Pennsylvania Self-Employed Health Insurance Plans And Rates
We assist you in finding, comparing and applying for quality medical coverage that stays within your budget. Often, it can be quite challenging if you are an independent contractor or have to find and pay for your own policy. With more than 38 years of experience and expertise, we help simplify the process, by researching all available plan options that can help you. Enrollment often takes less than 15 minutes, and there are no fees or costs. Association plans may also be available, although they generally charge fees.
Depending on existing medical conditions, and household income, you can customize benefits to match your budget. Freelancers, independent contractors, and consultants can also qualify for guaranteed coverage with the possibility of tax credits to help lower the premium. If you have a single employee (or more), the SHOP Marketplace can also be considered. Note: If your spouse is offered group benefits, you may not be eligible for a tax credit to help pay for an Exchange plan.
Under-65 plans allow self-employed persons to deduct 100% of the policy premiums from your adjusted gross income (AGI). To qualify, you must have a net profit from your business (Schedule C, Schedule C-EZ, Profit Or Loss From Business, Net Profit From Business or Schedule F). You may also qualify for the deduction if you used an alternative option to calculate your Schedule SE earnings. Sole proprietors and independent contractors can also benefit from current tax laws. If you have payed contractors via 1099, specific options may be offered.
Self-Employed Healthcare For Seniors
Many Medigap options (Advantage, Supplement, and Part D prescription drug) are offered for Seniors that are eligible for Medicare. A high-deductible (HD) plan with lower premiums is also offered. The current deductible is $2,300 with 100% coverage after the deductible is met. If you are a retiree (under age 65) and are receiving a pension from an employer, you may still enroll for a Marketplace plan. However, the full retail price will have to be paid since a subsidy would not be available.
A healthcare sharing ministry, although available in most areas, may not provide the appropriate guaranteed benefits that you should have. The “shared box” concept is more popular with applicants under age 65.
Pa Health Savings Accounts
Perhaps the most popular and cost-effective option is to purchase a Pennsylvania Health Savings Account (HSA). Although most self-employed residents are not aware of HSAs, this type of coverage will reduce your premiums, and allow you to save for future medical expenses on a tax-free basis. You can also terminate the policy at any time and change to a different type of plan. You never lose any accumulated money since it is always available. Deposits can be variable and also stopped or started at any time. Medical bills are easily paid online or at the location of treatment.
Funds can be quickly withdrawn, and lump-sum deposits are also accepted. When you become Medicare-eligible, although additional deposits are not allowed, accumulated funds can be used for approved expenses. It’s also possible that one adult family member will be covered through a Medigap Supplement plan, while the younger spouse continues coverage through an under-65 HSA. A high-deductible Medicare Supplement option is also offered to Seniors (Plan F HD). The current deductible is $2,300 (see more information below). Previous unused contributions can be used to pay for qualified Senior expenses.
Many of the large insurers in the state offers this type of policy, which can reduce your tax liability. A group plan may be available, depending on the number of employees and the percentage of participation. But beware. Often, group costs are significantly higher than private rates since the availability to shop plans is sometimes limited. However, if your employer is paying 40% or more of your premium, you’re probably getting a good deal. Many larger companies will contribute up to $3,000 towards their employee’s HSA. Annual check-ups and preventative visits are covered with no out-of-pocket cost.
Policies are no longer medically-underwritten, so approval is virtually guaranteed. If you employ less than 25 employees, tax credits may be available up to 50%. However, it is very possible that net costs will be higher. This may be one of the main reasons that some employers are changing employee status from full-time to part-time, so they are not forced to purchase coverage. In those scenarios, the employee can qualify for a federal subsidy, depending on household income.
If you have more than 50 employees, you must furnish medical benefits to your workers. This “mandate” began four years ago and was part of the Affordable Care Act (Obamacare) legislation. Employees that work an average of 30 hours are considered “full-time.” Oddly, the news was originally broken in a Treasury notes blog. Although employees often pay a much lower premium for their group healthcare coverage, dependents may not be so lucky. Often, their rates are significantly higher, since the employer may not be paying any of the premium.
What is an HSA?
An HSA is an alternative to traditional insurance. They allow you to pay for current medical expenses, and potentially accumulate money in a tax-favored side fund. You own, manage and invest your money and decide how funds are dispersed. We have devoted an entire page here to this type of contract. You can compare the lowest priced offers at any time on our website, and on and off-Marketplace plans can be viewed.
A catastrophic medical insurance plan is created with the HSA. Although this policy will pay for preventative coverage at 100%, most other expenses are subject to a deductible. You can choose from a wide range of deductible options. Each year, the maximum-allowed amount can change. Currently, it is $6,900 per person (maximum of two per family).
Pennsylvania HSA plans also provide Network-negotiated repricing discounts that will reduce your out-of-pocket costs on expenses that are subject to a deductible. These discounts can be quite substantial, especially for lab tests and X-rays. For example, a typical lab test that costs $150 could be discounted to about $25, or less. An X-ray charge may reduce from $200 to $50. The cost of an MRI may reduce from $1,500 to $700. That’s a lot of savings! Often, you can shop different providers for the best pricing.
