Health Insurance for Self-Employed People

Archived Q&A and Reviews

Self employed family health insurance

March 2013

Hello BPN Looking for suggestions on the best health insurance in the Bay Area to cover myself and family. I am self employed and currently have a separate health insurance to my currently preganant wife who has health insurance with maternity care. Our baby is due in May and I would like to move to a family plan once the baby is born. Any other self employed people with tips and advice? Any suggestions would be helpful Thank you Nick

We have been self-employed for almost 10 years. Currently, our Anthem BCBS plan (Lumenos with an HSA) charges $850 each month. We are healthy, in our 40's with two young children. The plan covers yearly well visits (yearly mammograms, paps, etc.), and vaccinations. Other than than, I believe the plan covers 70% of visits and the deductible of $2500 doesn't need to be met before the 70% kicks in. I don't know if it covers medicine, because it's been a couple of years since we've had a prescription. It doesn't cover vision or dental, but I have a contract job that is paying for that currently. I used a broker to get this plan, and the best advice he told me was to invest in an electric toothbrush and forego dental. Knock on wood, that is working so far! Good luck! anon

PPO suggestion for independent buyers

Jan 2009

We currently purchase Kaiser insurance as an independent family and are being charged about $900 for a family of three per month. This is very costly, as we work for ourselves and do not fall under any employers' health plans. I'd like to ask BPN members their suggestions for a good PPO plan, if there is such a thing, and pediatricians and gynocologists that would take PPO as I will probably switch out of Kaiser's plan after a month or two of research. K

Hi, I am also self-employed and have BCBS. I used a broker-Brian Fitzpatrick from Pleasanton years ago, but don't have his contact info any more. We were paying $350 two years ago for a family of four in California and since then have moved, but still have BCBS. We now pay $455, with a hsa, they pay the first $500 of expenses without us dipping into our deductible, which is $3000 for family (and even then they cover 80% before that is met). I'm even covered for maternity, which suprised me because both of my deliveries have run into the 6 figure range. What is not included are vaccinations, well visits, dental or vision. Instead, I go to Costco for eye visits, use a sonicare toothbrush twice a day, and if my kids need a shot we go to the health department. Good luck. I'm fed up with healthcare too. Jodi

We had to purchase our own insurance up until about a year ago. Kaiser was by an enormous margin the best value for the dollar that we found. Now that I am on my employer's plan, Blue Cross PPO, the premium is much higher than what I was paying for Kaiser(but my employer pays most of it), and the deductibles/ coinsurance/ out of pocket maximums are completely ridiculous. From your post I got the impression that you were looking for a less expensive plan. If I were you, I would stick with Kaiser but maybe increase your deductible or go with an HSA to lower your premium. Good luck. Hoping for reasonable health care someday . . .

I'll be interested to see what other BPN'ers have to say about this. I'm also self-employed and we pay about $1300 a month for health insurance for a family of four, through Blue Cross. Ouch! I investigated the possibility of a high deductible plan, which would only have cost us about $500. We would have had more out-of-pocket expenses, but those can be paid out of a health savings account (HSA) that you can set up and put money into pre-tax. All in all, they sound like a great deal, but when I applied for it for my healthy family of four, they rejected us because my younger daughter had recently had ringworm and (gasp) uses a prescription ointment for acne. Imagine, a teenager with acne! I'm going to keep trying to get one of these plans, but the experience left me wondering if the insurance companies are really granting them to anyone, or only offering them because they were mandated to by a federal bill a few years ago. It also left me more convinced than ever tha! t we have to get the insurance companies out of this business in order to get everyone covered in a fair and affordable way. In the meantime, I hope you find something, and I look forward to the other answers you receive. Single Payer Fan

We recently decided to get our own insurance and called Bett Martinez, a broker, in Berkeley. She helped us through the process of applying to Blue Shield for which we were all approved. You might ring her and tell her your needs and wants and see what she recommends...she was super helpful. Her number is 526-0312 deborah

