View Full Version : health insurance for self-employed

01-19-2006, 06:38 PM
Anybody got an affordable plan that they're happy with? I've got a rep from MegaLife(?) coming next week to try to sign me up. I'd like to be well informed about the subject so as to make an intelligent choice based on facts, not salesmanship. Anybody know MegaLife as good or bad?

High C
01-19-2006, 06:41 PM
I have the Blue Cross "Blue Saver" policy, which is a high deductible HSA type policy.

The whole HSA concept works out great for us. I recommend it highly, though it takes a bit of homework to understand it. It's different.

01-19-2006, 06:43 PM
I have health insurance...which I pay quaterly...Can't say it is good or bad because I have never had to use it...
Based on the policy...I suppose it is okay...but the truth would be in the pudding...If I ever have to use it...
I hope it isn't like my boat insurance... redface.gif

[ 01-19-2006, 06:48 PM: Message edited by: uncas ]

01-19-2006, 06:43 PM
I use a wife employed by a corporation. :D

Paul Pless
01-19-2006, 06:47 PM
Myself and several of my employees are covered by United Health Care and have been for six years. Seems to be competitively priced, I check the market about once a year. just a few months ago i compared it to BlueCross/BlueSheild nd found United to be a few bucks cheaper with better benefits.

A few of the claims in the last couple of years have included my broken ribs, a pregnancy with full prenatal care for one of my employee's wives, and a spinal surgery costing more than $25,000.00 for another employee. We've had no complaints and nothing but praise for them.

by way of comparison, I am a single 35 year old man, and my rate is $250.00 per month. I have a 20 copay, 50 emergency, 5 prescriptions, and a $750 stop loss. Dental and Vision benefits as well.

Alan D. Hyde
01-19-2006, 07:07 PM
Anthem has some good policies.

We're happy with ours.

Generally, the higher the deductible, the lower the premium, all other things being equal (AOTBE).


01-19-2006, 07:11 PM
Originally posted by Paul Pless:

by way of comparison, I am a single 35 year old man, and my rate is $250.00 per month. Katherine! You let this one get away? :eek: :D :D :D

High C
01-19-2006, 07:14 PM
:D :D

Paul Pless
01-19-2006, 07:20 PM
given a proper home environment I think I'd let myself be a 'kept man' for far less than $250 a month

- sorry for the thread drift

01-19-2006, 07:24 PM
If you haven't already, before signing on the dotted line, call you current health care providers and make sure that they accept xyz insurance. Then when you have them on the phone, ask how xyz insurance is to work with. My family physician of 7+ years was just about to quit taking one of the insurance companies I was looking at because they were slow to pay and kicked back so many claims.... :eek:

01-19-2006, 07:41 PM
concordia, that sounds like solid advice. I've got a Dr. friend who might know a bit about the workings of the different companies here.

Bruce Hooke
01-19-2006, 07:41 PM
I'm facing the same decision. First be aware that many things change from one state to the next. The available Blue Cross Blue Shield Plans will certainly be different in every state. Plans bought through "associations" are less affected by state regs for better or worse, usually worse. I believe every state has a Blue Cross Blue Shield, but in some cases it may go by a different name either officially or in the common lingo (e.g., I think Alan's "Anthem" is a BCBS). Here in Rhode Island, BCBS-RI has great rates if you've pretty much never filed a health insurance claim in your life for anything other than routine care like an annual check-up or maybe a one time event that could never conceivably repeat (like having your appendix removed). In other words almost nobody gets the good rates! Otherwise you get lumped into the high risk pool with everyone who cannot get insurance anywhere else (BCBS-RI has to take pretty much anyone). So, basically BCBS-RI is expensive.

However, I would certainly start by looking into your state BCBS. In my experience BCBS tends to have good plans, so if nothing else it is a good comparison point.

I talked to a MegaLife rep a couple of weeks ago and I am trying to decide what to do. I found this rep through something called the National Association for the Self Employed. This web page (http://www.selfemployedweb.com/nase-wsj2.htm) will give you some scary stories to ponder about MegaLife as well as some things to watch out for.

I may well still go with them because there just do not seem to be a lot of choices out there.

The key thing I would advise is go over the available plans very carefully. The key thing to watch for in my opinion are the things that can cost a lot of money -- hospital care, medications, and expensive outpatient services like MRI's. Also watch how the deductables and co-pays work to make sure you understand how much you could possibly be out if you had a major claim. My basic thinking is to go with a high-deductable plan and pay the routine stuff out of pocket, but try to make sure that if I get something like cancer I will be covered. To that end, make sure to ask about the lifetime maximum and per incident maximum on any plan. In case it helps you at all, I am considering MegaLife's Premiere PPO plan.

