Self-Employed? Here’s a Way to Get Group Health Insurance

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?illustration of multiple store fronts next to each other.

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.

Working Owners

man working closely on a kitchen faucet.
You don’t need to have a formal, incorporated business to be a “working owner”: you can do handyman work.

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. 

male and female gender signs connecting at the circles
AHP plans can base their premium rates on gender and other factors.

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.

“Medicare For All” Cause Friction In First Debate

In April, Senator Bernie Sanders introduced a new version of his “Medicare for All” bill, a single-payer health care that would eliminate private health insurance companies. Under Medicare for All, Americans would no longer pay premiums or deductibles, because the government-run system will replace private health insurance offered through employers. Republicans vocally expressed that Medicare for All is costly and ineffective. Democrats who stood behind the plan are slowly backtracking. During the debate on July 26, ten Democrats stood on stage, but only two raised their hands when asked if they were in favor of dismissing private health insurance. Some Democrats criticized the single-payer health care plan, broadcasting the first divide among the candidates.

red boxing gloves on a table. medicare for all debate.
During the Deomcratic debate, there was a clear divide among the candidates about Medicare for All healthcare.

Senator Warren and New York Mayor Bill de Blasio were the only two debating Medicare for All’s efficiency. Warren stated that Medicare for All solves the problems that families face due to rising insurance premiums. Most cannot afford healthcare.

Other Democrats offered to keep private insurance, in order to give Americans a choice. Sen. Amy Klobuchar said she was “just simply concerned about kicking half of America off of their health insurance in four years.”

Candidates Senator Cory Booker and Representative Tulsi Gabbard signed the Medicare for All bill but did not raise their hands at the debate. Even Representative Beto O’Rourke, who was once for the Medicare for All bill, changed his mind. It was clear he was not supporting it, stating that he would rather be in favor of a milder option allowing people to voluntarily buy into Medicare instead. “I think the choice is fundamental to our ability to get everybody cared for,” O’Rourke said.

De Blasio interrupted as O’Rourke spoke, the debate’s first interjection. “Wait, wait, wait,” he said. “Private insurance is not working for tens of millions of Americans when you talk about the co-pays, the deductibles, the premiums, the out-of-pocket expenses. It’s not working. How can you defend a system that’s not working?”

“That’s right. So for those for whom it’s not working, they can choose Medicare,” O’Rourke responded.

Former Representative John Delaney chimed in stating that “we should keep what’s working and fix what’s broken. We should give everyone in this country health care as a basic human right for free. But we should also give them the

the word healthcare in scrabble letterswith a green leaf to the left side of it.
The future of America’s healthcare is unclear. But for now, Medicare for All does not seem to be favored.

option to buy private insurance.”

A poll from the nonpartisan Kaiser Family Foundation found that Americans supported Medicare for All 56% to 42%. The numbers have fallen to 25% when people were told it could lead to delays in getting care, and to 37% when they were told it could lead to higher taxes. 

Democrat candidates displayed a clear divide and issue amongst Medicare for All. Even candidates, who once endorsed the bill in the past, showed they currently don’t support it. This is just the beginning of the health care battle.

Trump’s Plan for Health Insurance to Be Sold Across State Lines is Becoming Reality

While announcing the proposal of association health plans amongst small businesses, the Trump Administration is also aiming to facilitate health insurance policies across state lines. The rule will allow insurance companies to sell plans across state lines. The goal is to be able to provide plans and coverage that cost less.

Trump plans to allow insurance cpmanies to sell plans across state lines.
Trump plans to allow insurance cpmanies to sell plans across state lines.

Trump stated “I have private insurance companies coming and will sell private health care plans to people through associations. That’s going to be millions and millions of people. People have no idea how big that is. And by the way, and for that, we’ve ended across state lines. So we have competition.”

The issue that Trump is referring to is the state regulations that each state has. Each state differs in the requirements of what must be covered by insurance companies.

The association health plans would be considered under the federal law that allows large employers the freedom from state regulation. This way, these health plans can be sold across state lines.

Issues that lies with these plans are the fact that they can surpass the ACA’s requirement of providing the 10 essential benefits such as maternity care, mental health care, and emergency services to name a few. This allows the plans to offer fewer benefits, therefore costing much less. But the association plans cannot discriminate or overcharge individuals with pre-existing conditions.

These health plans can be structured across state lines, giving them the opportunity to market anywhere in the country. They may also set up to serve communities, or span several states. However, pricing is uncertain whether people in Manhattan will be priced the same as those in Texas.

“We are concerned that this could create or expand alternative, parallel markets for health coverage, which would lead to higher premiums for consumers, particularly those with pre-existing conditions,” according to a letter last month to state regulators, signed by America’s Health Insurance Plans and the Blue Cross Blue Shield Association. “Further, these actions destabilize the health insurance markets that guarantee access to comprehensive health coverage regardless of health status.”

Allowing this new rule will hopefully help Americans save money on health inurance.
Allowing this new rule will hopefully help Americans save money on health inurance, says Trump.

Pennsylvania’s acting insurance commissioner, Jessica Altman, voiced her opinion on the matter. “Generally speaking, these types of plans are exempt from state law and outside my jurisdiction,” Altman stated. “That means any issues that consumers have, I won’t be able to help them. More and more people would fall under the jurisdiction of the federal government, and I think state regulators would say we really do it better.”

The opportunity for health insurance plans to be sold across state lines will have an impact on the market. People will be able to purchase less comprehensive plans at a cheaper rate. But this can cause customers with extensive health issue or needs a hard time finding affordable plans. Healthier individuals will leave the marketplace for the skimpier non-regulated health plans, which will create a rise in premiums for those who need it- the sick.

Details on the rule must still be worked out by Congress and voted on, but if passed, it will change the health insurance market.