health sharing Ministries.

The guy that I just sold my practice to uses that and it paid for his ACL repair last year, minus the $1,200 deductible.
 
Christian Medishare plans just scare me. I don't care about paying even 10k for a major medical issue. But I don't want something bad to happen and get stuck with 100K+ bill.

I am scared they may reject me.
 
emergentmd said:
Christian Medishare plans just scare me. I don't care about paying even 10k for a major medical issue. But I don't want something bad to happen and get stuck with 100K+ bill.

I am scared they may reject me.
Click to expand...
My understanding is that they don't do any underwriting, they just have a 1-year exclusion on pre-existing conditions. How stringent that one year is I do not know, but I have yet to have a patient have anything denied by them and I probably have 80 patients that use these Health sharing plans.

Interestingly, during a series of meetings last year with my States' Blue Cross, they pointed out how nervous they are about these Health sharing Ministries because at this point they've built up enough cash to operate as a regular Insurance Company but without the regulations enforced upon regular insurance companies by the Department of Insurance.

Long story short, they're not going to run out of money if you rack up some impressive hospital bills.
 
I know someone with a $50k surgery that was handled well by a christian cost share, it worked well for me for minor stuff
 
VA Hopeful Dr said:
My understanding is that they don't do any underwriting, they just have a 1-year exclusion on pre-existing conditions. How stringent that one year is I do not know, but I have yet to have a patient have anything denied by them and I probably have 80 patients that use these Health sharing plans.

Interestingly, during a series of meetings last year with my States' Blue Cross, they pointed out how nervous they are about these Health sharing Ministries because at this point they've built up enough cash to operate as a regular Insurance Company but without the regulations enforced upon regular insurance companies by the Department of Insurance.

Long story short, they're not going to run out of money if you rack up some impressive hospital bills.
Click to expand...
But they are also clear about not being insurance. I didn’t actually write my “premiums” to the company. Every month I got a name of a person to send the premium too. That person was someone who had filed a claim and was “owed” money by the rest of the members. One premium per year went to the central office
 
So how does this work?

1. If this is not insurance, how can I know if my doctor takes this other than asking?
2. Do I pay everything out of pocket first and send my bill to medshare?
3. If I have hospitalization, surgery, or something expensive and have a 50K bill from 5 doctors, the hospital, labs then what happens? Do these billing entities send the bills to medshare and they ferry it out to members to pay for it? Do the bills go to me, and I send it out for medshare and just tell the billing entities to hold on?
4. Do I present my medshare insurance when I go to the doctors office, hospital just like reg private insurance? If so, is the process from my standpoint just like regular insurance?
5. Are office check ups handled the same?
 
@emergentmd The link I quoted is actual health insurance (Blue Cross/Blue Shield of Tennessee national high-deductible health plan coupled with a health savings account). The premiums are deductible.

I have no experience with the Christian med share plan or its deductibility. Not sure which you are asking about.
 
emergentmd said:
So how does this work?

1. If this is not insurance, how can I know if my doctor takes this other than asking?
2. Do I pay everything out of pocket first and send my bill to medshare?
3. If I have hospitalization, surgery, or something expensive and have a 50K bill from 5 doctors, the hospital, labs then what happens? Do these billing entities send the bills to medshare and they ferry it out to members to pay for it? Do the bills go to me, and I send it out for medshare and just tell the billing entities to hold on?
4. Do I present my medshare insurance when I go to the doctors office, hospital just like reg private insurance? If so, is the process from my standpoint just like regular insurance?
5. Are office check ups handled the same?
Click to expand...
The christian cost share I used worked like this.....every incident had a $300 deductible so I paid straight up for all my normal family doc visits. For hospital stuff/surgeries/etc I was still the payer for all bills. I registered as a cash payer because I was. I then submitted all applicable bills to the cost share manager for processing and then the next month started getting check from all over the country as other members were told to send me their “premiums”.

Had a friend get $50k worth of stuff get covered, I had a $2500 item processed that way
 
southerndoc said:
@emergentmd The link I quoted is actual health insurance (Blue Cross/Blue Shield of Tennessee national high-deductible health plan coupled with a health savings account). The premiums are deductible.

