Health insurance options for the self-employed

I got married relatively young, at age 22. There was a gap between my marriage which kicked me off my parents’ insurance and getting put on graduate school insurance. My father-in-law gave us short-term gap private insurance as a wedding present. It was expensive from my perspective (I was looking at an annual stipend of under $20K), but for private health insurance it was cheap.

Private Health Insurance Options

Private health insurance is one method that people use to get coverage when they’re self-employed or unemployed. Because the private health insurance market is broken, it can be prohibitively expensive, if available at all. Private coverage can be affordable if you are young, healthy, single (or male) and only need it temporarily. But if you don’t fall into all of those categories, it can be difficult and expensive. Fortunately, under the Affordable Care Act (ACA), private insurance can no longer kick you off if you get sick after paying for private coverage. Children with pre-existing conditions cannot be denied coverage. In 2014, insurance companies will no longer be able to deny adults coverage based on pre-existing conditions. Also in 2014, states should have their Affordable Insurance Exchanges set up, allowing individuals and small businesses to better shop for health insurance plans.

GRS has talked extensively about experiences purchasing private health. How I purchased private health insurance. Finding affordable health insurance when you’re on your own. How do you manage health care costs when you’re on your own. Hunting for health insurance.

Because of the adverse selection problem we talked about in my first post, group coverage may be a better option for most people.

Group Coverage Options

If we were 22 and married today, we would have no need for gap coverage, because one of the provisions of the ACA is to allow adults age 26 and under, including married adults to remain on their parents’ coverage. So I would have stayed on my parents’ plan, and my husband would have stayed on his parents’ plan. (My parents’ plan could not have covered my husband, however.)

The next time I was without an employer-provided (or in my case, graduate school-provided) insurance I was doing a post-doctoral fellowship at the National Bureau of Economic Research. They offer health insurance to their staff, but not to their post-docs. So I had to explore my options for health insurance.

In 1985, Congress passed the Consolidated Omnibus Budget Reconciliation Act, or COBRA. This law allows former employees and their spouses to keep their health insurance coverage from their former employer for up to 18 months (or longer in some cases), so long as the employee or spouse pays up to 102 percent of the full cost of the insurance. That means what the employer and employee were paying added together plus 2 percent for administrative costs. The insurance actually costs the employer a bit more than the 2 percent administrative costs because of problems with adverse selection — employees who leave and take up COBRA tend to be sicker than the average employee. Additionally, there’s a 60-day window before the ex-employee has to decide to accept coverage and the decision can be retrospective. That means you can go 55 days without insurance, get hit by a bus on the 56th day, sign up for COBRA in the ambulance on the way to the hospital, pay for those two months, and you still have coverage. (This kind of moral hazard problem causes COBRA to actually cost the company more than 102 percent on average.) Because it charges a flat 102 percent group rate for everyone, COBRA tends to be cheap compared with the alternatives if you’re older or unhealthy, but expensive compared with alternatives if you’re younger and healthy.

Another option is to work part-time someplace that offers health insurance to part-timers. In my case, Boston College offered me a one-day-a-week, grant-funded position that could include health insurance if I wanted that. Starbucks, Barnes & Noble, and UPS are well known for offering this benefit, though there may be a long wait before you actually qualify for the benefit.

not_that_kind_of_guildDepending on your business, you may be able to join a guild or union. Look into this option even if you think you don’t meet the criteria of the organization’s title. One of my post-doc predecessors had joined a local small-business association, despite not actually owning a business (I think the post-doc counted as contract work). For a time, my self-employed father belonged to the local Farmers Association (which had started as farmers, but included small-business owners) and was able to get health insurance from there, even though we lived in town and having a couple of apple trees and tomato plants doesn’t make a person a farmer. Many unions also offer health insurance, although there may be strict limitations on who can receive benefits, and unions have been dropping health benefits.

What I ended up doing was going on my husband’s insurance. That’s generally the most popular option for people who are married. Next year when my husband is working on starting a consulting business instead of being employed by the university, he will be on my insurance. It’ll cost a bit more than insuring us separately, but it is our cheapest option.

Government Options

If you’re over the age of 65 in the U.S., you no doubt know about Medicare. Medicare has two options: a single-payer traditional plan and a network plan called Medicare Advantage. Medicare Part A covers hospitals, Medicare Part B covers out-patient visits, and Medicare Part D covers drugs. Coverage is not completely free (even after a lifetime of taxes) — in general Medicare covers about half of costs for enrollees. Some of the excluded things we’ve grown to expect not to be covered, like dental, vision, and so on. Additionally, Medicaid will eventually kick in for long-term-care costs once an older person has drawn down enough wealth.