About to be self-employed, planning a pregnancy

June 2007

My husband is a self-employed attorney and I am leaving my job at the end of June. I currently have Kaiser through my work and he is (gasp) uninsured and has been for some time. We want to try to have a baby ASAP, and so need to figure out what insurance solution will work best for our needs. To complicate things further, we are considering a midwife or possibly a home birth. I tend to go to the doctor frequently, and haven't always been happy with Kaiser (Oakland) and getting referrals, although I just switched doctors and my new one seems better. I also would like to use ''alternative'' treatments such as chiropractic, acupuncture, etc. Some possibilities we are considering include: staying with Kaiser for me and adding him in a limited capacity (obviously he doesn't go to the doctor much), or getting Blue Shield PPO for me, and something with less coverage for him. Another possibility would be a health savings account for him or both of us (Kaiser and Blue Shield now offer these), which sounds attractive tax wise. We also will be looking for life and disability insurance policies in the near future. We are EXTREMEMLY confused right now and would love some help. Also, we are wondering if this is something an insurance broker or insurance advisor might help us with, and if so, who? We live in Berkeley. I looked through the archives for recs, and unless I missed something, everything is a few years old. We know this is a very complex question, and would appreciate any help!!! confused in berkeley

In our quest for self-employed health insurance, we had a wonderful experience with East Bay health insurance broker Carla-Jean Barker, who has a Berkeley office and also visited our home. She was smart, knowledgeable, warm, and caring--and found us great deals! Her contact info is:
Carla-Jean Barker CJB Consulting, Inc. CA Ins# 0D28718 P: 800.608.7278 F: 510.291.3223 www.cjbconsulting.net
--Happy insurance clients

Best option for family with self-employed dad?

March 2007

We are a family of 5 with 3 kids under 7 including a newborn. My husband is eager to change jobs, and this could possibly land him in an independent contractor/self-employed situation.

But we are really concerned about what to do for healthcare; w currently have healthnet ppo with health savings account... His employer does pay quite a bit per month, I believe. I am a SAHM.

Is Kaiser the best option? What have you done for insurance/healthcare? We do not make a lot of money, and my husband is still a student as well (so he could get care from the university if he needs it). How do others keep their kids healthcare going without paying tons of money per month? chrunchymama

We've been self-employed for 10 years and have been with Kaiser the whole time,including having both our kids with them. We pay about $330/mo. for a high deductible plan (HSA-compatible plan which is new this year). I don't know if it's the best rate now,but it was when we signed on,and we've been happy with Kaiser. The premiums will tax deductible if you itemize. Goodl luck.

2004 - 2006 Recommendations

High deductable on self-insured plan; pregnancy is planned

June 2006

I need advice on a ''individual'' healthcare plan for when I get pregnant again. My husband is self employed and I am a stay at home mom, so right now we have a basic PPO plan through Healthnet, the monthly premium is reasonable, but the deductible is high. It is Ok for now as we are in good health and I am not yet pregnant. I am looking for a plan that just I can switch to before pregnancy, and there wont be any suprise expenses at the end.I'd like to here anyones advice on plans that they have had..It was a lot different when I had a plan through my job. There was no deductible and I knew what to expect when I paid my monthly fee out of my check..Thanks for reading! mimosagirl

We are self-employed, have BCBS PPO 2500 for a family of four (34, 36, 3, 1) and pay $350/month (they just raised the rates from $300) and it pays maternity (with $2500 deductible). This also pays for 70% of well visits and vaccinations, etc. I think it's very reasonable. If you are healthy with no pre-existing conditions I really think it's the way to go. We could have purchased Kaiser, but like the providers we have with our PPO. Jodi

I have been self-employed and am also now a SAM / WAHM myself on my own insurance plan. Since going freelance, I've been amazed to discover what affordable options are out there for the reasonably healthy self-employed--far better rates than COBRA for sure! Although the rates have climbed for us as for everyone. I am in the middle of switching to a new plan right now and would encourage you to go to www.ehealthinsurance.com where you can see ALL the rates and plans available to you as an individual, and also for yourself and family members to compare. The most affordable plans don't usually cover maternity, but there are several options that do--look for the baby icon and check the specs. I was VERY HAPPY to discover BlueShield's PPO Spectrum plans in particular. Check out the 2400 plan for individuals or the 4800 plan for your whole family--they are just high enough deductibles to qualify for the pre-tax health savings account (HSA) you can get as an individual through Wells Fargo ($3/month, but we're coming out WAY ahead). The main thing to look at is the max out-of-pocket amount you'd have to pay in a calendar year--that's higher than the deductible and will be your bottom line for a baby delivery year (or any major event year). In switching from my old individual HMO with Pacificare, I'll be saving $400 / month in premiums for myself and my 2 daughters, plus we'll be adding my husband to the plan for the same exact rate. We'll still pay the same $35 copayments for regular check-ups as with the current plan, but unexpected appointments will cost us more, the BlueShield contracted rate. Still, in a relatively uneventful year, we will be coming out way, way ahead from my previous HMO. And in a major event year (birth) we'll still be just under what we were already paying per year. With our monthly savings, we can start socking away a little per month into the pre-tax HSA account to use for doctor's appointments and prescriptions (this could also really help you save up for the birth expenses). Unlike most work flex-spending accounts, you don't have to use it or lose it within a year (you can build it up like an IRA). One final note: if you know you have a birth on the horizon, it may behoove you to get the individual plan for yourself, with your own lower deductible/max out-of-pocket for the year of the birth, and put the rest of your family on the separate plan (unlikely they will max out). Sorry this isn't better organized, but I hope it helps! Good luck! Shelly

