Health insurance is expensive. And frustrating. Especially if you’re someone who is self-employed and does not have any employees. Until recently, if you were in this boat, then you were stuck getting insurance on the individual ACA marketplace, which could be very expensive if you didn’t qualify for any subsidies. But now, thanks to a relatively new rule surrounding Association Health Plans, you have a way to get more affordable group health insurance even if you don’t employ anyone else, or are as casual and unincorporated as a handyman or tutor.
What are Association Health Plans?
Association Health Plans (AHPs) have existed for decades, and are basically a way for small businesses to get affordable healthcare. Even though they have the word “plan” in them, they are not healthcare plans. Instead, an AHP refers to a large group of small businesses and sole proprietors banding together to increase their insurance purchasing power.
The small businesses in an AHP may all be in the same industry or the same geographical location, but either way, they can use their combined size to get healthcare coverage as if they were one large employer. For an insurance company, the larger the pool of people they are insuring, the less of a risk it is – so they can charge less per person.
Once you join, AHPs function much like traditional insurance. You will get the familiar insurance card and will have access to the insurance company’s set network of healthcare providers. Premiums will be set the same way they are with all insurance plans – AHPs could, at one time, use a small group’s health status to decide how much to charge, but they are no longer allowed to do so. However, unlike ACA marketplace plans, with AHPs there are no metal tiers to choose from, and AHPs can also choose to be more flexible with their enrollment periods than ACA plans.
Up until 2018, only small businesses that had employees were able to join AHPs. But, following an executive order signed by President Trump in 2017 (and some legal battles over new AHP rules), people now defined as “working owners” can also join AHPs. These “working owners” can also get coverage for their spouses and dependents through AHPs.
When it comes to AHPs, a “working owner” is seen as someone who is both an employer (since employers are the ones who can become members of AHPs) and an employee who can use the AHPs insurance plan. And you don’t need to have a formal, incorporated business to be a “working owner”: you can do handyman work, teach piano, drive for a ridesharing company, or tutor students in your spare time. Even if you have a regular full-time job, but don’t have health insurance, you can join an AHP based on your “side hustle.” To become a member of an AHP, you simply have to be earning money from the work you are doing and meet one of the following criteria:
- Work for an average of 20 hours per week or 80 hours per month as a sole proprietor or self-employed person. You can spread these hours over multiple paid, self-employed activities
- Earn as much as the cost of the plan coverage for the working owner and any other dependents added to the plan
The Disadvantage of AHPs
If you are a sole proprietor, or someone working at multiple unincorporated side jobs, and have been struggling to find affordable insurance, the possibility of being able to access group health rates can seem pretty exciting. But there are definitely critics of AHPs. Some claim that they weaken the entire ACA by drawing young, healthy people away from the marketplace, leaving older, sicker people to drive up prices.
But even if the stability of the ACA marketplace doesn’t worry you, you might be concerned about the main disadvantage for those getting an AHP policy: AHPs don’t always provide full coverage. Under the new rules surrounding them, AHPs are now treated like large employer policies and, as such, they do not need to follow a lot of the rules of ACA plans. The premiums may be cheaper, but the savings sometimes come at a price: large employer policies (and AHP policies) do not need to cover the ten essential benefits that ACA plans need to cover.
AHP plans can also base their premium rates on age, gender, and industry. So, in addition to worrying about whether you’re getting the coverage you need, you also need to check into how each plan is priced and make sure you’re getting the best deal.
Health insurance can seem like a wild, wild world sometimes. So much to know, so many possibilities, and so many pros and cons. While you may be going it alone in your job, you don’t need to go it alone when searching for the right plan for you. EZ.Insure is here to help and will offer you your own knowledgeable agent who can help you sort through all of the noise. We’ll get you instant quotes for free, so get started with us today. Simply enter your zip code in the bar above, or to speak with an agent directly, call 888-350-1890.