Ask HN: small startups, what do you use for health insurance?

#1

Post by javahava » Sat, Dec 10, 2011, 6:56 PM UTC

Do you use an HSA, or pay pricey premiums? I live in NYC, and (for me and my wife, who may try to start a family next year) am looking at plans of about $1.5-2K a month (assuming a child/children). As a couple only, it's about $1,300 a month. =/ What would you guys recommend in a situation like mine?

Re: Ask HN: small startups, what do you use for health insurance?

#2

Post by pie » Sat, Dec 10, 2011, 7:59 PM UTC

NYC provides a list of insurance options here:

http://nyc.gov/hilink

Some of the lowest-cost options are offered through Freelancers Union:

https://be.freelancersunion.org/benefits/

Re: Ask HN: small startups, what do you use for health insurance?

#3

Post by [deleted] » Sat, Dec 10, 2011, 8:00 PM UTC

[deleted]

Re: Ask HN: small startups, what do you use for health insurance?

#4

Post by phallstrom » Sat, Dec 10, 2011, 8:01 PM UTC

$2k/mo seems expensive even for comprehensive plans imho unless you have some conditions that bump it up. We're relatively healthy, two small boys, and opted for catastrophic/HSA option. Then we put the savings from the premiums into the HSA. I've found even with the routine visits for the kids and whatnot we still pay less than we would going with comprehensive. And worse comes to worse our total out of pocket is the same regardless. Point being, if you don't see the doc much, HSA makes sense. One nice thing is that our provider pays 100% of flu shots and routine health checkups which is all I use it for anyway.

That said... if you're starting a family... pregnancy (and RX) are usually (ever?) covered. So you might not have a choice.

As a small business, if it's just you and your wife (and your dependents) you can deduct the premiums though...

Re: Ask HN: small startups, what do you use for health insurance?

#5

Post by elangoc » Sat, Dec 10, 2011, 8:11 PM UTC

This is an important question, it's the kind of thing that needs to be on an FAQ somewhere. Here is the info that I've collected in the last couple of months (US-centric, sorry):

relevant YC posts/articles:

http://news.ycombinator.com/item?id=2247560

http://news.ycombinator.com/item?id=2851224

links from the comments, or elsewhere:

https://be.freelancersunion.org/benefits/ (you probably want to look this up, since they provide discounted health insurance plans for people in and around NYC)

http://www.nase.org/Membership/OptionalBenefits.aspx (smaller benefits, not full covereage, for people across the US)

http://www.anthem.com (For people in California - a sufficiently high deductible introduces risk but can drop your deductible to around $150-200 or less; mine is $108)

If you have a pre-existing condition, then you might find a plan through your state: http://www.healthcare.gov/law/features/choices/pre-existing-... (is this an outcome of Obama's Affordable Care Act?)

deciding whether/how to claim this on taxes (I haven't quite fully understood this, though):

http://www.irs.gov/newsroom/article/0,,id=220839,00.html

http://www.irs.gov/newsroom/article/0,,id=223666,00.html

http://www.usatoday.com/money/perfi/columnist/block/2011-04-...

advice via Reuters, FWIW: http://blogs.reuters.com/small-business/2010/12/06/health-in...

Re: Ask HN: small startups, what do you use for health insurance?

#6

Post by RudySF » Sat, Dec 10, 2011, 8:13 PM UTC

We're a small team of three (25, 28, 28) and the company pays for each person's individual plan with Anthem Blue Cross rather than a group plan which was more expensive for essentially the same coverage. It's about $200 per person per month.

Re: Ask HN: small startups, what do you use for health insurance?

#7

Post by javahava » Sat, Dec 10, 2011, 8:26 PM UTC

phallstrom wrote: post #4

$2k/mo seems expensive even for comprehensive plans imho unless you have some conditions that bump it up. We're relatively healthy, two small boys, and opted for catastrophic/HSA option. Then we put the savings from the premiums into the HSA. I've found even with the routine visits for the kids and whatnot we still pay less than we would going with comprehensive. And worse comes to worse our total out of pocket is th…

Thanks for the info - that's helpful.

> That said... if you're starting a family... pregnancy (and RX) are usually (ever?) covered. So you might not have a choice.

HSA's do seem to make sense, but the pregnancy and any potential complications were my main concern. It seemed from initial research that for this scenario, and regular plan seemed like the best option, unless you had a different experience? Perhaps use a typical plan initially, then switch to HSA's later assuming health is ok?

Re: Ask HN: small startups, what do you use for health insurance?

#8

Post by [deleted] » Sat, Dec 10, 2011, 8:36 PM UTC

[deleted]

Re: Ask HN: small startups, what do you use for health insurance?

#9

Post by TruffleLabs » Sat, Dec 10, 2011, 8:38 PM UTC

There is no cut dried answer in USA. Parameters to review: * what is your (you/wife/family history) current health? * what is your current list of medications and will they even be covered by an insurance plan you like? * how much risk do you want to carry (less premium, higher deductible) vs the insurance plan (higher premium, lower deductible )? * where you live. Certain regions will have higher premiums. * family vs single. * how close can you predict your health expenses into the future year?

Options to consider * alumni associations, affinity groups, clubs etc. may offer health plans * talk with an insurance broker. Yes, a real live person, as they will be knowledgeable about the current market and any issues with specific carriers and plans. They usually are free to talk with and obtain quotes from.

If you can do it, get a high deductible insurance plan with an HSA for the years in which you are not having a baby. HSA contributions get some tax deduction status and those unspent HSA dollars can be carried in to the future. My CPA says HSA contusions are a good way to save for long term future medical expenses.

For the plan year you get pregnant, aim to understand the total costs and can an HSA / high deductible plan fit your finances. Will you be comfortable taking on the out of pocket expenses (the high deductible part) and continue making contributions to the HSA?

Will/can your wife work for a company that can offer health insurance?

Getting a plan in place is something that will take 2 to 6 weeks to get ini place so don't wait too long.

Now for the bigger question: do you have disability insurance and life insurance also in place?

Fyi, COBRA will most likely be more expensive than any plan you can get at the family level.

Hope this helps:)

Re: Ask HN: small startups, what do you use for health insurance?

#10

Post by TruffleLabs » Sat, Dec 10, 2011, 8:43 PM UTC

One last item: you will have to shop each year. Was on Anthem for several years and then they raised their rates 30%, so shopped for a new plan. That worked well for two years and then that insurance company ran into financial trouble (in to receivership) so went back to Anthem at about the same price (ironic).