As a licensed health insurance agent in all 50 states, I work with self-employed people every day. Whether I’m working with someone who’s new to the world of self-employment or a seasoned pro, I tend to need to reassure them that a little education can go a long way. When it comes to buying your own health insurance, a good understanding of the basics can be the difference between coverage that does what you want, and coverage that leaves you hanging out to dry.
If you’re in relatively good health, the individual and family plan market (typically called “IFP”) can be a very good option for you. If your health is an issue, it can be much more difficult to find affordable health care, but not impossible.
There are a lot of organizations out there, including mine, that can help you. But, before you start to shop there, you need to know some of the basics:
1. Explore COBRA and alternatives to COBRA: If you’ve become self-employed after leaving a full-time position, you were likely offered COBRA continuation coverage. And, if your health is an issue, COBRA may be your best short-term option.
If COBRA’s price tag was a shocker for you, you should know that the government is currently offering a nine-month subsidy that covers 65% of the cost of COBRA for those who qualify. A good primer on COBRA, the subsidy, and your alternatives to COBRA is available www.COBRALearning.com.
COBRA typically provides very comprehensive benefits to satisfy a broad audience, but they may be benefits you don’t need. A relatively healthy person may be able to find less-expensive coverage, even after the 65% subsidy.
2. It is possible to get health insurance with some pre-existing conditions: Don’t assume your health will disqualify you. If you live in New York, New Jersey, Massachusetts, Maine or Vermont, you don’t need to worry about any pre-existing conditions. In other states your health insurance will be medically underwritten and could make you ineligible.
What I stress with people is don’t assume you won’t qualify. Some pre-existing conditions can, and are, insured every day. A good agent can direct you to carriers that are more likely to provide coverage to you even if you have a moderate pre-existing condition, like a back problem or asthma.
Many insurance companies allow you to apply for coverage for free, without obligation. If you take the time to investigate your options you might be surprised by what you qualify for.
3. If you don’t qualify, don’t give up: If you can’t qualify for an individual policy there are other places you can go, and other programs you can access for care. A great place to start is the Foundation for Health Coverage Education (FHCE), whose web site is located online at Each year the FHCE outlines public and private health care choices available in every state and makes them available to the public.
4. Be careful about what you buy and where you buy it: When you’re shopping for your own health insurance, you want to be sure you’re buying a major medical plan from a reputable insurance company.
If you start with an online broker, like eHealthInsurance.com, be sure they have a call center staffed with licensed agents in your state. It’s okay to apply for coverage through an online agent, but when you need to talk to a live person, nothing can replace… a live person.
It’s also a good idea to protect your contact information until you see a quote for a plan you might actually want to buy. Many websites that claim to offer health insurance will take your email address and/or phone number and sell it to an offline broker, who will follow-up with you via solicitation phone calls and emails.
5. Take 5 minutes to learn the basics: In the individual health insurance market you have the option to pick and pay for only those benefits you want. So, for example, you can buy a policy that does not cover maternity benefits or prescription drugs.
That’s great news if you’re a single man who is already signed up for a $4 Wal-Mart prescription drug plan. But, if you’re a woman taking a prescription that’s not yet available in generic form, you need to keep shopping. And, you need to look for the benefits you want.
You also need to know some basic terms like premiums, deductibles, co-insurance, out-of-pocket maximum and lifetime maximum. A great online resource that can help you navigate the process is available online at www.ehealthinsurance.com/guide.
Amir Mostafaie is the resident consumer health insurance expert at eHealthInsurance. In his current role as Manager of Training & Quality Monitoring, he leads the development & implementation of eHealth’s Customer Care Center training programs. Amir is licensed in all 50 States & District of Columbia & over the past 9 years has helped 1000s of people find health coverage that fits their needs. His background in medical field and expertise in the health insurance marketplace makes him especially qualified to provide assistance and insight on a broad range of health insurance topics.