The freelancer's guide to health insurance

A step-by-step guide to choosing the right plan for you

A health plan is a year-long commitment with serious implications for your ability to access and afford health care, so you need information and options you can trust.

Here at Freelancers Union, we can help you navigate the insurance market to get the coverage you need at a price you can afford. As an advocate for our members, our mission is to protect and improve the lives of independent workers. Part of that means helping you navigate the insurance industry, as well as connecting you to quality coverage at the best possible price.

When it comes to insurance, we’re experts. We have more than 20 years of experience connecting freelancers to the right insurance plans. When you purchase through us, you help sustain Freelancers Union’s advocacy, support, and community programs — at no cost to you! You can also rest assured that we’re here for you if you ever have questions about your health plan.

Here are some things to take into consideration before you commit to a plan for 2021.

1. Understand your options

Check your eligibility for free or heavily subsidized plans before shopping on exchanges. There are several government programs that may offer free or extremely low-cost coverage. These include:

  • Veterans Health Administration (VA): If you or your spouse is a veteran, you may be eligible for free VA health care.
  • Medicare: If you are 65 or older, have end stage renal disease, or qualify for social security disability payments, you are eligible for Medicare.
  • Medicaid: If your modified adjusted gross income is below 100 or 138 percent of the Federal Poverty Level (depending on your state of residence) for your size of household, you are eligible for Medicaid and ineligible for ACA subsidies.
  • Children’s Health Insurance Program (CHIP): If you do not qualify for Medicaid, your child may still be eligible for the low-cost CHIP program. Prices and eligibility vary by state.
  • Premium Tax Credits (ACA Subsidies): Before you shop for plans on exchanges, find out if your income qualifies you for subsidies in the form of premium tax credits.

2. Make a list of things that are vital to your healthcare plan

Be sure to consider your medical and financial needs. For example, if you are relatively young and healthy, you might want to select a high-deductible or catastrophic plan. If you have a chronic medical condition, a plan with a more expensive premium but lower out-of-pocket costs might work better for you. Different

3. Review the costs associated with health insurance plans

There are several different types of cost associated with insurance plans:

  • Premium: This is the monthly fee you pay to have insurance coverage.
  • Copay: A fixed dollar amount that you pay out of pocket for a medical expense until you have reached your out-of-pocket maximum. Insurance companies normally charge either copays or co-insurance for most services other than specific preventive health ones.
  • Co-insurance: A percentage of the cost of a medical expense for which you are responsible. For most services, you pay either co-insurance or a copay.
  • Deductible: The annual amount you are responsible for paying toward medical expenses before your insurance coverage “kicks in” to pay the rest. Although copays and co-insurance apply towards your deductible, you will still be charged copays and co-insurance after you have reached your deductible.
  • Maximum out-of-pocket: This is the maximum amount you will be responsible for paying toward medical expenses covered on your plan. Once you have reached this amount, you will not be charged for additional eligible medical expenses.

To help understand your health insurance plan, read our glossary of health insurance terms.

The overall cost of your health insurance plan is typically a combination of the various pricing factors listed above. For example, plans with higher premiums (monthly payments) will frequently have lower copays and deductibles. If you expect to have high medical expenses in the next year, you may want to sign up for a plan with a higher premium and lower copays.

4. Check prescription drug coverage

Each plan has a Prescription Drug List of covered medications. The medications are grouped into tiers based on cost. The amount you will pay for prescription drugs and whether specific brands or only generics will be covered varies from plan to plan. Not all plans cover all medications, and coverage of new or experimental treatments varies among plans.

5. Access to doctors and care facilities

Most plans have a network of providers, including doctors and care facilities as well as labs, pharmacies, and imaging centers. Some plans will not cover any out-of-network expenses, while others will only cover them at a higher rate or with prior approval. Evaluate plans carefully to ensure that your regular primary care provider (PCP) accepts your plan. If you are seeking a new PCP, make sure that there are in-network providers who are conveniently located and taking new patients. Don’t be afraid to make a call to better understand the scope of your network!

6. Plan limitations and exclusions

It’s important to know what your plan does not cover. Elective surgeries and alternative therapies are commonly excluded from most health care plans. Many health plans do not cover care provided by someone who is not in their network. Dental and vision services typically need to be purchased on separate insurance plans.