As far as I can tell, an HSA makes sense IF you regularly need medical care. If you can typically go a whole year and pay out only a few hundred dollars for health care then I see less point in the HSA, but a high-deductable insurance plan, which is the "other half" of an HSA, certainly makes sense.

01-19-2006, 07:46 PM
This may appear strange...but I'm gonna throw it out there anyway..
Had a friend who had several policies..one was through Am Express...the others I'm not sure..anyway...he had at least three policies...not counting a co-dependent with his wife's
He destroyed his ankle....okay...should not be a problem...he's was overly covered.
The outcome is that the insurance companies...spent months fighting among themselves as to which one was gonna pay.
The guy had to take a mortgage on his house...as he was getting stuck with the bills...I mean 45,000.00 plus.
To this day...don't know how it turned out and what company paid.
Again...just thought I would throw this out...

ps..my plan is MD BCBS...Care first. Again, have never had to use it...so..don't know if it is any good....

[ 01-19-2006, 07:47 PM: Message edited by: uncas ]

01-19-2006, 08:13 PM
Hey JMAC have you looked into Dirigo? http://www.dirigohealth.maine.gov/ Baldacci has a lot riding on it, it seems O.K. to me.

Peter Malcolm Jardine
01-19-2006, 08:41 PM
250 a month? Yikes.

01-19-2006, 09:06 PM
For many years before we qualified for medicare Nancy and I were on BCBS Care First Individual and spousal policy for the self employed. We had a 1000 dollar deductable and an 80/20 copay (the 20 was ours) to a max of 2500 annual out of pocket expense. So when Nancy had cancer our total cost was about 5000 dollars spread over the fall of 1999 and the spring of 2000.. The cost was on the order of 1005 per quarter (Nancy just checked her records) That was for 2003.

We were pleased with it because it opened doors for her treatment with out a lot of hoops to have to jump through.

01-19-2006, 09:07 PM
ssor...thanks..If nothing else..ya put my mind at ease...as this is the policy I have... :D

George Roberts
01-19-2006, 09:08 PM
JMAC ---

I certainly have a good plan, but like everything else it might not be the plan for you.

If you are self employeed (I am, you are)...

Have your business employ your spouse and provide insurance for her and her family. Deduct the insurance cost on Schedule C.

If you have cash for minor expenses (we do)...

Get an HSA with with the highest possible deductible - $10,000 or $5,000 something like that.

My wife and I are mid 50's and considering the tax breaks - the HSA we have provides free insurance - $3 million worth each. The tax deferred savings is what we are after.

[ 01-19-2006, 09:09 PM: Message edited by: George Roberts ]

01-19-2006, 09:10 PM
Originally posted by Peter Malcolm Jardine:
250 a month? Yikes.That's cheap for a good policy. At last check, my health insurance cost Nissan about $258 a month. They charge me $12 a month and my co-pays are similar to Paul's.

01-19-2006, 09:24 PM
What would an HSA be? I think I'll try again to get a price with Dirigo. A few months ago I was given a ballpark of around $400 a month. Can't do that!

George, I'm spouseless at the moment, lost my insurance in the divorce, but gained peace of mind and return to sanity. I do have kids that I hire here and there, but they're insured with the ex.

Paul Pless
01-19-2006, 09:27 PM
Scary part about the cost of insurance is that I offer it to all of my employees and many of them turn it down to get a $200.00 a month raise instead.

01-19-2006, 09:30 PM
That is scary but understandable...Money is a bit tight...and needed for other things...
Everyone just has to pray that something medically serious doesn't happen...to them

01-19-2006, 09:30 PM
I NEVER gripe about my health insurance. It may not be perfect, but it's always picked up the tab when I needed it too.

Paul Pless
01-19-2006, 09:32 PM
That $200 a month is less than 10% anually for any of my guys. I've contemplated changing my benefits policy and requiring that they take it, but I haven't decided a good way to phase that in yet.

01-19-2006, 09:36 PM
Would you be better off to just bite the bullet and do it. You could make it mandatory for new employees and offer it to the older ones.

Paul Pless
01-19-2006, 09:43 PM
I will definitely require that any new employee take it, but is it really fair for me to require my current staff to accept it if they haven't in the past. I pay the first $200.00 a month of their insurance. for some of them they would be losing that money plus having to pay out of pocket possibly an additional $75.00 a month. I compensate my guys very well and it was a shortsighted decision on my part that led me to this situation. A desicion I made more than 6 years ago to let some of the guys opt out of the insurance and take the cash. To bite the bullet and foot the bill plus ive the guys their deserved annual raise and bonuses is a bit more than I personally want to pay out of pocket.