Medicaid is another government provided health insurance program. For the most part, Medicaid covers two groups: the poor elderly living in nursing homes and the disabled make up two-thirds of the costs of these rolls, and the remaining one-third consists of pregnant women and their children. The State Children’s Health Insurance Program, or CHIP, is related to Medicaid and specifically targets children. CHIP generally has higher income limits for eligibility than Medicaid does, and has been allowed to expand under the ACA. Medicaid and CHIP programs differ by state. Medicaid is often referred to as the “best insurance you can’t buy” — it has very low out-of-pocket expenses and covers a lot of things. The drawback is that its reimbursement rates tend to be low so it can be difficult to find a physician who will take it.

If you have been denied coverage, or your potential coverage is prohibitively expensive, many states offer high-risk pools. These plans vary quite a bit by state, so contact your local state pool to find out about eligibility and other criteria. Additionally, under the ACA, there are new pre-existing condition insurance plans. You qualify for these plans if you have been denied health insurance over a pre-existing condition and you have been without health insurance for at least six months.

If you are a veteran and meet an income means test or have a service-related disability (and diabetes may qualify as a service-related disability if you served in Vietnam), then you may qualify for VA benefits. VA runs its own system of hospitals and clinics, so you get care at these specific government facilities.

Non-Insurance Options

Non-insurance options can provide limited health care. There may be a non-profit health clinic in your area — our local non-profit is called Health4All — that provides free or reduced out-patient care. Drug stores, local hospitals and HMOs, and even Walmart, may offer walk-in clinics in your area for things like vaccines and blood-pressure tests. Some even offer a nurse practitioner or general physician to check out your cough or rash or pink-eye.

Self-care may keep you out of the doctor’s office, though obviously it is not much help if you get hit by a bus or have a heart attack. GRS has addressed how to save money on prescriptions, survival techniques for the barely insured, and preparing to get sick.

Finally, if you have emergency medical care needs and can’t pay your bills, there’s always bankruptcy. Not an option we want to consider, but health costs are a leading cause of bankruptcy for good reason.

Are there any self-employment health insurance options that I’ve missed? If you’re self-employed, where do you get health insurance? What are the pros and cons to the type of insurance you chose?

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There are 42 comments to "Health insurance options for the self-employed".

  1. Tom Murin says 10 November 2012 at 05:38

    I didn’t realize that a married child could remain covered under the parents’ policy. So much for the concept of emancipation.

    Otherwise, I think it should be noted that Medicare is a Federal program and Medicaid is State run program (but I am fuzzy on the federal involvement as to rule making, eligibility, etc.)

  2. Joanna Lahey says 10 November 2012 at 06:16

    The views herein are mine alone and do not necessarily reflect those of Texas A&M or NBER.

  3. Steve says 10 November 2012 at 07:02

    Nice write-up, but you seem to have glossed over the part about health-care being a service someone has to be ‘hired’ to provide. If you do not qualify for an insurance plan then you are responsible for your health-care yourself. All insurance plans do is transfer the risk (for a cost – usually monthly) from you to the insurance company. Someone still has to pay the provider when you utilize their services. A high-deductible policy with an HSA is a very cost-effective route for people who aren’t part of a ‘pool’ that the insurance companies recognize. For the insurance companies it’s all about reducing their risk (cost). As a country, we are on the verge of finding out just how expensive all of these government programs really are…

    • Joanna Lahey says 10 November 2012 at 07:53

      You might be interested in the first and the last (next week’s) posts in this series.

    • Bill in NC says 11 November 2012 at 18:31

      The high-deductible policies are attractive.

      But you still have to medically qualify for them – e.g. exceed height/weight limits and you’re only offered the state high-risk pool (can easily be over $1000/month)

  4. Carol says 10 November 2012 at 09:59

    In NJ we have a plan offered called an “EPO.” It has limitations in annual coverage, and would probably be considered more of a catastrophic plan. It is far cheaper than the other plans(which can run over $1,000 for one person, per month.) If not for this plan, I would be uninsured, so I am grateful for this offering.

  5. Trudy says 10 November 2012 at 10:28

    I’ve been reading these posts with the hope that I’d learn of an option to cover us affordably before I reach retirement age (a few years away), but alas, that is not the case. My husband earns a good living as an independent consultant but insurance costs are prohibitive for a small business owner. Consequently, I am employed full-time for the sole purpose of providing our health insurance coverage for a reasonable cost-share amount. We are healthy and I would love to retire (and make space for a younger worker). We have saved our entire lives and could retire now if not for health insurance costs. (We don’t want to risk our entire savings for some unexpected health care need).

  6. SLCCOM says 10 November 2012 at 11:34

    In Pennsylvania, we could get group health insurance through the Chamber of Commerce.

  7. Ben Johnson says 10 November 2012 at 11:54

    Just don’t get sick till 2014. After that, if you do get sick, then buy insurance – they can’t deny you for pre-existing conditions.

