Health Insurance for ICs in 2020

[Groove]

What are you guys doing for health insurance next year? I used Cigna from the Marketplace last year but this year was looking into "Physician Solutions" which was sent out through my CMG employer. I'm a little unfamiliar with the business model. They deduct like $2500 at the beginning of the month, and then deposit that amount minus the cost of the plan minus a $95 administration fee. My understanding is that it is done this way to overcome federal wage laws and give access to group benefits. Anybody have experience with them and can comment on how they compare with Obamacare?. It sucks that we have so few options as ICs.

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[bravotwozero]

Yeah my group's health insurance plan has the same workaround procedure. I am fortunate that I am on my wife's health plan, which is much better than what they were offering.

 

[beebermd]

I’m doing the same thing. Basically it’s set up as a business. You pay an initial 2k as your buy in to the “business”. This is refundable if/when you leave. They take out 2500/mth and take your premium out of that and the auto refund the difference back to you. They do this because by law they have to pay you something, so they are “paying you” the difference. There is a 95$ admin fee every month. premiums are the same as the BCBS you can buy by yourself. BUT the deductibles are lower and it’s a PPO. In Texas this appears to be the only way in IC can get on a ppo. You will get a K1 at the end of the year, so there will be a tax liability but supposedly it’s only around 30 bucks.

 

[southerndoc]

Physician Solutions isn't offered to everyone. Apollo and a few others have agreements with them. I've been using them for 3 years now without any problem. I originally used their partnership with HealthEquity for their HSA account, but I've since set one up with Fidelity (no fees). Instead of choosing the HSA option, I choose to have my "salary" deposited as $290/pay period direct deposit to HSA and remainder into checking account.

I've had great experience with them. Kathy Wagoneer has been very responsive to emails. It is a little complicated come tax time trying to get your deduction as it's reported on a K-1.

No issues with reimbursements. I did have the low deductible plan the first year and we had absolutely zero issues with paying for things once we exceeded it. I now have the $10k family deductible and never reach it (thankfully). PCP visits for annual health are still covered as are pediatric annual visits. Sick visits aren't until you meet your deductible.

 

[deuist]

I had Physician Solutions for only a few months. It was an expensive way to get a Blue Cross of Tennessee plan that didn't cover chronic disease. I dropped them and bought a different plan in the individual market. The coverage is still terrible, but it costs less.

 

[southerndoc]

Doesn't cover chronic disease? Please elaborate.

 

[Groove]

I got off the phone with the Physician Solutions yesterday and I can't say that I was terribly impressed with the guy's sales pitch. The coverage seems similar to what I could get as a gold plan in the open marketplace. PCP visits are $15 with Cigna, 20% with PSOL. Specialists are $60 with Cigna, 20% with PSOL. 20% co-insurance for hospitalizations with PSOL, 30% with Cigna. Prescriptions....man does PSOL have any prescription coverage? It looks terrible from what I'm reading. You basically owe 100% on all prescription costs until your out of pocket maximum is met (4K). So, unless you're filling a bunch of crofab, C1 esterase inhibitor, epipens and dolobid Rx, you'll probably be paying 100% of your prescriptions for the entire year. The Cigna marketplace plan pays for prescriptions, $10 for generic, $50 brand name. The primary benefit that I can see with PSOL is the out of network coverage and all the "fluff" benefits like life insurance, life assistance programs, workers compensation benefits, etc.. I don't need any of that, especially the workers comp since I have a full disability policy. I'm not married, and don't have kids so I don't really need life insurance. I don't even need dental or vision since I don't have any cavities and my vision is 20/10. However, I'm one of those guys that is always paranoid that something is going to happen when you least expect it, so I like to plan accordingly. I had a health scare a year ago where I thought I had cancer and it turned out to be absolutely nothing but it damn sure put things in perspective and made me grateful for the disability policy. The main thing I'm worried about is severely injuring myself out of state while skiing or something and racking up an ICU bill in CO before they can transfer me back to my home state. I don't think these marketplace plans cover things like that if I'm not mistaken. I'm not even sure PSOL does... Regardless, the PSOL is definitely the more expensive plan. Decisions, decisions. Man, life sure would be easier if we were all W2s.

P.S. Also, the PSOL requires 100-120 hours full time to qualify. I think it's 120 for TeamHealth, and the others, 100 hours for Apollo. I said "Well, what if I changed employers?" He said "No problem, we understand things like that...we wouldn't terminate you." I go "Well, what if I was in a MVC and couldn't work for 3 months due to injuries and then couldn't work the required 100 hours/mo?" He paused and went "Well, I mean...we're understanding with situations like that. We'd ah....we'd be um....understanding....(long pause)... so no worries." So, I guess if you ever planned on working part time for 6 months out of the year, PSOL has the right to cancel you for working under the required amount of hours. God help you if you were injured and could only work part time for the remainder of the year. I guess they could technically cancel you then too. What a weird policy....why would they have that requirement? So they can be assured that you're going to be able to pay that $2500 automatic deduction from your bank account on the 1st of the month?

My girlfriend used the dilemma to casually mention how much easier and cheaper it would be if we were married and I was on her plan from work. I quickly changed the subject.

 

[southerndoc]

I have two choices where I live: Physician Solutions (BC/BS of TN) or Kaiser. Easy answer for me.

You can get a plan that pays for all your medications. You will be paying for it though. Insurance companies are there to make a profit. They aren't going to feel grace and just give you your medications. You -- and millions of other people -- collectively pay for them.

I view insurance as a catastrophic health plan. I need something to cover me for an MI, CVA, etc. I don't need coverage for the common cold.

BC/BS of GA used to offer individual plans that would cover everything like traditional insurance. When I crunched the numbers, I was spending more than what I was spending for a high deductible plan with the deductible included (i.e., $18,000/year for $5000 deductible counting as $23,000 in paid premiums vs $24,000 in premiums with a cadillac plan).

All I can say is that I've never had any issues with Physician Solutions. Neither have any of my colleagues that use them. They are not -- nor do I ever want them to be -- cadillac plans meant to cover your ordinary expenses. Me and my colleagues do not want to share in that price.

 

[deuist]

Doesn't cover chronic disease? Please elaborate.

Blue Cross of Tennessee does not cover autism services. If I'm going to pay for everything out of pocket, I'm not about to keep a $2000 a month insurance plan.

 

[Porfirio]

Obamacare Market Place
$825 a month prem
$6,500 individual deductible
$13,000 family deductible
100% covered after meeting deductible
Has to be in network
HSA qualified ($7,100)
Coverage for myself, my wife, and our newborn
Me: healthy no problems
Wife: healthy no problems
Newborn: healthy no problems

I pray everyday nothing bad happens to us.

2019 was $530-709 prem per month (added the newborn)
Same deductibles
My wife maxed out her deductible and my newborn started her deductible. Birth cost us $8,000 total. We also saved $7,000 in the HSA (did not use because this is a stealth IRA).

 

[GeneralVeers]

Now that Obamacare is dead (bye individual mandate) if you are healthy, with no pre-existing conditions you can buy short term policies for up to a year at a time for low cost. I can get a short term policy from Anthem or United for about $120/month with a $1000 deductible. Far better than the crap Obamacare I was paying $400/month and had a $40000 deductible.

Another secret to saving is to get individual plans rather than family plans. Typically if two of you go in, you double the cost AND the deductible, meaning that if one of you ends up in the hospital your out of pocket is twice what you'd pay over an individual plan.