Like I said, I'll just phase it in somehow. my big issue is that I think of my staff as an extended family and I hate to see them make a bad decision - like turning down health insurance.

01-19-2006, 09:46 PM
Sometimes, being the boss sucks.

Paul Pless
01-19-2006, 09:48 PM
Sometimes, but generally its better than the alternative, actually I don't really know that - I've never had a real job, i've always worked for myself. At this point i consider myself unemployable.

01-19-2006, 09:51 PM
At this point, if you hate your boss, you're kind of SOL. :D

Me, I just steal cars from mine. ;) (Before anyone gets too upset, I take care of all the department cars so I'm supposed to have them)

01-19-2006, 10:05 PM
Paul, If you could go to a higher deductible policy and place the difference in insurance cost in a sinking fund to cover the deductible in the event of a catastrophic health event for one of your employees. You still might be able to cover them from financial disaster. Insurance coverage that picks up everything is always very expensive.

Bruce Hooke
01-19-2006, 10:22 PM

Have you considered that fact that some of your employees may get coverage through a spouse? If that is the case, and if it is a better policy they are getting through there spouse (or more likely simply less expensive to them), they could get really ticked off if you force them to also get a policy through you. I suppose you could take a line to the effect of, you can turn down the policy, but only if you have other coverage, and argue that it is for the good of the company because sick workers are not doing anyone any good.

You could also consider lowering how much they get if they turn down the insurance to simply provide some inducement to them to accept it.

If $200/month is 10% of their take home I can see why some are turning it down. If I'm doing the math right that means a total take-home of $24,000/year, and on that kind of pay $200/month for health insurance is a good chunk of money. I'm not saying what you are doing is wrong, and I'm not saying that they are right to turn it down, I'm just saying that is a difficult position for all concerned.

Right now, for me, health insurance costs about half what it costs me to keep a roof over my head, and I've got a high-deductable plan. Nothing else in my annual budget even comes close to rent and health insurance.

Paul Pless
01-19-2006, 10:33 PM
Bruce I wouldn't require someone to purchase duplicate insurance. I have twelve people on staff right now making from approx $25,000.00 to over $80,000.00 a year. I know that that $200.00 a month can be a chunk and I also know that to reverse my decision after this long it would be me forcing my values onto them, but I think that's probably whats going to happen. I'll ty to make it as painless as possible.

01-19-2006, 10:34 PM
Can you offer some sort of FSA or HSA to help offset the cost?

01-19-2006, 10:37 PM
Paul, maybe you could hire me on as a Central Maine rep for whatever it is that you do. I'll accept the health plan and settle for the lower end of the payscale. I'm a hard worker...

Paul Pless
01-19-2006, 10:38 PM
JMAC, so you feel like taste testing dog food? ;)

01-19-2006, 10:38 PM
FSA, HSA- Food Stamps Anonamous, Hot Soup Anonymous? What do they stand for?

01-19-2006, 10:40 PM
Flexible Spending Account, Health Savings Account

01-19-2006, 10:41 PM
I would, as any good manager would, delegate that to my close associate, a short haired mutt, and oversee the affair, and then provide you with CRITICAL DATA.

Bruce Hooke
01-19-2006, 10:42 PM
Somebody making $80,000/year certainly shouldn't be skipping health insurance for $2400/year! I know that you didn't say they were, I just hope their not! Someone making $24,000/year I can understand a bit more.

I think you are probably right to force them to have some sort of coverage. I think my last employer did the same, but I'm not sure because I never considered not accepting it. For me it was just a question of which plan I would choose (it was a big company so we had multiple plans to choose from, but even the cheapest came partly out of our paycheck as a deduction).

Paul Pless
01-19-2006, 10:44 PM
I pay the first $200.00 for anybody. i only offer one plan its the one i mentioned above. And your correct its only the guys on the lower end that turn it down.

01-19-2006, 10:47 PM
Somebody remind me to never gripe about my benefits package again. It makes working for the corporate entity almost worth it, almost.

High C
01-20-2006, 12:50 AM
Paul, why would you want to force your employees to spend their earnings as you see fit?

Employer provided health insurance is to blame for a lot of what's wrong with today's health care system.

For Heaven's sake, don't force that on anybody.

Paul Girouard
01-20-2006, 01:03 AM
Here's my two bits , make EVERY ELECTED OFFICAL IN USA a person in need of health care, not provided by the govt., once elected insured for life, who voted for that ???