I have no experience with the Christian med share plan or its deductibility. Not sure which you are asking about.
Click to expand...
Sorry,

I was asking about the Med share plans. I am going either with med share or your link. I really appreciate it.
 
sb247 said:
The christian cost share I used worked like this.....every incident had a $300 deductible so I paid straight up for all my normal family doc visits. For hospital stuff/surgeries/etc I was still the payer for all bills. I registered as a cash payer because I was. I then submitted all applicable bills to the cost share manager for processing and then the next month started getting check from all over the country as other members were told to send me their “premiums”.

Had a friend get $50k worth of stuff get covered, I had a $2500 item processed that way
Click to expand...

So the premiums does not go to the Med share plan administrator but directly to a member? So I could get a bunch of checks from different people to cash?
 
sb247 said:
Not could, do
Click to expand...

So Say I went to the ER, Check out as cash pay patient. They tell me the bill is 2k cash pay. Do I pay the 2k, keep the bill, and file with the medshare assuming I met all deductibles (or whatever they call it). ERs many times have bills from the ER group, Hospital, Radiologist, etc.... Do I have to talk to each billing entity, negotiate a cash pay, and then submit all of the different bills?

What if I was hospitalized? Do I get discharged with cash price and then negotiate on my own cash prices for all other bills that eventually comes (surgeon, internist, gas, path,etc) then send in the bills?

i dont mind this but seems like alot of work and possibly alot of unknown bills.
 
VA Hopeful Dr said:
My understanding is that they don't do any underwriting, they just have a 1-year exclusion on pre-existing conditions. How stringent that one year is I do not know, but I have yet to have a patient have anything denied by them and I probably have 80 patients that use these Health sharing plans.

Interestingly, during a series of meetings last year with my States' Blue Cross, they pointed out how nervous they are about these Health sharing Ministries because at this point they've built up enough cash to operate as a regular Insurance Company but without the regulations enforced upon regular insurance companies by the Department of Insurance.

Long story short, they're not going to run out of money if you rack up some impressive hospital bills.
Click to expand...

Do you or anyone who is on these programs have any preferences on the big 4 (Liberty, Christian health, samaritan, Christian care). If so, why?
 
emergentmd said:
So Say I went to the ER, Check out as cash pay patient. They tell me the bill is 2k cash pay. Do I pay the 2k, keep the bill, and file with the medshare assuming I met all deductibles (or whatever they call it). ERs many times have bills from the ER group, Hospital, Radiologist, etc.... Do I have to talk to each billing entity, negotiate a cash pay, and then submit all of the different bills?

What if I was hospitalized? Do I get discharged with cash price and then negotiate on my own cash prices for all other bills that eventually comes (surgeon, internist, gas, path,etc) then send in the bills?

i dont mind this but seems like alot of work and possibly alot of unknown bills.
Click to expand...
Yes, negotiate cash rate and then submit bills for “coverage “ while beginning payment. It’s a little more paperwork but cheaper
 
emergentmd said:
Do you or anyone who is on these programs have any preferences on the big 4 (Liberty, Christian health, samaritan, Christian care). If so, why?
Click to expand...
I know folks with positive experiences with samaritan and christian health
 
emergentmd said:
Do you or anyone who is on these programs have any preferences on the big 4 (Liberty, Christian health, samaritan, Christian care). If so, why?
Click to expand...
Most everyone I know uses Liberty, but since sb has a different experience it might be a regional thing.
 
southerndoc said:
You must have at least 2 employees to be covered under their small group plans. Therefore, they do not apply to almost all independent contractors. They used to offer individual policies, but they stopped last year I believe.
Click to expand...
You are right. I just tried
 
VA Hopeful Dr said:
Most everyone I know uses Liberty, but since sb has a different experience it might be a regional thing.
Click to expand...

Thanks for your input on Liberty being a good med share program. I looked in detail on the big 4 and it looks like liberty is the best. I am going to try this after I make sure our PCP's takes this.
 
