This post originally appeared on The Distillery, a blog that covers the real experiences of entrepreneurs in New Orleans.
Okay, it’s time to talk about that thing that no one really feels like talking about–healthcare coverage. I know you have a lot on your plate, and the last thing you want to do is sift through health insurance plans. But if you’re an entrepreneur, that means you probably don’t have a generous healthcare plan through a job. You’re trying to make ends meet while you pour your heart and soul into your company. We love your hustle. But while you’re busy hustling, life happens. And heaven forbid you find yourself facing a serious health issue. I’ve been there, and I hope you never do. Because it sucks!
So, instead of bringing you a typical, “5 Reasons Why You Should Be Insured” post, I thought I’d share the experience of one entrepreneur who went through the process and had success. Josie Guste Mahana, of Gustofy, talked to me about her experience navigating the healthcare marketplace and shared her insight-straight up, unpolished, and to the point. Just the way I like it. Here it is, as told by Josie.
I’m no insurance expert but I have gone through some of the rigmorale of getting insurance for myself once I became self-employed and starting building my own business. A fellow entrepreneur said this was helpful for him and that I should share it. So here’s what I know:
I’ve been covered through healthcare.gov since I left corporate in March 2014. The more I deal with this the more I think I get it.
Healthcare.gov is the online healthcare marketplace where you can shop for healthcare plans from various insurance companies.
When you apply through healthcare.gov they check to see if you are eligible to get any tax credits. (This is based mostly on your income level.) If you can’t get a tax credit, then you pay the full premiums on the plans they offer through the various companies they contracted with (i.e. BlueCross, Humana, etc.)
When you select a plan, healthcare.gov sets it up with the company you selected. For example, I chose a BlueCross plan so healthcare.gov set up my account with BlueCross, but I pay BlueCross directly each month. BlueCross charges the total premium but if you have a tax credit, healthcare.gov pays BlueCross whatever the total credit amount is that you receive. which reduces your overall premium.
Throughout the year healthcare.gov requires to you prove your income status. If you don’t submit the proper paperwork when they ask for it, then you lose your tax credit and your premium goes back up with your provider (in my case BlueCross) because healthcare.gov won’t submit the tax credit to BlueCross anymore until you send in your proof of income or whatever documentation they tell you they need.
FYI: The communication and information flow between healthcare.gov and the insurance companies sucks. So, if you aren’t eligible for a tax credit, it may be worth a shot to shop on healthcare.gov for plans just you would on trip advisor for travel – and if you see a plan you like, call the company directly and see if they can offer you that same plan at the same price through them directly.
This is to give you an idea on plans.
I’m a 32-year-old female – independent, self employed with no dependents.
I went through healthcare.gov and got both medical and dental coverage. I received medical coverage through the BlueCross and dental coverage through Delta Dental Insurance. I receive the tax credit for medical but not for my dental.
I have the Delta Dental PPO plan and it costs me $43.53 per month and the coverage is good.
For medical, I have the “Blue POS copay 70/50 $3000” plan and the premium for me is $314.98/month – I receive a tax credit because I estimated an income at approximately $19K, since I am building a tech startup and I don’t know where my income will end up being. I receive a $224 premium tax credit per month which I can have applied in full each month.
Here’s the deal with the credit. When it’s time to file for your taxes, the income you actually made the following year will determine if you have to pay back the government for that credit, or if they owe you money. In my case, I believe if I don’t receive any income this year that I may actually owe them back the $224/month that they applied to my insurance.
Something to note: After you apply for healthcare coverage through the marketplace, if healthcare.gov determines that you are eligible for a tax credit, you can decide whether or not you want to receive the full amount, or if you only want to receive some of it. For example, I was eligible for $224/month, but if I wasn’t sure where my income status would end up for the year, and I didn’t want to owe the government money at tax time, then I could have decided to take only a part of it each month or none at all. I hope this helps!
FYI: Since we first talked to Josie, her insurance profile status has changed. So, bear in mind each individual’s circumstance and needs are different. But there are options out there. The deadline to enroll for coverage through healthcare.gov is Tuesday, December 15. Now, go get covered!