I got a question from a reader about health care:

I’m shopping around for health care and it would be real interesting and helpful to see what people say and recommend in the comments section.

If you have any tips leave them in the comments. I’m sure many readers will find this helpful.

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59 Comments

  1. What great timing. For the past several years , I had been on a policy with my then girlfriend. Her office recognized domestic partnerships, so while we were together we took advantage of that. We’ve since split up, and now I’m looking for a policy on my own. I’m in Pennsylvania, my inclination is to go with a PPO with a high deductible. Any advice good or bad on my plan is appreciated.

  2. I guess I am asking…what is it about being photographer and healthcare have as a common interest when it comes to healthcare?

    I can share this….I have private health insurance and also business photography insurance from TC&P.

    But what I do NOT HAVE and need as of late, due to an assignment I took, is Workmans Comp or Disability coverage….and I’m gonna need to buy that in addition to the other two policies.

    TC&P does not and will not offer workman’s comp.

  3. I would suggest starting your search with the various professional organizations that offer access to health insurance as a benefit of membership — ASPP, NPPA and ASMP all offer that as a member benefit.

    http://aspp.com/index.php/insurance-benefits22
    http://www.nppa.org/member_services/special_offers/?offer=assochealth
    http://asmp.org/articles/member-benefits.html

    And there are groups like the Freelancers Union and Fractured Atlas, groups that work with self-employed creatives, that also offer this benefit. Access through these groups vary greatly from state to state:

    http://www.freelancersunion.org/
    http://www.fracturedatlas.org/

    It’s still expensive, but at least you have access through these organizations. It can be very hard to get independently at any cost.

  4. In addition to the professional organizations Sid mentioned, also look at PPA for health care. Membership also includes $15K insurance for your photo gear, but health care is a separate cost.

  5. I have found it advantageous to join the local Chamber of Commerce for group coverage.

  6. I’ve found that marrying someone with a real job and good health care is the best way to go ;-)

    • …until your better half decides that she has had enough of that role and now you are both figuring out health care shopping isn’t as fun as…. much.

    • that is the best advice! Photography programs should organize mixers with pre-med and engineering programs.

  7. My advice? Vote democrat in the next election because republicans want to give private insurance companies another 100 year run at “fixing” healthcare (apparently because they’ve done such a bang-up job with the last 100 years). Alternatively: 1) move to Canada; 2) join the military; 3) get elected to congress (either branch), and you’ll get a government paid Cadillac plan that, while it’s so good you will refuse to give it up, it apparently isn’t something that’s good for the general public…

  8. Sadly I think Jeff and John’s advice hit the nail on the head.

    Oh, and eat a lot of kale.

  9. Along these same lines, what about business (equipment) insurance? Anyone care to weigh in on that one as well?

    I see William mentioned PPA above: Here are some details: It costs ~$325/year (cost to be an Active Pro PPA member) covers up to $15k, with a deductible of $250 ($500 for breakage). This only covers depreciated value though, calculated on the age of the equipment. For a full replacement value option, they do offer their Photo Care Plus program which you have to pay an annual premium on.

    Just for an example, I entered $25,000 of assets into the PhotoCare Plus calculator, and it would cost $437 (You still need to be a PPA member to use this service as well, so add another $325). Therefore, if you’re not in PPA (and not interested in joining), and can find private equipment insurance for less than $750 elsewhere for similar coverage, that would be the better deal.

  10. John W, I came on here planning to say “move to Canada”, but you beat me to it! (btw, I took your advice)

    Alternatively:

    move to France

    move to the UK

    move to Cuba!

    ;)

    • I’m in New York state and used to qualify for Healthy NY. I don’t qualify now and thought I was screwed! However, if you find a insurance agent that deals in health insurance–and specifically, with Excellus–there are high deductible policies for small business (that you use in conjunction with a Health Savings Account–just like I did when I qualified for Healthy NY) with premiums that aren’t that much more.

      • There is a (100% legal) workaround:

        If you have a spouse or other family member who helps with your photography business IN ANY WAY you can put them on Payroll and have your business provide a Healthy New York family plan (which then covers you AND any other family members, including kids, elderly dependents, etc.- a bit roundabout but it works and is legal). This way, your company is technically a “group” (of two) and qualifies for group plans, rather than more expensive individual plans.

