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I am especially curious what freelancers in the NYC area are doing.
Thanks!
My first suggestion: Keep the health insurance through your wife if you can and if she is still working. It is hard to beat the plans sponsored by employers as they get subsidized group rates to offer to employees.
But if you absolutely need to buy your own, you have 2 options:
Option 1: Use Obamacare [0] and see your options. You can try healthsherpa.com [1] which is a unofficial wrapper on top of obamacare and you can compare the various plans.
Option 2: You go and buy health insurance directly from an insurance company without the extra layer of obamacare in between. You can use sites like ehealthinsurance [2] to get some quotes.
Option 3: Use an insurance broker. Find someone locally in your area. Sometimes brokers can get you good deals.
All options have benefits and problems. I personally hated obamacare as it was too much bureaucratic crap to deal with and now you have 2 layers to work with. The only advantage of obamacare is that if you are considered poor by obamacare standards, you can get subsidy on your premiums if you enroll through obamacare. But if you don't care about these things or are not applicable to you, then just go buy insurance directly and not even bother about obamacare.
Monthly Costs depend on a few factors:
In-network vs Out-Network: Very important factor. You can only go to certain doctors/hospitals etc that are "in-network". Some plans only allow in-network. Some plans have both but have higher premiums. Also, out of network coverage is very limited usually.
Co-Payment: This is the amount (usually $10-$30) that you will pay for every visit to a doctor. Some plans have no co-payment while most have the range as I mentioned.
Deductible: This is the amount that you will pay first for any medical expenses before your insurance company pays anything. So if you go for a plan with "high deductible", then your premiums may be lower and so on.. I will say that for a family specially with kids, I personally prefer zero deductible as it can save you more over a year since kids visit doctors frequently. But if you think you won't visit the doctors as much in a year, then go for high deductible. Again, just a choice and no right answer here.
Co-Insurance: This is the portion that you will pay after your insurance company has paid the remaining portion. For example, if your co-insurance is 30%, then the insurance company will pay the 70% for the medical expenses and you take care of the rest. Again, to get here, you will have met your deductible first.
Out of Pocket limit: This is the total amount you may pay for an entire year. Anything over this, the insurance company pays regardless. For example, lets say your deductible was $500, co-insurance 30% and out of pocket limit is $5000 for the family and you end up with a bill of 14,000 on your very first visit during a calendar year. In that case, you will pay upto the total of $5000 (including deductible+co-insurance) and insurance company will pay the remaining balance of $9000. After that, you will not pay anything for that whole year (except copays). Plans with higher out of pocket limit may have lower premiums by logic.
PCP (Primary Care Physician) required: THis may not affect cost but important factor to know. Some plans require you to choose a PCP and only use that PCP as your well, PCP. You have to let the comnpany know if you change PCP.
Specialist Referral required: Some plans require you to get referral from your PCP before you can visit a Specialist. This is critical as you cannot go to a specialist on your own in that case.
Hope this helps. Happy to give you more inputs if you need.
[0] https://www.healthcare.gov
ACA has basically made this a non-issue. Figure out how big of a deductible you can absorb, walk through your state's exchange and find something reasonable. Then (this is the most important part), raise your rate to compensate for your newly legitimate business expense.
Did this 3 years ago when I broke out on my own. I'm in Boston. MA has a decent portal through their MA Health Connector site. For my family (Wife, son and myself) I pay $760 on a high deductible plan for health and $99 for dental for my wife and me. Once my son needs dental it'll most likely go up by about $40 for the dental. My only advice is to really sit down and determine what you're going to need for coverage a…