The best way for an IC to escape the horror that is Obamacare is to incorporate and then sign up with a payroll company. They payroll company (I use paychex) pays me and my spouse as W2 through my company. They also allow me and all employees to sign up for a group health insurance plan as well as 401k.
 
So how much does this cost for Paychex to handle your payroll? I assume you employ your wife under the LLC/C/S?

And by doing this, can you tell me what the premiums are for a high deductible plan?

Are we talking above or below 1k/mo for premium?
 
emergentmd said:
So how much does this cost for Paychex to handle your payroll? I assume you employ your wife under the LLC/C/S?

And by doing this, can you tell me what the premiums are for a high deductible plan?

Are we talking above or below 1k/mo for premium?
Click to expand...

They charge about $45/year per person on payroll to issue checks, so the cost just to do payroll and issue checks is minimal.
 
Health sharing ministries is a reasonable option. Read my post on it here: Christian Health Care Sharing Versus Health Insurance (the comments are better than the post).

and this guest post by an emergency doc: Health Sharing Versus ACA Health Insurance Plans

You can also just buy health insurance on the open market (not the exchange since you make too much to qualify for a subsidy). That's what I do. Just hire a health insurance broker to shop it around. It doesn't cost you any extra.

I don't know about Physician Solutions, but why not include them in your search? If the health insurance is cheaper/better than what you can get through an insurance broker, then why not?
 
southerndoc said:
Physician Solutions, LP | Independent Contractor Benefits

You become a partner, pay into the partnership and receive refunds of overpaid premiums. They send you a K-1 each year.

You get a high-deductible health plan that's a nationwide Blue Cross/Blue Shield of Tennessee policy. There are three options available. All are HSA compatible. You get reduced monthly fees if you use Health Equity as your HSA custodian.

They charge $90/month administrative fee, which is a bit pricey but for some states, this is the only way you can get a BC/BS policy that is widely accepted... plus it's an employer-sponsored plan and not an individual policy.
Click to expand...

This is the reply I received from them:

“So you are not an IC with ApolloMD, Schumacher Clinical or Team Health now?

These are the only groups we are partnered with in this model to offer to their IC's”

I guess I’m SOL unless I’m affiliated with one of these.


Sent from my iPhone using SDN mobile
 
The White Coat Investor said:
Health sharing ministries is a reasonable option. Read my post on it here: Christian Health Care Sharing Versus Health Insurance (the comments are better than the post).

and this guest post by an emergency doc: Health Sharing Versus ACA Health Insurance Plans

You can also just buy health insurance on the open market (not the exchange since you make too much to qualify for a subsidy). That's what I do. Just hire a health insurance broker to shop it around. It doesn't cost you any extra.

I don't know about Physician Solutions, but why not include them in your search? If the health insurance is cheaper/better than what you can get through an insurance broker, then why not?
Click to expand...

Does anyone know any health insurance brokers in Texas?
 
EM Junkie said:
This is the reply I received from them:

“So you are not an IC with ApolloMD, Schumacher Clinical or Team Health now?

These are the only groups we are partnered with in this model to offer to their IC's”

I guess I’m SOL unless I’m affiliated with one of these.


Sent from my iPhone using SDN mobile
Click to expand...

Oops, I didn't know they only partnered with those three (I'm with ApolloMD).
 
Im in the same boat. IC in texas. For the last few years I just independently got insurance through BCBS. My premiums is basically increasing by $900 per month and the coverage is decreasing. All for an HMO.
My problem with the health share is I have a daughter with a metabolic disorder so they dont work for me.
Physicians Solutions sounded promising until you said they only work with those three groups. Bummer
Any other tips would be appreciated
 
southerndoc said:
Physician Solutions, LP | Independent Contractor Benefits

You become a partner, pay into the partnership and receive refunds of overpaid premiums. They send you a K-1 each year.

You get a high-deductible health plan that's a nationwide Blue Cross/Blue Shield of Tennessee policy. There are three options available. All are HSA compatible. You get reduced monthly fees if you use Health Equity as your HSA custodian.

They charge $90/month administrative fee, which is a bit pricey but for some states, this is the only way you can get a BC/BS policy that is widely accepted... plus it's an employer-sponsored plan and not an individual policy.
Click to expand...

