What You Should Know About Self Employed Health Insurance
Reader question:
I’m about to start my own business. What do I need to know about health insurance?
Abigail
Great question.
Having self employed health insurance is more important than even having health insurance while you are employed by a company. Consider the fact that all of your health insurance is funded by yourself, and if you don’t have it, should something happen to you that puts you in the hospital for a few days, you’ll be out of work. And if you’re self employed, you don’t get paid for things like sick days and vacation time, so not only will you have a huge hospital bill, but you will also be out several days of work with no recompense.
Getting health insurance if you are self employed is financially responsible even if nothing happens to you medically while you have it. The self employed are allowed to claim their health insurance costs on their tax returns as a business expense. For self employed people looking for a good health insurance plan, there are health savings account, which are tailored specifically for the self employed.
If you intend to be self employed, you need to find out what you will do about health insurance before leaving the job you’re at now. Looking for health insurance if you happen to have a pre existing condition, or your family does, can be difficult, and you might have to end up getting insured through your state’s high risk pool, which can be costly.
You might want to save costs and guard your personal information by not employing a health insurance broker. This is understandable, but if you choose to go this route, you will need to put much more effort and research into your search. You will need to understand the different terms and policy speak that come along with health insurance plans so that you can be sure that the plan will cover you and your family. Or you could choose to go with a broker. They cost, but they also know more about you, although they tend to be pushy.
As mentioned before, a good plan for the self employed is a health savings account. These are trusts with a bank or credit union which are tax exempt and are paid into by you, in the form of cash. In order to work, they have to come side by side with a health insurance plan with a high deductible. It gives you greater coverage than your average plan.
Cheers,
Fashun Guadarrama.
I can’t pay for an individual medical health insurance plan!
Reader question:
I can’t pay for an individual medical health insurance plan! What do I do?
Greg
I’ll help you.
There are a lot of reasons that somebody might not be able to afford individual medical health insurance coverage. Sometimes, if you are a student in college, you might have recently been dropped from your parents’ health insurance plan and, busy with school and having only a part time job, might find it difficult to pay for your own. If you find yourself in this situation you should see what kind of deals your college has to offer when it comes to health insurance.
Even if you aren’t a student, there is something there to help you. A lot of federal programs exist that can either provide someone with medical health insurance or help them to get it, so long as you are eligible.
- Medicaid. This is for people who have a low income and are pregnant, or for their children. It does not cover the adult, though, unless they are pregnant, so if you have children but are also looking for health insurance for yourself, this won’t provide all that you need.
- Medicare. This is most often used for people who are sixty five and up and people who have disabilities that make it difficult for them to get work and provide for their own medical health insurance. It also provides for people who are in the later stages of renal disease.
- Children’s Health Insurance Program. This covers the gap between Medicaid and actually being able to afford health insurance on your own. You have to make a very low income to qualify for Medicaid, and if you make more than the eligibility mark but still can’t handle the high medical health insurance costs, CHIP can help. Again, though, it only provides for children.
A lot of states have their own plans that help children with parents who can’t afford medical health insurance get insured. This doesn’t help the parent, but there are some states that do extend this coverage to insure the parent of said children as well, although not very many states do this.
Cheers,
Fashun Guadarrama.
What affects the appeals process for a health insurance claim denial?
Reader question:
I need to file a health insurance claim appeal because my claim was denied, and I would like to know what are the factors that affect the process of the appeal?
Lauren
Great question.
If a health insurance company wants to be accredited with the National Committee for Quality Assurance, then they have to provide the right to get an external appeal reviewed by a board of medical professionals in their health plans. It’s possible for this right not to be included in a medical health insurance plan, but the idea there is that it only isn’t when the employer pays for all of the health insurance costs. There are, in addition, a few laws from the federal and state governments that affect the health insurance claim appeal process.
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Federal government laws
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The President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry has created a process by which the appeals must go. If the medical health insurance plan is a federal one, then it has to go by the regulations instituted by the Commission.
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In the same vein are medical health insurance plans that contract with Medicare. If a medical health insurance plan does this, then it comes in the contract that they have to go by the laws of the Commission as well if they want to continue working with Medicare.
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State Laws
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There are laws that regulate who can be on the board that is reviewing the appeal of your health insurance claim. It is required that they at least be a medical health professional, and in many states they have to have a medical license in order to be on the board.
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Most states also have laws instated that say that your own doctor can go through the appeal process for you if they believe it is right to do so. This is why you usually want to get help from your doctor to go through the appeal process.
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Some health insurance plan will dole out awards or punishments based on whether or not a doctor recommends medical procedures or treatments that the plan does not want to pay for. Many states have laws that protect a doctor’s ability to do so and be protected.
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Many states even have groups of patients going through a health insurance claim appeal that can meet together, sponsored by the state, and help each other with the process.
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Cheers,
Fashun Guadarrama.