Considering leaving my job; husband is self-employed

June 2006

I'm considering leaving my job and becoming a stay-at-home mom. But my husband is self-employed and we would have to pay for our own health coverage. We have two young kids and have no major health problems, though my son has some allergies and gets sick easily. We've used Kaiser in the past and prefer not to go that route. Does anyone have a PPO health plan they like that isn't too expensive? Any suggestions/recommendations/tips would be appreciated! Soon to be SAHM

When seeking health insurance I recommend working with a broker. They have much to offer in terms of knowing what is out there, knowing what is a good match for you, and knowing how to get your application in order so you will be accepted. They will also act as your advocate if you have questions you are trying to resolve. I think Bett Martinez is very good. She has a small operation, and she specializes in quirky sitations such as obtaining plans for small groups, non-profits and for people who may have a complicated medical history. She can be reached at 510-526-0312 Ilana T

We have individual PPO plans through Blue Shield of California, and we have had no problems with them at all anon

Health insurance is an expensive proposition. I think about it this way: You buy homeowners or renters insurance for much less money than most people pay for medical insurance, but you don't expect the homeowners insurance to cover replacing lightbulbs. You have that coverage for catastrophic needs like a fire or robbery. If you are the average healthy family, you do not utilize 5-10 thousand dollars per year of medical care, so why would you want to pay premiums of that much, just to avoid paying for the occasional doctor's visit?

My recommendation is that you look for a PPO plan which allows you freedom of choice of your providers and hospitals (although your copay may change for out of plan providers)and has a high family annual deductable. A healthy family is hard pressed to spend even the highest deductible of $4500 per year on medical care, and your premiums can be low because you are not asking the plan to 'pay for your lightbulbs'. However, in the circumstance that there is surgery required or some other serious illness, you have coverage for this catastrophic event.

Some of these plans also allow you to save money in a tax deferred account called a medical savings account. It earns interest tax deferred, and can be used to pay medical bills. With many of these plans, if your saved money is not used for medical bills by the time you reach retirement age, it can be used for retirement also.

A good plan which has both of these options is the Blue Shield MSA plan. I purchased mine through a broker called Jim Fleming. You by no means need to contact him, but he is constantly reviewing insurance plans, and has the most up to date information, so he does the shopping around for you. His phone # is 925 891-3000

I highly recommend putting the majority of what you would pay for premiums for a low co-pay plan into an MSA. Why pay premiums for what you hopefully will never use anyway? Good Luck Elizabeth L

Buying a small business, will now be self-employed

August 2005

I'm in the process of leaving my ''normal'' job and buying a small business, meaning that I will be self employed. The one thing that really scares me is how to deal with insurance, since the insurance through my current job is the only insurance my family has. Does anyone have advice about how to deal with insurance when self employed? It seems to be unbelievably expensive. Many thanks. going solo

I highly recommend Diane Sickman, a local Oakland woman I have know for years. She is a former teacher and spends as much time with potential clients educating them, as needed. She is smart, honest, and makes insurance very easy to understand. She prides her self in being helpful, and kind, whether she makes a sale or not. She works for Allstate Financial and her office is in San Rafael. I know her history of helping folks out with getting the issues and options clear, and then if they want, helping them choose any kind of insurance, although health insurance is her current specialty. I know you will enjoy her and encourage you to call her. And she has a live person answer the phone, not a voice mail run-around! Diane Sickman, Personal Financial Representative, Allstate, 532 4th Street, San Rafael, CA 94901 415-453-4300 Louise G

We are also self employed and have Blue Cross Blue Shield PPO with a $2500 deductible (per person). This is for a family of four (ages 33, 35, 2 and baby). Our monthly cost is $303 and as you may already know, part of it is tax deductible when you working for yourself.