Make then find it like we have to , they'll fix it , till we demand that , status quo :(

Two terms then out , move up (higher office ) congress to senate , state to federal , or move back to the private sector , without life long perks , period, PUBLIC SERVANT , not servant public !

I don't care what's not spelled right , you get the message smile.gif


[ 01-20-2006, 01:30 AM: Message edited by: Paul Girouard ]

George Roberts
01-20-2006, 02:25 AM
Paul Pless ---

The $200/month seems a bit high. Are you offering a group plan or an individual plan? Group plans are a lot more.

Perhaps you could offer a high deductible individual plans. That might reduce the cost to under $100/month.

01-20-2006, 02:41 PM
Dirigo- got a qoute based on 2004 tax return. Looking at $380 a month after subsidies. Can't do that. Anthem BCBS had a catostrophic plan w/ a $15,000 deductible for $125 a month. That I could swing and it would hopefully keep me out of bankruptcy if something bad happens. Yeah, this is way better than Canada....

Paul Pless
01-20-2006, 03:15 PM
Paul, why would you want to force your employees to spend their earnings as you see fit?
This is the only area that I would do so, and I've been reluctant to do so. When I was fresh out of college and building my business, money was tight and I dropped my own health insurance. I promptly broke my left ankle and broke my right kneecap and tore my right ACL in a whitewater canoeing accident. That little scenario set me back about 20 grand. It was a hard lesson, I'd not like to see people that I care for go through.

Paul Pless
01-20-2006, 03:17 PM
The $200/month seems a bit high. Are you offering a group plan or an individual plan? Group plans are a lot more.
Its a group plan that we (myself and my staff) are very happy with. See above post.

Paul Pless
01-20-2006, 03:19 PM

If your just looking for something to avoid finacial catastrophe look into an interim plan. After I got banged up when I was younger I took a Nationwide interim policy out it was really cheap, and was renewable in three month terms for up to a year.


High C
01-20-2006, 04:21 PM
Originally posted by Norman Bernstein:
...As much as I wouldn't want to do battle for yet another entitlement program (and thereby give every conservative in this bilge apoplexy!), I'm resigned to the opinion that single payer national health insurance is the right answer. Not the perfect answer... but the best answer.How would this make health care cheaper?

Bruce Hooke
01-20-2006, 04:55 PM
BEFORE THE DEBATE GOES INTO HIGH GEAR can I recommend or request that political discussions about health care by shifted to a new thread. If we let this become a discussion about nationalized health care and the like that will quickly bury the original purpose of this thread.


01-20-2006, 05:29 PM
I've heard this straight out of CEO's mouth- "The primary objective of a corporation is to provide shareholders a profitable rate of return on their investment."

It's not let's make a great product or provide a great service at a reasonable price. There are so many plans out there that it all becomes a crapshoot. Why not one plan without the need to show 10%+ profit every quarter? If other countries in the world pull it off, why not us? In fact, why not make it a point of national pride to come up with the best derned health coverage in the world. We're smart people, we could do this!

Yes, against my better judgement, I have ranted...

Paul Pless
01-20-2006, 05:39 PM

That's the primary thing that all graduates of a business school should know. And its certainly the view I've taken in growing my own business. However that quote doesn't imply that those profits should be found in the short run. I, and many other managers do indeed take a long term view towards profitability. In the long term things like customer service, quality of product (data in my case), and ethical and moral corporate citizenship come to the forefront of any responsible manager's decision making process.

sorry for the rant ;) ,


George Roberts
01-20-2006, 07:41 PM
JMAC ---

There are 2 reasons that employers provide insurance:

1) Employers can deduct the cost. Most employees cannot.

2) Insurance is not subject to "wage" taxes.

It always benefits an employee for the employer to pay for the insurance.

There are differences between "group" and "individual" policies.

An insurer of a "group" policy MUST insure anyone (no matter how sick) who joins the "group." An insurer of "individual" policies may reject anyone they wish. "Group" policies always cost more than "individual" policies. A group policy for my wife's business would cost 3 times what individual policies (same insured; same coverge) would cost.

When your insurance person comes to talk, get quotes for "group" and "individual" policies as well as MSA policies. I suspect that MSA policies without any required savings by you or the employees will be the most cost effective as well as being affordable.

01-20-2006, 07:55 PM

State Farm agents sell their short term, college, right start, HSA and traditional health plans so it may be as easy as calling the agent you already do business with. (25% of the USA's cars are insured with State Farm)

I have a number of clients who are pleased with them.