        Better yet, if you’re running payroll for a family member, you can additionally set up a Section 105 (Bizplan) medical reimbursement plan for your business through TASC (www.tasconline.com) and deduct the FULL amount of your medical costs (insurance premiums, copays, deductibles, glasses, dental, prescriptions, etc.) on your schedule C, which results in a considerably larger deduction for your business. The only catch is that you have to offer the same benefits to ALL your employees, so it only works if you don’t have any other employees on payroll (freelancers/independent contractors are not on payroll).

        I set this up through Paychex, the payroll company, who has their own insurance division which knows how to set this up. It costs something like $75/month to have them manage your payroll for one employee.

        The savings are *enormous* and well worth the trouble.

  13. I have a PPO which is very basic and frankly it blows- All of the advice from above such as move to Canada, UK, or France is the way to go considering that I’ve used all of their healthcare – If I am injured on location, please be sure not to put me in an ambulance- it’s not covered….. there is some website for marrying a canadian if you are up near the border- Good luck and go ObamaCare Go!

  14. Because of the new health care legislation, anyone under the age of 26 can get on or stay on their parent’s health insurance until they turn 27. That is in effect now and I’ve been recommending it to my students. Now younger people out of college can take a job they want and not worry about health coverage if they can get or stay on their parent’s insurance.

    As far as where to get health insurance coverage, the organizations mentioned here are good ones. My only advice is to avoid “GOLDEN RULE INSURANCE.” This company has a habit of suing people when they get sick or they think you are sick. I know because when I was on their high deductible insurance, they thought I was really sick and they sent someone to my door who served me papers. In other words, they sued me. After I little research, I discovered that Golden Rule Insurance does this as a matter of practice: in other words, it’s how they run their business. Funny that “Golden Rule Insurance” was being investigated by the then democratic House, and, as soon as Newt Ginrich and the Republicans took over the house in the 1990’s, the investigation was dropped. Gee, I wonder why?

    “Big Donor Let Off The Hook: No More House Investigation”

    “A House Energy and Commerce Committee investigation of Golden Rule Insurance was dropped after Speaker Gingrich’s ascension. Last year, Rep. John Dingell said that Golden Rule “routinely engages in extraordinary practices designed to intimidate, coerce, and frighten…and scares consumers with doomsday predictions shored up by misinformation and threats of canceled policies.” Golden Rule executives have contributed $117,076 to GOPAC, $42,510 to Gingrich’s campaign committee, and an undisclosed amount to the Progress & Freedom Foundation.” source: http://www.congressproject.org/ethics/ethrel.html

    Bottom Line: Some companies offering high deductible insurance sell you “Golden Rule” policies. Be careful what you purchase.

  15. I just buy my insurance direct from my local blue cross. I am young and relatively healthy with no employees and no spouse, so it only costs $130 a month for a PPO plan with (I think a) $2000 deductible.

  17. Here’s some insight from my perspective.

    For health insurance, I have BCBS PPO plan for @$120/month w/ a $2500 deductible. Not a great policy, but I’m young, no kids, wife, etc, includes an annual check-up, and just use it as a back-up incase I get run over by a bus.

    I use Hill & Usher (http://www.hillusher.com) for all my business insurance. I have $30k coverage for personal gear, $30k for rental gear & $3MM per instance liability, and they are very competitive with pricing. My previous agent recommended them and they have been great, very quick customer service, etc.

    A job required me to get a Worker’s Comp policy and Hill & Usher handled that for me as well. The price is based on your business gross, so that will vary from person to person.

    Hope that helps!

  18. I used to have a BCBS PPO plan “in case of emergency” — which, unfortunately for me, occurred and forced me to pay the deductible. I wouldn’t recommend the ‘in case of emergency only’ plan unless you have the money for the deductible set aside. Also – the majority of the PPO plans I looked into (at the time) didn’t cover pregnancy which I found to be frustrating — any specific advice from readers on more female-friendly health insurance plans?

  19. Beware of BCBS PPOs. Read the fine print. All of it.

    I used to have a Blue Cross PPO with a $2500 deductible. I was in an accident accident that required major surgery. Some P.O.S, dickhead BC doctor on the other side of the country, (who never saw me) decided that I did not need any of the physical therapy, post-surgical cold therapy, a continuous passive motion machine for my surgically reconstructed joint, crutches, etc. etc. that my nationally renowned ortho surgeon prescribed. To make a long story short, I was completely fucked by BC after paying my premium religiously for over 8 years without a single claim.