We chose a high deductible because we rarely see a doctor besides a yearly physical and they still pay around 80% of our well visits for our baby, preventative care screenings, etc. We also received a preferred rate for being in excellent health and no prior health issues.

We went through a broker named Brian Fitzpatrick and his number is 800-486-9189. Good luck. Jodi

My husband is self-employed and I took a year off from work after our child was born. During this time we paid for Individual Plans from Kaiser... One thing to keep in mind is that it was less expensive to have separate plans for each of our family members (2 adults and one child), than to have a Family Plan.

But it was still ridiculously expensive. Around $600/month, I think. Been there...

Health Insurance companies consider two a group. So if you have an employee you may qualify for a group plan rather than an individual one. Other ideas are- there are a few associations out there that still have plans available- my association provides a group health plan for our attorney members. One other avenue to check out is alumni associations- sometimes they have special buying power. My organization uses a Insurance Broker- Myers-Stevens. You might give them a call as well as they can walk you through this process and tell you what's available to you 1-800-862-4243. Good luck! Juliette

Congrats to you on going solo!

I just recently made the jump as well, and like you, feared securing (or not) personal health insurance for my family. We were able to secure a family health insurance plan at what I feel is a great price: well under $500/mo for 2 parents and 2 kids).

It seems that the trade off that we had to consider was: how much did we want to pay per month and then how much risk did we want to assume throughout the year. Since we've all been healthy, we took a low monthly payment with a moderate deductible and low out of pocket maximum--or in other words we plan to be healthy or just a little bit sick. If something catastrophic occurs, our out of pocket risk is relatively low. We didn't get prescription coverage. You can also apply for a health savings account with our plan and put away money for health care at a pre-tax rate. Nice.

We ended up going through an insurance broker in SF. Although we worked with someone who seemed relatively green, she did her homework and had the guidance of the owner of the firm and we were collectively successful getting a great plan. They are Shargel & Co. www.shargel.com. (they have info on their web site for small business plans as well)

I will say that the process of applying is fairly brutal. These companies want a tremendous amount of detail on any health issues you've had going back 20 years. I found that part infuriating, but we made it through and got approved at a good rate (based on our family's overall health rating and age). I've applied in the past and not been successful. There are also more expensive programs available if for some reason the insurance company won't accept you for an ''underwritten'' policy.

I'd say: start working immediately on finding personal health insurance. It takes 6-ish weeks start to finish. You might be able to get your coverage and avoid having to pay for Cobra, which for us would have been obscenely expensive.

Good luck! --happy to be insured

I was self-employed for years and during that time we had Blue Cross (HMO--CaliforniaCare) insurance for my family of four. It did get more and more expensive as time went on, but that reflects what's happening for everyone, even if your employer pays part or all of that cost. By the time I took a ''real'' job almost 3 years ago, I think it was costing us about $400 a month. That's just medical. We didn't have dental or vision insurance. I'm sure it's gotten higher. During the time I was self-employed, my frustration was that I was never able to find any other choices. Blue Cross and Kaiser seemed to be it. I heard about other possibilities, through alumni associations, for instance, but never found anything we were eligible for.

Maybe someone else on the BPN will know of some other options. The good news is, the Blue Cross insurance was accepted by everyone, the coverage seemed to be just what we were used to (and just what I now have as an employee) and you can cancel at any time if you find something else. Good luck with it! Been There

Health Insurance for self-employed musicians

March 2004

My husband and I are both self-employed musicians, in need of comprehensive health insurance (preferably PPO) for our family. Any suggestions of where on earth to look? Are there any groups we could be a part of for better rates? Evie

Check out www.ehealthinsurance.com
Used to insure myself

Another source for insurance to cover self-employed musicians is www.fracturedatlas.org, which starts at $75 per month. anon

Self-employed with diabetes - trouble finding a plan

May 2004

We both had individual policies for many, many years (20+) through Blue Cross of California, before leaving the state in 2000, so I could attend graduate school. We had no trouble getting coverage in Oregon, and both have individual policies through Regents Blue Cross of Oregon. Now that school is done, and we are ready to come home, my partner and I find ourselves categorized ''uninsurable.'' He is a self-employed children's book illustrator. The catch is that he is a Type I diabetic -- otherwise in excellent health --, but using an insulin pump. I take antidepressants for mild bipolar disorder, and therefore also have a pre-existing condition. (Who doesn't?) Is there anyone out there who has some advice, has ''been there,'' and can allay some of our fears. We've been steered towards a MRMIP plan, but need more information. E & K

I have diabetes and am self-employed also, and it's very difficult in California to get health insurance! I was able to become a member of Media Alliance (in SF) when they let anyone join, and have been covered by their group plan, which includes many choices of insurers, BC,BS, Kaiser, HelathNet.. I think you now have to actually show that you do work in ''media'', but this may be possible for your husband, and then you can be covered as his partner. Good luck - Lucia

2003 & Earlier

Group Plans for self-employed?