7. Health and wellness resources

Some plans offer extensive preventive care services without copays. Other plans offer rebates for use of health clubs and facilities, or if you commit to certain healthy activities, such as smoking cessation, weight loss, or health monitoring. While certain plans may cover alternative health care, such as chiropractic or acupuncture, many do not. Don’t be afraid to make a call to better understand the wellness benefits included with your coverage.

When you buy health insurance through Freelancers Union, a portion of your purchase goes right back to the freelance workforce — at no additional cost to you.

Where you buy insurance matters. Invest in your health and a better future.

FAQs about health insurance

Do I really need it?

Even if you are young and healthy, you need insurance. One accident, illness, or injury could be financially devastating. While the federal penalty for not having health insurance is no longer in effect, D.C., Massachusetts, California, Vermont, Rhode Island, and New Jersey all enforce penalties that can range from under $300 to over $1,000 each year.

My plan is ending. How do I find a new one for 2021?

If your plan is ending, you can shop for a new plan during the current Open Enrollment period — which ends on Sunday, December 15 — on our benefits platform or state exchanges.

I think I’m eligible for a subsidy. What can I do?

Under the ACA, you may be eligible for a subsidy or tax credit toward your health plan if your modified adjusted gross income is between 100% and 400% of the federal poverty level for your household size and you are not eligible for Medicaid, Medicare, or employer-sponsored ACA-compliant insurance. If your income is below 100% or 138% (depending on your state of residence) of the federal poverty level, you are eligible for Medicaid rather than ACA subsidies. If you are 65 or older, you are eligible for Medicare rather than subsidies. To determine your eligibility, visit here. If you think you are eligible for a subsidy, our platform will connect you to your local exchange for relevant information.

When can I enroll in health insurance?

Open Enrollment for 2021 coverage began on Sunday, November 1, 2020, and runs until Tuesday, December 15, 2020, in most states. During this time, you can enroll in a new plan or change your current plan. States offering extended open enrollment periods include California, Colorado, Connecticut, Florida, Massachusetts, Minnesota, New York, Rhode Island, and Washington, DC. To make sure your coverage for 2021 is in place on January 1, you will need to enroll in and pay for a new plan by December 15, 2020.

What kind of plans are out there?

Under the Affordable Care Act, insurance plans for individuals are offered at five tiers:

  • Catastrophic (available for those under age 30)
  • Bronze
  • Silver
  • Gold
  • Platinum

While higher tiers may be more expensive up front, that isn’t always the case, and the total amount you pay for covered services may be lower. Compare prices carefully in order to find the plan that offers the best value for your individual circumstances. While all ACA-compliant plans must offer the same 10 essential health benefits, some plans offer extra benefits that may be particularly valuable to you or your family. Also, plans may differ in which providers you can access, as well as certain preventive services and benefits. Compare plans in different tiers carefully before making your final selection, as you won’t be able to change insurance plans until the next open enrollment period.

Can I enroll at a different time?

Yes, but only if you qualify for a special enrollment period by:

  • Gaining or becoming a dependent
  • Losing existing health coverage (through job loss, separation from a spouse, etc.)
  • Expiration of COBRA
  • Loss of eligibility for or expiration of a student health plan
  • A permanent move or relocation to an area with different health plans
  • Dramatic change in income that affects your eligibility for tax credits or cost-sharing reductions.

If any of these special circumstances apply, you may be eligible to enroll for a limited amount of time after the event. If you don’t enroll during the open enrollment period and you don’t have a qualifying event, you will be unable to buy ACA health insurance until open enrollment in 2021, although you will still be eligible for Short-Term Health Insurance Plans.

What if I have a pre-existing condition?

The ACA made it illegal for insurance companies to deny you coverage, refuse to cover treatment, or charge higher premiums for pre-existing health conditions.

Where can I find health insurance?

You have three options:

Our National Benefits Platform, which provides a curated selection of health insurance options for freelancers across the country.

Your state’s health insurance marketplace (you can see a directory of state exchanges and the federal exchange at healthcare.gov).

The websites of individual private insurance plans.

Where should I go if I have questions?

Start by viewing your options at https://freelancersunion.org/insurance/health.

If you have specific questions about a particular plan, call the insurer to get the best and fastest answer. You can find many insurer phone numbers on our website. You can also email us at membership@freelancersunion.org and we’ll respond as quickly as we can.

Get covered! It’s easier than you might think. You also can spread the safety net by sharing information about our National Benefits Platform to help your friends get health insurance, too.

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