I have been with Physician Solutions for four months now and will be dropping them. They charge $1900 a month in premiums plus many thousands more for deductible. They don't cover many things in my area, despite previously stating over the phone that they would. For example, even though we technically have dental insurance, they will not cover crowns. The cost associated with being with them has simply become unsustainable, and frankly, purchasing a family plan as an individual would come with just as many benefits.
 
deuist said:
I have been with Physician Solutions for four months now and will be dropping them. They charge $1900 a month in premiums plus many thousands more for deductible. They don't cover many things in my area, despite previously stating over the phone that they would. For example, even though we technically have dental insurance, they will not cover crowns. The cost associated with being with them has simply become unsustainable, and frankly, purchasing a family plan as an individual would come with just as many benefits.
Click to expand...

Who are you going with now? When I was comparing options, I did not find a better solution in Georgia. Unfortunately, it seems I'm paying out the wazoo for any plan I can get in Georgia without going with Kaiser (where we would have to change our current physicians).

I have Blue Cross/Blue Shield of Georgia currently with dental and vision coverage. Vision coverage is pretty good with them, but dental sucks. They do not cover anything with the dentist we use.

One of the options offered the FirstHealth network, but I'm not sure how well they are with coverage outside of Georgia.
 
southerndoc said:
Who are you going with now?
Click to expand...

Wife got a job so that we could go off of her insurance. Unfortunately, you are correct. Any plan that you get as an individual is going to cost upwards of $2000 a month in premiums, and that doesn't include the lack of coverage for leave you holding the bag for many other expenditures.
 
deuist said:
Wife got a job so that we could go off of her insurance. Unfortunately, you are correct. Any plan that you get as an individual is going to cost upwards of $2000 a month in premiums, and that doesn't include the lack of coverage for leave you holding the bag for many other expenditures.
Click to expand...

I ended up going with a plan that is $1700/month with a $3800 family deductible tied to an HSA. I started to do the $6600 deductible, but we anticipate more healthcare expenses this year. Hopefully 2019 will have better options. We shall see. I decided to start my high deductible plan in December so I can get the full year HSA contribution allowance (if you get HDHP/HSA-compatible plan in December and maintain an HSA-compatible plan the entire year in the following year, you can make the full year's contribution with only last month coverage).
 
southerndoc said:
I ended up going with a plan that is $1700/month with a $3800 family deductible tied to an HSA. I started to do the $6600 deductible, but we anticipate more healthcare expenses this year. Hopefully 2019 will have better options. We shall see. I decided to start my high deductible plan in December so I can get the full year HSA contribution allowance (if you get HDHP/HSA-compatible plan in December and maintain an HSA-compatible plan the entire year in the following year, you can make the full year's contribution with only last month coverage).
Click to expand...

Wouldn't count on it. My premiums are lower but my deductible is higher.
 
AAEM is now offering health insurance to physicians, but you have to be a member.

AAEM
 
emergentmd said:
So how does this work?

1. If this is not insurance, how can I know if my doctor takes this other than asking?
Click to expand...

You don't.

2. Do I pay everything out of pocket first and send my bill to medshare?
Click to expand...

Yep.

3. If I have hospitalization, surgery, or something expensive and have a 50K bill from 5 doctors, the hospital, labs then what happens? Do these billing entities send the bills to medshare and they ferry it out to members to pay for it? Do the bills go to me, and I send it out for medshare and just tell the billing entities to hold on?
Click to expand...

You get the bill and then submit it.

4. Do I present my medshare insurance when I go to the doctors office, hospital just like reg private insurance? If so, is the process from my standpoint just like regular insurance?
Click to expand...

You have a card that you present which may or may not (probably will not) get you a discount.

5. Are office check ups handled the same?
Click to expand...

Everything is handled the same.

It works, but understand that what they will or will not cover is explicitly tied to reducing risk by living a certain lifestyle.

If you go to the bar on Friday night and get plastered and wreck your car, you're going to be solely responsible.

If you are an IV drug user and end up with Hep C or HIV, you're going to be solely responsible.

Only you can decide if your lifestyle is compatible with such a sharing program.
 
