Insurance coverage options

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The irony of trying to find good health insurance as a doc...

If you are in private practice what do you guys do for health insurance? My wife carries our insurance, which worked well but now we have kids and she wants to stay home. Off the exchange a crap plan is around $1500 a month, and that's from an insurer that I reject in my own practice.

-I am trying to find something small on the side that is part time to get coverage, while maintaining the practice. Private practice has been very good, and I hate to take time away from it. Any unique gigs out there you guys do just for the insurance?

 

[Stagg737]

If there's DPC in your area I'd go with that plus a catastrophic plan for wrap-around coverage.

 

[TexasPhysician]

The irony of trying to find good health insurance as a doc...

If you are in private practice what do you guys do for health insurance? My wife carries our insurance, which worked well but now we have kids and she wants to stay home. Off the exchange a crap plan is around $1500 a month, and that's from an insurer that I reject in my own practice.

-I am trying to find something small on the side that is part time to get coverage, while maintaining the practice. Private practice has been very good, and I hate to take time away from it. Any unique gigs out there you guys do just for the insurance?

Hire an employee. Then you qualify for higher quality business health plans.

 

[Sushirolls]

Hire an employee. Then you qualify for higher quality business health plans.

This is what I noticed too. Individual/family coverage is more expensive then going thru your business identity.

I also have to question, if your private practice is so good, shouldn't there be funds to cover this? As an individual self employed person, you will clearly hit the healthcare tax deduction. Look into that. So you could potentially upgrade for the higher quality plans, and get a pretty decent tax deduction at the end of the year. But this deduction is not available to people who have the option to use spouses insurance, but if she stays home, you could be eligible.

 

[Sushirolls]

"Self-employed persons can take a deduction for health insurance premiums they pay for coverage for themselves and their dependents directly on Form 1040. This is another above-the-line adjustment to income. You can enter the total of what you paid on line 29 on the first page of your 2018 tax return.

This is one of those deductions that can reduce your AGI from the total of your gross income, and you don't have to itemize your deductions to take it. It's not limited by the 7.5-percent-of-AGI rule—you can claim the entirety of what you spent on premiums, although you can’t add in any uninsured medical costs unless you also itemize—you would claim these on Schedule A along with all your other itemized deductions."

 

[Sushirolls]

Let us know what you end up choosing.

 

[Jules A]

In my experience the only health insurance plans that are really good are through the larger teaching hospitals, VA or a state job. Fortunately most hospitals in my area offer benefits at a slightly increased employee contribution for 20-30 hours per week commitment.

 

[Sushirolls]

In my experience the only health insurance plans that are really good are through the larger teaching hospitals, VA or a state job. Fortunately most hospitals in my area offer benefits at a slightly increased employee contribution for 20-30 hours per week commitment.

Hmm... need to probe this a bit. What does good mean? Out of pocket expenses? Deductible? Co-pays? Co-insurance? Ob benefits? Psych benefits?

Please clarify what "really good" means.

I've seen good with small employer business, or union port workers, or even health systems. I mean good based upon in-network expanse, higher payments to clinicians, lower out of pocket expenses for the beneficiary, and lower deductibles.

 

[TexasPhysician]

You can sign up for business plans if you provide coverage to your FT employees. The plans are much better than the exchange. I do this.

Some community colleges will allow you to purchase health insurance. As a “student”, you are in a low risk pool and the plans are usually good. An attorney friend of mine take 6 hours every semester to purchase the plan.

 

[Jules A]

Hmm... need to probe this a bit. What does good mean? Out of pocket expenses? Deductible? Co-pays? Co-insurance? Ob benefits? Psych benefits?

Please clarify what "really good" means.

I've seen good with small employer business, or union port workers, or even health systems. I mean good based upon in-network expanse, higher payments to clinicians, lower out of pocket expenses for the beneficiary, and lower deductibles.

Yes I would imagine union benefits are very good but not sure why I assume that. Good to me means BC/BC getting to pick who you see, low deductible, good prescription and dental coverage, reasonable premium $350 +/- per pay period for couple. Anecdotal only but I've had what I felt were excellent benefits through two large teaching hospital type systems and the VA. My spouse works for a smaller community hospital and the benefits are fair although it appears would be costly if something significant happened and you aren't willing to go to that hospital. I personally place a higher value on large hospital system offerings.

 

[downwithDTB]

Good to me means... low deductible... reasonable premium $350 +/- per pay period for couple... Anecdotal only but I've had what I felt were excellent benefits through two large teaching hospital type systems and the VA.

These teaching hospitals/VA are massively subsidizing these plans if your premium is $350/month for two people and you have low deductible. In addition, hospital systems often have the best advantage with health insurance because they can self insure (not really insurance per se, just keeping a large pot of money to pay your bills with an insurance company administering the benefits) and keep everyone's care in house, cutting cost massively.

There is simply no way that someone who is self-employed can get insurance for the price that they would pay out of their paycheck if employed because the employer with these "good plans" is paying the majority of the expense due to the tax advantage of paying you in health insurance instead of direct salary. I would run the math, but if you're young and healthy, a high deductible will probable actually save you more money in the long term *if you're paying the entire cost of your policy.* Remember, the insurance companies have to win on more than the average person to stay in business. You don't want to be paying a lot extra so that they are fully covering a few outpatient visits a year.

 

[Jules A]

These teaching hospitals/VA are massively subsidizing these plans if your premium is $350/month for two people and you have low deductible. In addition, hospital systems often have the best advantage with health insurance because they can self insure (not really insurance per se, just keeping a large pot of money to pay your bills with an insurance company administering the benefits) and keep everyone's care in house, cutting cost massively.

There is simply no way that someone who is self-employed can get insurance for the price that they would pay out of their paycheck if employed because the employer with these "good plans" is paying the majority of the expense due to the tax advantage of paying you in health insurance instead of direct salary. I would run the math, but if you're young and healthy, a high deductible will probable actually save you more money in the long term *if you're paying the entire cost of your policy.* Remember, the insurance companies have to win on more than the average person to stay in business. You don't want to be paying a lot extra so that they are fully covering a few outpatient visits a year.

Agree 100%, and excellent point that in many cases, mine excluded, these type employers do pay less. The state is a good example in my state the pay is so substandard that their excellent benefits could not possibly make up for it for my situation.

Also important to consider for those of you who are young and healthy that you are only young and healthy until you are not. Odds may be in your favor of being fine for many years but problematic if things take a turn. Same can be said for short term and long term disability benefits expensive to fund out of pocket but an excellent perk if offered through employer. Hope for the best but prepare for the worst is how I proceed. Now in mid 50s interesting to note how few peers actually have no health issues or no history of a significant medical event and we would probably be considered a fairly healthy lot as compared to most middle aged Americans.

 

[FlowRate]

Hire an employee. Then you qualify for higher quality business health plans.

Are you buying a plan for your business which also covers your employee or do they have to purchase/opt-in separately? How much are you allowed to make your employee pay for it? (obv you could use it as alternative comp, it all adds up to one lump of money.)