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Anxiety Antidotes

For self-employed business owners, health coverage is an ongoing battle between finding affordable medical insurance and being able to cover enough operating costs to keep their company viable.

Michele Chiappetta
June 28, 2019

The No. 1 reason most people cite when they tell me why they’re not in business for themselves is health care. Navigating medical care without breaking the bank deters a lot of people from walking away from a full-time job. And it’s not hard to see why, especially if you have attempted to wade through these complicated waters without drowning.

To me, health insurance and medical care have come to feel like the stock market, which is to say, it’s like taking a trip to Vegas to bet all my money, without the upside of cocktails and buffets to enjoy. It’s maddening to know I can make the smartest choice I can in health coverage that’s also affordable, and yet I can still get hit brutally in the wallet at the end of the year.

I’m not alone. Other self-employed pals struggle with figuring out how to handle their health care too. And it’s not cheap. “My biggest bill, aside from rent and car, is health care,” says Gina Conroy, a single mom, teacher, and writer. She and I are in the same boat — trying to make ends meet without spending everything we have on health insurance.

Interestingly, a lot of doctors don’t like the current minefield of health insurance either. “Physicians are getting frustrated with the current health care model,” says Scott Street, D.O., who provides direct primary care at Remedy Health in south Tulsa. “The model is what’s failing us; it’s not the providers. We want to provide good care for people and take care of them.”

Owners of very small businesses — those with fewer than 50 employees — are not required by the Affordable Care Act to provide health coverage to their employees. But that doesn’t mean those employers don’t feel a sense of obligation to their employees or struggle with the decision to forgo a company plan.

Especially since the ACA also mandates that each person have health insurance or face penalties. The individual mandate affects the business owners themselves, who must purchase insurance plans for themselves and their families.

In September 2016, the National Federation of Independent Business (NFIB) released a survey given to small-business owners, asking them to rank 75 issues according to how much it affected their business. The study showed 52 percent of small-business owners named the cost of health insurance to be a critical problem.

The NFIB’s Small Business Problems & Priorities report also showed the cost of health insurance was the No. 1 issue facing small businesses, topping the list since 1986, and causing more concern than government regulations and federal taxes.

If you’re in business for yourself, there are tons of numbers to add up and coverage options to evaluate. All of them take money out of your pocket. Picking a good option can feel like a crap shoot. But you have to start somewhere, and that’s what this particular article is all about. Here’s a quick overview of the options you have in Green Country, their advantages and pitfalls.

Spouse’s insurance
If you’re married and your spouse’s company will cover you at a reasonable cost, consider yourself fortunate. Getting coverage through a spouse is an excellent option if the math is right. But do your homework first. Some companies only cover employees, not their families. Others (like my husband’s company) charge the full premium rather than a subsidized one to family members, which may make other coverage options cheaper (though not necessarily better). And many companies don’t offer coverage for partners who aren’t married.

Health insurance marketplace
Whatever you think about the Affordable Care Act, you’re probably dealing with its repercussions. The marketplace subsidies are based on your estimated income for the upcoming year. The more money you make, the less assistance you qualify for. Take too high of a subsidy based on your future income, and you’ll owe a ton back to the IRS at tax time.

The problem is, it’s not easy to get health insurance without going through the marketplace. If you want traditional health insurance, expect to do the marketplace paperwork, even if you don’t want to take the subsidy. If you’re married, expect to get categorized based on combined income rather than your stream of income.

Oklahoma’s version of Medicaid, SoonerCare provides health care services for low-income children and pregnant women, people with disabilities, and the elderly. You have to make under $13,000 per year to qualify, which means you’re living beneath the poverty line. Make more than that, and you won’t get SoonerCare. But that doesn’t mean you’ll benefit from a subsidy through the marketplace. Many people fall into a gray area where they can’t get SoonerCare but can’t afford marketplace premiums.

Health care sharing programs
One option, if you meet the qualifications, is to participate in health care sharing, available through groups like Liberty Health Share and Medi-Share. These faith-based programs have lower monthly fees than traditional insurance premiums. You can see any doctor you want, pay out of pocket, then submit the bill to the group for reimbursement.

It’s affordable, but it has its challenges. The religious nature of these programs means that you won’t qualify if you aren’t willing to meet specific requirements. They’re not going to pay for abortions or overdoses. They may refuse to cover birth control pills. They may issue you restrictions if you exceed a certain weight or have issues like high cholesterol. And while you’ll pay your bills in full upfront, you may not get reimbursed fast, which could cause problems with your cash flow.

Direct primary care physicians
This model is popping up all around Green Country, and it works like this: You pay a monthly fee directly to the doctor for regular, guaranteed access. Prices are transparent, costs are kept affordable, and you don’t make insurance claims. Patients get more time with the physician, and physicians help patients without the stress of jumping through insurance hoops. For simple, everyday care, this model makes a lot of sense.

“Our concept is that basic primary care should be affordable and accessible,” says Street, whose office, Remedy Health, works with all ages, pediatric to geriatric, and all income levels, working poor to CEOs. He handles the full range of medical needs that you’d see a primary care physician for.

At Remedy Health, patients pay a monthly membership — $65 per month for adults, $25 for children (if a parent is also a member), with a cap so large families aren’t priced out of participating. There’s no cost to see the doctor, and members get unlimited office visits. You’ll still have to pay for specialist visits, and you probably need a catastrophic care plan to cover issues like cancer and heart attacks.