    Might as well freeload like government is trying to get us to do. Lets enjoy the ride down!

    • Joanna Lahey says 10 November 2012 at 12:01

      That type of moral hazard is precisely why Jon Gruber says the individual mandate is necessary for the ACA to work. People have to buy insurance before they get sick, not after. (And why they didn’t introduce the denial for pre-existing conditions to the law right away– these parts have to be coordinated.)

      He talks about it here:

    • Holly@ClubThrifty says 10 November 2012 at 13:15

      I’m sorry…but am I missing something here? What exactly do you think is wrong with health insurance companies having to cover people with pre-existing conditions? What do you expect them to do? Curl up in a corner and die? I don’t understand how mandating coverage for people with pre-existing conditions is the same as the government encouraging everyone to be a freeloader.

      And Joanna is exactly right….the mandate requiring people to buy insurance is supposed to fix the problem of people waiting to get sick to buy insurance. But let me go ahead and take a guess that you have a problem with the mandate as well.

  8. Babs says 10 November 2012 at 13:28

    “employees who leave and take up COBRA tend to be sicker than the average employee.”

    That’s interesting. I wonder if it is really true. I assume it is based on actuarial data.

    On another note. Our company is in a small group plan. Our insurance company won’t let us enroll anyone who works less than 20 hours a week even if we want to. I wonder if they also think part timers are sicker than the average employee.

    Thanks for another informative piece.

    • Joanna Lahey says 10 November 2012 at 14:06

      Just on average because some people leave employment for health reasons, especially those who don’t get employed after (COBRA can be a bridge to public insurance such as Medicare or Medicaid). Also anybody who takes COBRA retroactively after a negative health event is automatically more expensive than average. And healthy young folks can often get a cheaper plan in the private market, so it tends to be the more expensive people who use COBRA.

      Obviously not everyone who takes up COBRA is sicker than the average employee, particularly those who leave for reasons that have nothing to do with health. But the ones who do drive up the cost compared to the average working person. There’s a nice literature on COBRA.

      That is interesting about your insurance company and part-timers. It could very well be that they’re worried about adverse selection of people who need health coverage being able to work part-time but not full-time because of their health conditions. I haven’t seen that looked at, just the opposite about companies increasing part-time positions that they don’t have to give benefits with (and making full-timers work more hours).

    • mca18974 says 10 November 2012 at 17:01

      “employees who leave and take up COBRA tend to be sicker than the average employee.”

      That’s interesting. I wonder if it is really true.”

      I’ll bet it is. I was an employee benefits clerk when COBRA first kicked in; it was really expensive then and it was even more expensive when I looked into it after leaving my job in 1997, so it’s probably even worse now. The only people willing to pay that price would be those who are, or anticipate, using the service (health care) and would be paying even more if they didn’t have COBRA. It’s still a limited benefit, though; with the current high unemployment rate 18 months isn’t a lot of time anymore for people who are between jobs – not when it’s taking so much longer to find something else. I have also heard that some employers are delaying coverage of new employees much longer than they used to. I can’t confirm this, but I suppose it makes sense from the employer’s point of view; it saves them money and if the new hire is on COBRA they don’t have to worry about that person not having coverage.

      Our health care system is seriously, seriously broken and the Affordable Care Act is not going to fix it. In fact, I think it’s a misnomer; with the current “system” (I use the word loosely) in place there’s no way to make care more affordable. In fact, I’m not looking forward to being forced to buy something I can’t afford. And honestly, I’m wondering what will happen to those of us who can’t.

    • maggie says 12 November 2012 at 12:25

      Actually, it totally makes sense. Cobra can be really expensive, so many people who are healthy when they become unemployed choose not to get cobra. But if you loose your job and have existing health problems, you are more likely to get choose to pay for Cobra if at all possible.

  9. Becky+P. says 10 November 2012 at 14:11

    You asked about other options.

    There is a group called Samaritan Ministries which specializes in Christians (who should supposedly have a lower risk lifestyle) or Christian Medi-share. Their insurance tends to be quite a bit cheaper than regular health insurance and I understand that at least one of these is going to be allowed under “Obamacare” regulations.

    But I’m like at least one commented–I’m not sure how insurance actually controls the cost of medical care! It is a bit over the top, (to me) when about 45 min. of being in the hospital costs a patient over $1500 (my son, seizures). Plus the ambulance ride ($700+). His insurance had a limit of $1500 incident. (It didn’t lower the cost of health care at all–it just covered some of it so we didn’t have to pay for it all out of pocket.)

    Maybe limiting doctor’s malpractice liability would be a great place to start so they could lower their own cost of their own liability insurance and pass it on to their patients.

    • Joanna Lahey says 10 November 2012 at 14:59

      I had not heard of Samaritan Ministries. I also didn’t know you could offer insurance based on religion (though I know you can offer it based on group membership). I’ll have to look into that to see how they work it.