    As far as I’m concerned, BC can spend eternity in hell sucking on satan’s hemorrhoids.

    Read the fine print and do not take your insurance agent’s word for anything.

  20. 1. ASMP & PPA have health insurance plans for members.
    2. Google ‘Freelance Healthcare Plans’ and there are lots of different groups who group sole proprietors together to get a group rate. I was once with something called The Alliance.
    3. The big health plans did offer singular insurance but it’s a pain and you have to apply.
    4. The best way? Get married to someone who has a job working for a big corporation. :)

  21. All I can say is good luck getting an individual (not group) policy if you have any “pre-existing” condition. Wasn’t that supposed to change under Obama Care?

    • As Jim points out in the article he cited, it did change under Obama Care, but that part doesn’t go into effect until 2014. Until then, people with pre-existing conditions (like myself, type 1 diabetic) are screwed. I got laid off last year from my staff photography job, and I’ve been doing well with the new business, but I can’t even get coverage. There are very few options (especially here in the south) to get affordable coverage.

      What I have found really great are the Patient Assistance Programs offered by the drug companies. I’ve been signed up with two for almost a year now, and I get most of my meds free, shipped to my doctor’s office. I haven’t actually been to see my doctor for a clinical visit in over a year (can’t afford it without the insurance), but even so, I’m getting all the meds I need for free. I would definitely recommend the PAPs.

  22. To all those considering a move to UK, sorry guys, we have plenty of photographers here already :-) Our health service is generally great, sometimes has problems but it’s nice not to have the worries that you US citizens have hanging over you. If you do decide to come over though marrying a medic, nurse, or in my case midwife puts you up a notch in the care stakes as your partner will know what strings to pull to get to see the best doc.

  23. I’m so p!ssed right now with healthcare. I did a ton of research and made more excel spreadsheets than I care to divulge in a search for affordable healthcare. I’m currently paying Blue Shield $320/month for a very basic PPO plan. I’m 34 years old and could be the healthiest man alive. This is beyond robbery. My lady/domestic partner of 13yrs pays around $370/month for a similar plan.

    Better yet, I get a letter in the mail about every 6 months citing “increasing cost in the healthcare industry” therefore they have to increase my premium another 13%….are you kidding me???? Cost are rising that fast?

    We are paying out the a$$ and I’m still scared if something happens because it will still cost a fortune.

    Something has got to change, this is ridiculous. Why does the United States have some of the worst healthcare in the world yet we pay the most for it???

    • Re: “Why does the United States have some of the worst healthcare in the world yet we pay the most for it???”

      The answer is complicated, but I believe major factors are that the system is designed to benefit doctors/hospital owners/drug companies/insurance companies.

      It is not designed to benefit the customers/patients.

      • Actually we have some of the best healthcare in the world. We just have the worst system. The two should be distinguished.

        Our leaders go on and on about how taxes will stifle economic growth and kill the so called American Entrepreneurial Spirit, yet I am scared to death to start my own business because of this conversation. I would much rather have a high, predictable tax, than the possibility of bankruptcy constantly looming.

        • agreed Kyle – I read it as ‘worst healthcare [system]’

          US healthcare is world-class, but the cost is out of all proportion.

          And when you see reports that “Medical bills prompt more than 60 percent of U.S. bankruptcies” you have to feel that there is something seriously wrong with the system.

          How many bankruptcies in Europe are due to medical bills? I can certainly not think of a single case I know of, and I grew up there!

      • Well..remember..we are lawsuit crazy. Have you even heard the premiums Docs have to pay for E&O coverage?? Its crazy.

        We need a change in the legal system…and its simple…make people who bring lawsuits and fail, pay for the costs. I think everyone will think twice before filing a lawsuit just cause their mama told them so!

        • very good point Anand.

  24. I moved to Europe where they have universal free health care. Solved that problem.

  25. 1400/m cobra — aetna. ugh

    2 little kids, parents healthy.

    w universal health care we could take the entrepreneurial risks we don’t dare to take now. instead, it’s “full time freelance”

  26. Every year I have to go for a cheaper and cheaper plan with Horizon BCBS for me and my two kids because every year, for no reason at all, it goes up another hundred dollars a month. Right now I am paying $800 a month with a $5000 family deductible, which strangely I never seem to meet. So for 2011 I paid $9600 in premiums and another, I don’t know, maybe $4999 in deductible? So what’s that, $14, 599 a year to receive nothing at all? Plus putting two kids through college on a freelance paycheck. All I can say is, hurray for generic zoloft.

