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When I first decided I was going to work from home and become self-employed, my Mom was mostly worried about health insurance coverage. I’ve never been a sickly person, but my Mom is a Type A worrier (love you, Mom!) and thinks “worst case scenario” about me all the time.
Surprisingly, she wasn’t worried I would “make it”, in terms of being able to pay the bills (which I guess means she believed in me! Yay!), but she did ask “what if you get into an accident and don’t have health insurance?”
My first reaction, as a Millennial, was #YOLO because I’m young and invincible, then I got off the couch and my knee cracked and I remembered “oh yeah, I’m 30. It’s all downhill from here.” (just kidding 30 and up readers!)
Now that I have a spouse, a house, and an adorable dog, I do have responsibilities and, unfortunately, medical debt is still a serious and terrible burden for many Americans. I couldn’t let my family lose our house and become destitute because I wouldn’t get insurance, so I started to look into healthcare options. I read about all my options and even found out that if your insurance company doesn’t cover all of your medical expenses, you can let gap cover take care of the rest and your medical expenses will be sorted. There were just so many options in the US.
And then I decided to move to Europe. Just kidding, my husband wouldn’t move with me. Here’s what I actually found, and what I decided to go with to keep insurance costs down while covering myself for most calamities.
Healthcare doesn’t have to be a big expense, but it can be expensive and, at the very least, having health insurance can give you peace of mind in case anything terrible happens. Unfortunately, your choices in the US are bad, worse, and the worst. Here are some options:
The Affordable Care Act
Even with the implementation of the Affordable Care Act (ACA, also called Obamacare), health care in many cases is still tremendously expensive. I know for a fact, because Arizona had one of the biggest premium increases in the country recently.
If your current employer offers health coverage, really research your insurance options as a freelancer/self-employed person. You don’t even have to sign up to get information on Healthcare.gov – simply type in your age, gender, annual income and other information, then you’ll be given a list of plans, costs, and deductibles, plus whether or not your current doctor accepts the plan. What I’ve learnt from this experience though is that trying to control rising health care costs is incredibly hard for most people, that’s why I’m beginning to understand why some business use claims data analysis to help them out when it comes to providing health care for people.
The ACA’s health care options for me were pitiful and laughable – $6,000 deductible with monthly payments of $350, and my primary care doctor didn’t accept any of the plans offered in my state, so that was pretty much off the table.
Just in case you’re not sure what a deductible is, basically this insurance plan expected me to cover my own expenses up to $6,000 before my health insurance kicked in. And I would pay an additional $350 for the “privilege” of health insurance. (insert frowning gif here)
Next – your spouse’s insurance, if you have a spouse and their employer offers coverage. In most cases, signing up for your spouse’s coverage only makes sense if you have a child or two. In our case, my husband doesn’t have an “employee + spouse” insurance option, only a “employee + family” option, which would have been $600 a month (up $500 from the roughly $100 he spends on his own health insurance).
While our deductible would have remained low, $1,500, I wasn’t really keen on paying $500 a month for insurance I rarely use. I know, I know, insurance is “just in case”, but I can’t “just in case” spend $6,000 a year. You probably can’t either.
Note: In many cases, you’ll qualify for your spouse’s insurance even if you’re not married. This is considered a “qualified domestic partner” and you can be any gender to receive this benefit.
Health Sharing Ministries
Finally, in desperation I turned to Facebook and found the FinCon group! The FinCon group is made up of a ton of personal finance gurus and lots of self-employed people, and they recommended health sharing ministries.
In many cases, health sharing ministries are religiously affiliated and require you agree to their religious-terms. No, this does not mean you have to go to church. In general, health sharing ministries require you to:
- Take care of yourself and don’t be reckless with your body (so no more drag racing on the streets, Fast and Furious fans)
- Don’t do drugs (so Walter and Jesse from Breaking Bad would be bad candidates)
- Don’t smoke (you shouldn’t smoke anyway, it’s expensive!!)
There are some less favorable things to health sharing ministries, like no access to mental health care and some stipulations on when you can use your benefits. Also in some cases, there is a lifetime cap, which can be scary if you get cancer or in a terrible car accident. If this is something that has happened to you, then it might be worthwhile to look at personal injury law to see if anything could be done about your car accident.
Health Sharing Wins
In the end, the health sharing ministry had the lowest deductibles and lowest monthly premiums. I even was able to get a plan with no lifetime cap, which, like I mentioned above, is incredibly important if something catastrophic happens to you and costs you (and your family) $1 million or more.
I ended up choosing Liberty Healthshare, which is religiously-affiliated, because of those reasons and because I was raised religious and am comfortable with their guidelines. Liberty isn’t your only choice though:
Christian Healthcare Ministries
Unfortunately, I haven’t found any non-religious health sharing organizations out there, but please leave a comment if you have!
What About Healthcare Abroad?
If you’ve read a now-old-but-still-relevant article I wrote over at Your PF Pro, I’m actually a pretty big fan of health care in other countries. In fact, when I travel to Europe (which is infrequent; I’m not fancy), I’m never worried about getting hit by a car or even getting ill, because I know I’ll be treated well and not charged a million dollars (probably. There are always exceptions).
However, unless you live near a border or for some reason frequently fly to medically-equal-to-the-US countries regularly, going abroad for health care is not realistic. Not many people can just head down to Mexico for dental work like I did (at the time, I only lived about 30 minutes from the border and I wasn’t working).
That said, if you decide to get work done abroad, you have to do your research. Here are some things to consider:
- Find a doctor that speaks English – many do, but some don’t. Find one you can communicate with
- Verify with ex-pats online or with people who’ve had work done abroad. There’s nothing like a personal recommendation from someone you know, but expatriate communities online are also very helpful at providing recommendations for good doctors and dentists
- Start small. Maybe don’t go for a big, time-consuming procedure – start with a wisdom tooth removal (if you can) to get a feel for health care abroad. It’s not for everyone.
Personally, I don’t have a lot of free time to spend a few hours traveling to Mexico, having work done, then waiting forever in the border line to cross back into the US, for most health procedures. I like my US doctor and haven’t needed expensive work done, but I certainly wouldn’t rule it out in the future.
That’s the weird patchwork of health care I found in the US – do you have any questions about health care I could answer? And if you’re self-employed, what are you doing for health care?