Aug 2003

Any suggestions for ways that a self-employed person can get a group insurance plan? I've heard that some coops might offer this option to non-worker members, but can't find one that does. I have an individual plan now but am seeking options. I checked the website and didn't find this information. Jane

Try PacAdvantage. You should be able to find it on the internet. It's what's formerly known as the HIPC - Health Insurance plan of California. Its for small employers (2 is the minimum I beleive), but allows you to take adantage of group rates and benefit plan designs. Good luck sharon

I have a small business and we get our health insurance through something called California Choice. I believe the website is www.calchoice.com. It groups all the small businesses and individuals together into larger groups to get better rates. Amongst our employees, some are on HealthNet, some on MaxiCare, some PPO, some HMO. It's worked really well for us. Our broker is a fellow named Joe Danes with ISU Insurance Services based in San Francisco. His assistant is Jeannie Grollman and the number is 415-625-5177. cc

Some professional organizations sell group insurance. I know IEEE does, and it's a pretty good deal for what you get. Worth checking into, anyhow.

When I was looking, I found a group plan through UC Alumni. Anyone could join the Alumni association, even if you never attended school there. The plan wasn't bad, but we ended up going with one through a professional organization. If you are a member of such an organization you could check with them. Brian

Cobra running out soon - need health insurance

October 2001

My health (HealthNet HMO) and dental (Delta Dental) is running out December 1 (COBRA) and I need new insurances. I am self employed and need it only for myself. HealthNet offers individual coverage, similar to the one I'm having now, which costs $225,- per month. There is also a plan for $70 less but with a higher copay and a yearly hospital deductable of $2000,-. I have been to the hospital 3 times during my life which was for three labors/deliveries, and since I'm done with having children, I am considering that option, too. Which other health plans are similar to HealthNet/ have the same doctors on their list of providers? Are there any plans which I should stay away from? The other/bigger question is about dental insurance since Delta doesn't have individual plans (as far as I could tell from their webpage). I love my dentists (Dr. Ota/Dr. Honda) and would like to continue with them. I am looking for a dental plan (HMO preferably), which covers most of the dentists here in the area (like Delta does). What would be a reasonable dental plan which offers this? Any recommendations are highly appreciated! Thanks a lot! Susanne

I looked into this for our entire family about 3 years ago. The best deal I could find for health insurance (HMO, same doctors as before in Alta Bates Medical Group) was through Blue Shield. I couldn't find a dental plan like Delta Dental, though. My dentist's office recommended that we self-insure (i.e., just pay as private patients) and it has worked out so far. All of the dental plans I looked at only had partial coverage. Some health insurance plans also offer something like a dental PPO which is very inexpensive but the dentist choices are limited; ours still didn't seem worth it for us. Fran

Delta does offer a dental HMO through its affiliate PMI. It's called DeltaCare for families and individuals. You'll see a giant link on their home page at www.deltadentalca.org which will take you to their online enrollment form. Granted, this is not the Delta Dental you're probably used to. Using an HMO means you must select from one of the dentists on the HMO panel (you'll see a list online), you'll probably be paying some copayments since it is a self-funded program (your employer isn't subsidizing it) and you may not always be able to get an appointment exactly when you want to. But I think these limitations are common to all dental HMOs and not Delta's in particular. If you truly want a plan that allows you to select most dentists, you're going to have to select something other than an HMO -- probably a PPO. It will be significantly more expensive, and more difficult to find individual/family coverage. Cristin

I was in the same position you are last spring. After doing some research, I decided on a Blue Shield PPO -- I pay under $200/month, high copays and some hospital deductible. However, given that I rarely go to the doctor or the hospital, I think it's a better bet than a higher monthly premium. After all, it's just trying to make an educated guess as to what will be more economical, given your situation. As for dental, all the HMO's I looked at only had very limited panels of dentists. Delta seemed like the only good plan around, and it was a higher monthly cost than I wanted to pay. My dentist, whom I adore, suggested that I not have dental insurance but assume that what I would pay out of pocket would not excede what I'd pay for insurance. I also had any optional work done the last month before the insurance expired. LIANA