  27. My wife and I are both photographers in California and we set up an LLC for our business. With regards to Health Insurance we picked a policy that was right for us (coverage vs. price) by working with a local agent that was recommended to us. This helped to see what options we had and to speak with a person in person about what was available. We have our health insurance through our business, as a result it is an expense for the business that is deducted come tax time. With regards to Business insurance we have our insurance with TCP. Hope this helps.

  28. Move to canada, I cut my tendon and had micro surgery, cost 0$, cost in united states (multi thousand dollar surgery in the states)

  29. I live in Canada and thank God for our health care system, especially when my daghter contracted leukemia and required a bone marrow transplant – a quarter of a million dollars if done in the U.S., and zero if done at home.

    However, nothing in ths life is truly free. I pay 47% tax.

    Still, I prefer it this way. Each to our own, I guess.

    • Andrew points out something important here: Canadians can do math. Many, maybe most, Americans, would be way ahead of the game if they had to pay a 40% + tax rate and had universal, government paid health care. However, rather than trying to understand the implications of a single payer system, most people cop out and instead memorize mantras that they simply repeat until they become truths: Taxes are bad, no new taxes, ohmmm; free market is good, government is bad, ohmmm. The result? Dogma trumps pragmatism almost every time in American politics.

  30. I am an agent for Health, Disability and Life in California.

    Few things I will share here:

    1. Best possible option is to be on the spouse’s plan at work if you can. Nothing beats that.

    2. If you want cheap, look for a HSA plan with a high deductible. Open a HSA account and put some funds in there…you get a tax deduction! Yipee!

    3. For younger clients, I normally suggest going with PPO…but a young married client..go HMO. This is assuming that young married will soon have a family. When you go PPO, remember to put aside the annual deductible.

    4. There are some HMO/HSA plans..these are new and could fit the bill.

    5. Things to watch out for: Annual out of pocket limits / Copays / Hospital copays / emergency copays / urgen care copays / lifetime limits(though I think due to Obamacare, these are unlimited now).

    6. Oh…the costs will continuously increase at a much higher clip than inflation….more like 20-35% increases every year.

    7. Finally…the holy grail tip…if you can be qualified as a “small business”..look for small group plans. They may cost a bit more, but the benefits are sometimes much better. For example, no pre-existing condition clauses…or you can get a plan that can cover fertility treatments. Most individual plans will not cover this (at least in California).

    Btw, disclosure..I am not soliciting business here and these are general guidelines and your situation can be different in your state. Don’t try to sue me. :)

    • Just don’t ever sell a “Golden Rule” policy. “Criminals” is a nice word for them.

  31. Oh…the #1 policy you should get is.. disability. Much higher chance of you not being able to continue your career due to injury/accident then a heart attack. You will not have any income if that happens. So…make sure you have a source that can replace that.

    I do a lot of planning for business owners…they are clueless about these risks and rather would save a buck. This is an area that one should NOT be saving a buck.

  32. wow. thanks for all the awesome comments. very helpful… even the ones about moving to another country.

  33. Why does the working class ever vote Republican , it beats me.

    • …because they all think they are going to win the lottery (George McGovern).

  34. Health Savings Account with catastrophic coverage through the PPA for about $200/month. Very good plan for not much money.

  35. Another confounding aspect to this whole problem is just how much “winking and nodding” happens on every level. Insurers, HC providers, agents and subscribers all seem to recognize just how illogical and inefficient the system is from top to bottom and yet no one seems to be willing or able to make changes. Like some of the earlier posters, premiums for my family (wife, 2 kids) increase every year despite the fact that we are undeniably exactly the kind of insureds that these providers want to have (no claims, pay our premiums etc).

    At renewal time last year, I was informed that my “group” was being disbanded and my new premium would be close to three times what it was…up to $4200/month. That’s four-thousand-two-hundred dollars. For the same lackluster coverage and service. My agent found a workaround which I won’t elaborate on here, but which will keep us insured for at least another year. There have been many other contortions necessary over the 15 years I have been buying coverage.

    My point here is this: never, ever accept the first thing you are told by an insurance company. Almost every time someone in my family visits a doctor for anything, even a routine checkup, there is some sort of clerical issue that requires me to spend twenty minutes on the phone with our insurer to question or dispute a charge. I may regret putting this in writing, but I haven’t lost one yet. I HATE this part of running a business but it’s necessary, at my level, to control every cost that I can.