NOTE: there are many laws and regulations that self-employed persons must be aware of. Legislation often changes and the cost of maintaining and operating a business will fluctuate. The Pa IRS Small-Business Web Page provides free information regarding state agencies, general services that are offered, and Department of Labor and Industry links. Several carriers may offer small-business medical plans that require only two employees.
How much does a “high-deductible” (non-HSA) plan cost?
Rates vary, depending upon where you reside, ages of persons to be covered, the carrier, and your household income, since a federal subsidy is available. We have illustrated below several scenarios along with the monthly cost of coverage:
40-year-old married couple living in Allegheny County with household income of $40,000
$115 – UPMC Advantage Bronze $6950/$35
$261 – UPMC Advantage Silver $2,650/$25
$272 – UPMC Advantage Silver $0/$50
50-year-old married couple living in Dauphin County with household income of $60,000
$32 – UPMC Advantage Bronze $6950/$35
$65 – Geisinger Marketplace HMO 30/60/6600
$101 Highmark my Direct Blue EPO Bronze 7900
55-year-old married couple living in Montgomery or Philadelphia County with household income of $50,000
$79 – Independence BC Personal Choice EPO Bronze Reserve
$94 – Ambetter Essential Care 1
$191 – Independence BC Personal Choice PPO Bronze
40-year-old married couple with two children living in Montgomery or Philadelphia County with household income of $82,000
$370 – Independence BC Personal Choice EPO Bronze Reserve
$384 – Ambetter Essential Care 1
$472 – Independence BC Personal Choice PPO Bronze
High Deductible Plan F For Seniors (HDF)
A “high-deductible” Medicare Supplement Plan (HDF) is also available for Seniors. The annual deductible is $2,300. The benefits are identical to regular Plan F, although the deductible must be met before covered expenses are paid in full. Applicants with no major medical conditions that have reached age 65 should consider Plan F (HD). Companies that offer this type of plan in the Keystone State include Cigna, Americo, Medico, Mutual Of Omaha, Continental Life, Independence Blue Cross, Humana, Highmark, and New Era Life. Female monthly rates are shown below for the largest counties in the state:
$49 – Americo
$50 – New Era Life
$50 – Cigna
Allegheny and Westmoreland Counties
$41 – New Era Life
$45 – Cigna
$45 – Americo
Bucks And Montgomery Counties
$44 – Americo
$50 – New Era Life
$50 – Cigna
Lancaster, Berks, Lehigh, Luzerne, Dauphin, Erie, Cumberland, Lackawanna, Northampton, and York Counties
$34 – New Era Life
$40 – Americo
$41 – Cigna
$41 – New Era Life
$49 – Americo
$50 – Cigna
Another option that will substantially reduce premiums is a “catastrophic only” policy. Coverage is limited to major medical items, but rates are generally hundreds of dollars less (per month) than a conventional comprehensive policy. Preventive benefits are still covered at 100% on this type of policy. Although prescription coverage is limited, the savings in premium usually offsets the lack of benefits. NOTE: Unless you are under age 30, you can not apply for this policy on the Marketplace.
Ideally, the perfect candidate is a young person (or couple) that is just starting a business. Bronze-tier plans should also be considered. Shown below are the “catastrophic” plans offered in Pennsylvania. Availability is determined by your county of residence.
UPMC Advantage $7,900/$0 (Partner, Premium, and Select Networks)
Highmark BS my Direct Blue Major Events EPO 7900
Geisinger Health Plan Marketplace Value
Independence Blue Cross Personal Choice
US Small Business Administration
The SBA offers many programs and has two Pa district offices. Their locations are in King Of Prussia (Parkview Tower 1150 First Avenue) and Pittsburgh (411 Seventh Avenue). Services provided include financial assistance through guaranteed loans for established and new companies, loans for veterans, free counseling and advice, loan programs for international trade companies, free services through Small Business Development Centers (SBDC) and help to companies that are owned by economically and socially disadvantaged persons. Self-employed healthcare information can also be found through several government websites that are provided to consumers.
Pennsylvania Small Business Development Centers (SBDC)
SBDC is an accredited organization that offers training, consulting, and many other resources for new and estatblished companies. They partner with the US Small Business administration and have 18 centers in Pennsylvania. University locations include Penn State, Pitt, Temple, Lock Haven, Clarion, Lehigh, Bucknell, Duquesne, and several others.
Pre-business and planning seminars are provided along with marketing and promotion, accounting, strategic planning, and human resources help for established businesses. Environmental management assistance is also provided, if applicable. Not-for-profit businesses are not eligible for assistance from SBDC. Managaement and training is provided at no cost. Expenses are paid by the SBA, and several government agencies.
If your priority is to pay as little as possible, but still protect you and your family against a serious accident or chronic illness, this is a good choice. Of the new Metal policies that will be offered on the State Exchange, the Bronze option would be the closest fit to a catastrophic policy. You may be able to purchase coverage separately from the Marketplace although you would not be eligible for a federal subsidy. However, if you are a high-income earner, you would not be losing any savings.
We work with self-employed business owners and small and large companies every day and we’ll find high quality health care at the lowest available rate offered by each carrier. To compare the best choices, please provide your zip code at the top of the page. You can also call or email us.