Annemarie Marek needed health insurance. But the cost of coverage was enough to make her sick.
As a nonsmoker in good health–and with no history of claims–Marek pays about $230 per month for medical coverage, on top of an annual $2,500 deductible. The package includes a 5 percent discount on prescriptions, but Marek has seen the deductible cost jump 20 percent annually since she first purchased the plan in 1992. Although her Dallas-based marketing communications firm, Marek & Co., foots the cost of her health coverage, Marek quips, “Remember, I’m a sole proprietor.”
So costly is health insurance for independent professionals and home-based business owners, like Marek, that many have opted to go without coverage. According to the healthcare website 98000reasons.org, approximately 56 percent of its 600,000 members are uninsured. And 11 percent work from home, notes the website’s national director of health care, Jamie Amaral.
“It’s a huge issue,” says Amaral, explaining that available policies often don’t match the business owner’s needs or ability to pay. “There’s either too much coverage, so they’re too expensive, or they’re so bare-bones there:s little benefit,” she says.
According to a recent survey of uninsured Americans by WellPoint Health Networks Inc., in Thousand Oaks, Calif., 25 percent of respondents said they would purchase health insurance–if it was priced affordably. What’s more, respondents perceived the cost of insurance coverage to be twice as much as it actually was.
Affordable health insurance policies do exist, if you know where to look. Follow our guidelines to find a plan that suits your needs without breaking the bank.
Assess Your Needs
Before you start shopping around, take the time to determine your minimum health care requirements. Make a list of care or treatments you need, as well as the amount for copayments (what you’ll pay to the care provider at the time of service) and out-of-pocket expenses (usually your maximum deductible) your business can afford. A rule of thumb: The more you pay per visit, the lower your premium. Also keep in mind that preexisting conditions such as asthma and diabetes typically boost premium costs.
Next, consider which of the three general types of health plans best suits your needs. A health maintenance organization policy is the most affordable, but it limits you to a select group of doctors on the HMO’s list. More expensive is a preferred provider organization (PPO) policy, which is less restrictive, but also requires you to choose from a prescribed roster of doctors and facilities. And more costly still is an open policy, which provides near-unlimited access to doctors, hospitals, and surgical or clinical facilities.
Shop for a Plan Once you’ve settled on a health care strategy, you need to find a policy to match it. David Ludwig, senior vice president of agency management with WellPoint, recommends you get quotes from at least three agents before settling on a plan. Consider these six starting points to find what you need.
* Inquire whether your local chamber of commerce and your industry trade association offer member policies.
* Ask your peers for referrals to trusted health insurance agents.
* Contact the National Association of Health Underwriters (www.nahu.org), an association of independent health insurance sales agents.
* Call your state’s insurance commissioner’s office and inquire whether your state participates in a small-business coverage pool, suggests Amaral. Also referred to as “catastrophic insurance,” coverage pools accept employed workers who have been denied coverage by a commercial carrier or employer due to a pre-existing or chronic condition. However, the cost can be high–from $400 to $600 per month per person, according to the NFIB.
* If you’ve recently left a company to work for yourself, you might want to consider signing up for a COBRA plan. Although this lets you extend your existing coverage from your former employer, Amaral warns that the cost can be up to three times higher than traditional coverage.
* For general information and policies, checklists, charts, and questionnaires, head to the Agency for Healthcare Research and Quality (www.ahcpr.gov).
Doctor in the House
Once you’ve collected quotes from several providers, next you’ll want to scan the provider directories for primary care physicians or general practitioners whose names you know–or who have been recommended to you. If you’ve moved to a new area, look for board certifications and other credentials; you can often find this information at the insurance carrier’s Web site.
For comprehensive information and online application processing and policy ordering, check out Web sites such as ehealthinsurance.com, InsWeb.com, HealthAxis.com, and Insuremarket.com. Each site simplifies the process of finding affordable health insurance, says Vip Patel, CEO of ehalthinsurance.com, Sunnyvale, Calif.
“The hassle factor results in a barrier,” says Patel, whose company represents Blue Cross-Blue Shield, Prudential PacifiCare, United Healthcare, Cigna, and Aetna in a number of states.
If price is your primary concern, consider creating a checklist of your required services–and how much each may cost, advises Ludwig. Weigh the desired monthly premium against the deductible, the out-of-pocket maximum per occurrence, as well as other medical charges.
To further cut costs, Ludwig advises that you raise your deductible (the amount you’ll pay on each occurrence before the insurance kicks in) or lower your lifetime benefit (the amount for which the insurance ultimately is liable in the event of a long or catastrophic illness). Then invest that amount.
That’s what Marek did; she then earmarked the savings for health emergencies.