    Find an agent to work with…most of them are people too and understand how messed up the system is. They also want to provide service and sell insurance. So much about the way healthcare is marketed preys on fear, guilt and lack of knowledge about the system. You can only make informed decisions if you demand information and a full accounting of all of the options.

    Best of luck.

  36. If you have any family members that are veterans you can usually become a USAA member and they have very good rates for all kinds of insurance, car, home, medical. I have kids and both my wife and I are self employed and we got a decent plan, with a high deductible but decent coverage, for way less than any other place I found.
    Worth a shot if you qualify

    jml

  37. My wife and daughter and I pay less than 1k/m for ppo coverage in California. We have USAA for other insurance, which is good as jeremy stated, but, they do NOT offer maternity care, so we had to opt for another company who had that as part of their coverage, which was rare and expensive and with a super high deductible … I find it amazing that other human beings, even if they work for insurance companies, wont offer coverage to propagate our species!! Quite sad…

    • We chose to pay out of pocket for midwifery care (not covered by ins) and received 90% more service and education for 10% the cost. California has way more midwifery options than we in conservative Indiana.

  38. I was having a conversation with a friend about this just the other day (OK…I was bitching about how my health insurance premium skyrockets annually to the point where I’m at now with a yearly deductible that could finance a small nations debt!) and he suggested I check out APA’s affiliated health care plans handled by TEIGIT. I did. The monthly premium for my wife and I would be…$4,915.40. Almost sixty grand a year?!! Surely I wasn’t reading something right on the website, so I called and was told that yes, that was the premium but that there was no deductible and they had no preexisting health condition exclusions. Whoopee!!! I guess if I was suffering from multiple cancers this might be an answer, but Holy Crap…it makes me wanna move back to Canada!

  39. Who ever mentions the military as an option beware, it is not as good as you think. Those who don’t serve until retirement can get care though the veterans administration under certain circumstances typically a service incurred disability. If you retire typical costs for the standard plan are 25% of the treatment costs. If you pay for the prime program typical cost come down significantly. I have had around $100k in costs for surgeries, hospitalization, therapy and prescriptions, and my costs has been just over $1k. It cost me almost 20 years though and my ex gets half the pay.

    I will have to say this we can’t blame the politicians for the mess, we voted, good or bad results we put them into office. If we don’t like what they have done, fire them. Personally I don’t care what party they belong to they all are greedy mother effers and suck. I think it is house cleaning time. I would rather see some successful entrepreneurs filling the seats than who is in the mix for any of the parties. People need to vote! you can’t believe what is being said….

  40. I had Freelancers Union Insurance (through the Freelancers Insurance Company) for the last few months (since September) and they are expensive and the coverage is awful. As in, I’m getting bills for things that should have been covered–extraordinarily expensive bills, to boot–and getting reimbursed is hell. This is my last month with them, thanks to my boyfriend’s healthcare plan finally covering me. Without that, I’d be stuck with Freelancers’. I don’t qualify for Healthy NY and the rest of the PPO options are just unfathomably expensive. NYC is probably one of the toughest markets in which to buy individual health care plans.

  41. I just did some pretty intensive researching, the best plan I found, including looking at ASMP plans, was a BCBS plan…. Vital Shield 900 generic Rx. I’m 25, healthy, living in CA and got a quote of $124.00/mo, and included 4 co-payed doctors visits without a deductible, a low deductible, a $3500 out of pocket limit, 0% copay. Rates and plans are going to vary on your location and age, so it might not all be the same.

    Again, I’ve read pretty awful reviews about BCBS so I’m treading with caution and am settling down to read all the fine print this weekend. But this is what I’ve learned, so far. Good luck to everyone!

  42. I’m an american that moved abroad to Europe many years ago as a teenager, after years of traveling (uninsured) I settled as a resident in the Czech Republic. Fortunately they force you to get state insurance to be a resident, and although it’s since risen from about $300 for a year to about $2500 for two years, its almost the same level of insurance as a Czech Citizen and will cover you pretty well when traveling throughout Europe. Not a perfect solution, but Europe has a larger safety net for the freelance for sure.

  43. Move to Europe!
    I live in France and the ease of getting affordable (and quality) healthcare is amazing. I’m under 26 so I’m still technically on my parents’ plan in the U.S. as well, but yeah, Europe is the place to be.

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