Ask HN: What healthcare options exist for entrepreneurs?
Would like to know what are the best options for healthcare when working for yourself in California. How much should I expect to pay?
I’m from Australia and don’t need to ever worry about health care costs; and you’d never in my life get me to vote to have a system like yours here.
I say this not to rant, but to hope in my heart that America can deliver this level of care to its citizens, and free you and your family from this burden.
Insured families pay $1200-1500/m for premiums with thousands of dollars of deductibles and annual limit on spending. And the. Have to fight for every cent the insurance companies do their damn best to not pay.
How will we pay for single payer? We take all the money that goes for healthcare right now, burn half of it and use the other half. Or less.
Kaiser is their own insurer/pharmacy, and works like a mini version of single payer. If you're younger than me (I'm 43) you may find some plans with them that are cheaper.
Another option is OneMedical, which is kind of boutique health care for wealthier people, but lets you do a lot more online than most medical services and may be worth a look. https://www.onemedical.com
Umm...probably rephrase.
However, to call it a true concierge practice would be a joke, in my opinion. I've never had the money for one (10k+ per year fee), but a friend of mine did have one of these, and at least in his case they were able to cure a serious back problem of his through cutting edge and non-invasive therapies. I wouldn't expect to find anything close to that at One Medical.
Still would say the One Medical membership fee ($200) is worth it if you can find a decent doctor there and if you're not happy with what you currently have.
As far as price, just check the market. There should be a way to see prices without even creating an account. The total price to account for is premium*12 + out_of_pocket_max, which should be between $11-15k for the year for a single person regardless of what plan you have. For me, I'm at about $490/month for a $7900 out of pocket max, which puts my total liability at $13780 for the year. Though, it will probably be less than that given that I'm healthy. That said, I'm not in CA.
Anyway, good luck! Running your own business is exciting and this is an expense. Also worth noting that your premiums are completely deductible as a self-employed person, which is normally not the case.
I hope we do Medicare for all. This system is so broken, it is time to learn from Europe, Japan, etc. I don't get why we don't steal great ideas because we are doing terrible.
I'm not sure the rules on posting links. I'm not associated with any of the above. But whenever I'm relocating and working a contract without benefits. I use those three sites to narrow down my options.
All links on HN are auto tagged with 'nofollow'.
How'd you do what you did?
Also, sole-proprietorships and S-corps, LLC or not, are considered pass through and all company income is considered personal income as far as the IRS is concerned. There's no such thing as not paying yourself in this context to drive down your income.
ACA is fully based on projected income for the year. Previous year's tax returns are one way of substantiating your projected income. But not required. If you are living off of savings and not making a profit yet on your business, you can pay yourself a small salary and qualify for full subsidies from ACA.
If you file as a C Corp (which you can do with an LLC), you could even hold profits in retained earnings and not pay them to yourself yet. You would of course have to pay corporate tax on those retained earnings.
https://www.healthcare.gov/income-and-household-information/...
However, for most people, the primary number to estimate this is your adjusted gross income, which they explicitly instruct to use line 7 on the 1040. It's not entirely clear to me who the regulatory authority is now that the tax penalty has been taken away for not carrying insurance, but I'm pretty sure it's going to look bad if you say that your income is near $0 to get a subsidized plan and your actual income is above the subsidy level and the IRS will have this information.
As far as holding the money in a C-corp, sure. However, then you're going to pay the corporate income tax rate for keeping the money in C-corp, file much more complicated paperwork than you would as a sole-proprietorship (depending on the state), and then likely have to pay additional taxes or play games once that money turns into income. All of this is to save on what's going to turn out to be likely less than $5k in premiums, which are already tax deductible as a self-employed person.
I'll still contend that the comment is largely false given the idea is to save money by pretending that there's no income. The IRS isn't dumb and they'll get their taxes eventually even if it requires an audit. It seems like a huge hassle and liability to play this game to save such a small amount of money. If this isn't a small amount of money, then the OP isn't in a position to start a business, unfortunately.
Most early businesses don't make much profit if any. Mine did not and so we kept our income right in the sweet spot to get max subsidies.
We paid ourselves that small salary and plowed every bit of the remainder into growing the business. In other words, there was no profit at the end of the year.
We had absolutely excellent coverage for around $100 a month total for a family of two. In one year we had $70,000 in expenses from a broken ankle that needed major surgery. And the next year a complicated pregnancy that cost $40k. We paid our max out of pocket those two years of $1500 each year.
You might be prioritizing developing your product over making income, or reinvesting income rather than spending that income personally. Or you might have savings or existing investment funding. There are many common scenarios such as these and none of them involve fraud.
You can be building up a substantial asset and living frugally and it doesn't affect your eligibility because of the lack of an asset test and because any capital gains are not realized) or assessed) until the business is sold.
Also as a single person you can earn up about $12K and not pay any premiums under Obamacare, or get up to about $48K and still get a subsidy. If you have a family of 4 these figures and $23K and $96K respectively. So obviously you don't have to get your income down to $0.
But I think the rates you posted are federal poverty level for a family of 4. Obamacare coverage kicks in at 138% of FPL all the way up to 400% of fpl.
Below 138% FPL disqualifies you for obamacare because you would qualify for state medicaid coverage.
If you’re young and in good overall health, this might be a choice to consider.
When you have a contract with an insurance company, that service provider has to pay up or you can sue them if they don't. Sure, there might be a co-pay or a high deductible, but if you draw an unlucky card with cancer / heart / cardio disorders, they will fork out six-seven figure sums to get you better.
"Christian Healthcare Ministries" and the like have no obligation to pay out and you are gambling on their goodwill, which can be revoked at any moment with no recourse. Further, they often have _lifetime_ caps of ~$100k per diagnosis/condition, and in case of any serious illness this will be chewed up in 3-4 months, then you are on your own.
The lifetime limit is more complicated than that as they seem to have separate programs for up to a maximum and everything beyond that. For example, Samaritan Ministries (one of these programs) costs ~$500/mo for a family for everything up to $250,000 and about $500/year to cover $250,000 with no limit. I’m guessing that’s done because they have members who live in inexpensive countries, but it seems like the extra annual cost should just be rolled into the monthly so no one makes the wrong choice about how much to cover.