Cross-posting what I just replied to a large Facebook group:

HEALTH INSURANCE 2018
Like many other independent contractor physicians, I was having a really hard time finding (good) health insurance coverage for 2018. I came across something called a VEBA Trust, or "Voluntary Employee Benefits Association", which essentially is an alternative to a traditional insurance company. I've never used anything like this before, but one of these trusts run by a company called IPCA (Independent Physicians Consulting Association) based in Georgia is going to be offering plans nationwide for 2018 to Physicians, PA/NPs, RNs, etc. They have 9 different plans to choose from, ranging from a $250 deductible/$3k OOP to a $6500 deductible/OOP; with 20-30% co-insurances (gold/silver equivalent). My quoted premiums (for 30yo me and wife, and 2yo) ranged from $1300-$2000/month. I've attached the plan details to this post.
From what I understand, the big differences between this and a traditional insurance company is that:
• They use two different "provider networks" - FirstHealth and PHCS. Both of them seem to cover a lot of places; you get access to both, and they cover people nationwide. This is the company that decides the contracted rate, etc.
• They don't do the actual claims themselves, but they work with a local claims processing company to manage these. IPCA can help you if you're having issues though
• They can start your insurance on the 1st of any month, and don't fall into the 'open enrollment' deadline
Other than those, I believe they function like a normal insurance company. They have contracted rates with providers, they have a network, deductible, co-insurance, etc. They have no caps like health cost sharing agreements due to stop-loss insurance. This specific company initially started with ApolloMD helping get their IC physicians health insurance. They use CVS for all pharmacy benefits (retail and mail-in).
To get a quote, click this link and then go to "Major Medical": (sorry SDN won't let me post a link even though I meet all the requirements...?? someone who has privileges please PM me and i'll share the links?)
I have nothing to do with these guys and get nothing from them, just wanted to help everyone out. I'm about 80% going to sign up with these guys unless one other thing I have in the pipeline pans out. The people who have been helping me at their office have been great, so I'm sure if you reach out with questions they can help answer them.
Good luck!
 
ApolloMD uses a different company/solution now, and we did so for a reason.

Keep in mind a few things about IPCA:
- it's a SELF-insured network -- generally, with most self-insured networks, if everyone backs out at once, if too many payments annually, etc., it could collapse and leave you with a huge bill (unless they have a secondary insurance; I would specifically ask them about this);
- their customer support is horrible from what the docs that used to use them say

Having said that, some of our physicians have stayed with them.
 
Update: No escape from Obamacare for me this year. My paycheck company could not find an insurer in NV willing to provide a private, off-exchange plan. My ****ty obamacare plan is going up $100 this year to $383/month. We are down to two insurers in the State: United Healthcare, and Silver Summit which is a medicaid replacement plan.

Truly a deplorable situation. Let's hope the abolishment of the individual mandate gets to Trump's desk so I can finally pay for reasonable insurance than I actually want.
 
southerndoc said:
ApolloMD uses a different company/solution now, and we did so for a reason.

Keep in mind a few things about IPCA:
- it's a SELF-insured network -- generally, with most self-insured networks, if everyone backs out at once, if too many payments annually, etc., it could collapse and leave you with a huge bill (unless they have a secondary insurance; I would specifically ask them about this);
- their customer support is horrible from what the docs that used to use them say

Having said that, some of our physicians have stayed with them.
Click to expand...

Thanks for this. They told me specifically that they have stop-master insurance to prevent this. Not sure what to say about customer service but I've had ****ty enough dealings with Cigna/BCBS so who knows. For me, It's either this or a BCBS HMO that covers no one in my city
 
VeerTheTIGuy said:
Thanks for this. They told me specifically that they have stop-master insurance to prevent this. Not sure what to say about customer service but I've had ****ty enough dealings with Cigna/BCBS so who knows. For me, It's either this or a BCBS HMO that covers no one in my city
Click to expand...

Also beware, as I found out most privately-offered insurance these days is NOT compatible with the HCA, meaning that you are on the hook paying for the difference in cost between your health insurance and the Individual mandate penalty.
 
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