      We definitely need Malpractice reform. Unfortunately, even if we could fix it perfectly, when the people who study it run the numbers, it makes only a small difference, decreasing costs less than 10% for the even the most generous estimates (more like a decrease of 2% for most estimates). Still, it would make a big difference in how care is provided in many situations. Unfortunately it isn’t as simple as just capping damages (if it was, I think we would have done that by now!) and is going to require a lot more work on what that reform should look like.

      Additionally, it isn’t clear that doctors pass on cost savings to patients. The market isn’t perfectly competitive so they don’t have to unless they’re altruistic. They can take any savings as profit to pay their student loans or increase their quality of life.

      I think the first and second post talked about how insurance changes the costs of medical care. PPOs add competition into the market and bargain down hospital costs. Proper use of insurance means people get more preventative care, use standard doctors visits instead of emergency room care, and are more likely to treat chronic conditions, and see the doctor before illnesses become incredibly expensive.

      Overall, does insurance bring down the cost of healthcare… well, without insurance we probably wouldn’t have as good health care (there would be less invention and innovation) so costs would be lower but quality would also be lower. The standard question is, “Do you want to pay today’s prices for today’s health care or 1950s prices for 1950s healthcare?”

      Having a limit of how much insurance covers is actually not insurance– it is the opposite of insurance. Real insurance has a limit of how much you have to pay out of pocket, not how much the insurance company has to pay. (My dental “insurance” isn’t really insurance– it also has caps on how much it pays.) One of the things that the ACA addresses are limits to how much the insurance company will pay. (And again, people running the numbers find that when not having maximums is mandated for all insurance companies, it doesn’t increase costs much.)

      Yes, even with insurance, medical care is expensive, and yes, hospitals and doctors mark up the bills they send to the insurance companies (and the insurance allows less through their group bargaining arrangements). And yes, insurance adds a lot of expensive red tape (something else the ACA is addressing via mandating a single form for all insurance companies and pushing for electronic records). But we do get a lot out of the medical care we get. I am just amazed at medical technology these days. But we pay for that.

      • Tom Murin says 10 November 2012 at 21:20

        Your response doesn’t make to too much sense to me:

        “Having a limit of how much insurance covers is actually not insurance— it is the opposite of insurance. Real insurance has a limit of how much you have to pay out of pocket, not how much the insurance company has to pay. (My dental “insurance” isn’t really insurance— it also has caps on how much it pays.)”

        As you know, insurance is when risk is taken on by another party (the carrier). The transfer of the risk does not have to be complete and having limit makes sense just like having a deductible and co-pay. The transfer is more limited than we like for dental (it is close to “dollar trading”) and you might be better off self-insuring for dental and putting the premium dollars in a FSA or HSA.

        Maybe you are referring to UC & R type limits? I tend to agree with you on this since a consumer can’t really negotiate these charges and cannot easily determine the charge or amount the carrier will pay in advance.

        • Joanna Lahey says 10 November 2012 at 21:48

          The economic definition of insurance is not risk taken on by another party (although it generally has that aspect). The economic definition is that it is a mechanism that smooths out consumption across different states of the world (see week 1’s post). Something that fails to smooth out consumption when you are hit with a negative shock is not acting as insurance, at least not after the point at which the insurance stops paying.

          That’s not saying it isn’t necessarily worth buying, just that it doesn’t technically function as insurance under the economic definition. It is only insurance up to a point.

          Another odd way that insurance works from an economic standpoint (though not necessarily from a non-economist standpoint) is that you are covered by COBRA during those first 60 days whether or not you pay for it. You have insurance because you can get that insurance retroactively.

      • Becky+P. says 11 November 2012 at 00:19

        The Christian groups aren’t technically insurance, but apparently are going to be allowed. They are people who agree to share costs act as a self-insured group.

        As weird as it sounds, it appears to be working. I was skeptical when I first heard about it years ago but now that our own health insurance seems to be going higher and higher and higher and we don’t have a higher income, I’m considering it. I would imagine many people who are living a Christian lifestyle and want to participate, might opt for such a thing. I think it makes perfect sense if you don’t live a high risk lifestyle.

        But on another front, I have heard good things about the Canadian system. I have heard some bad, but two friends of mine now live there and both have benefited greatly from being able to get healthcare.

        I know that it sounds socialistic and all that, but I wish that the US would have a two tiered system–a public one where a person could get basic health care for free or preferably with a small co-pay like $100 including emergencies and then the ability, if you have money, to pay for private services if the public is too slow, you don’t like the doctor, etc. That way everyone could be covered–maybe a lower level for everyone, but at least it would be something.

        But don’t ask me how it would be paid for. I have no idea how it all works. Just what “I wish”. 🙂

        • Steve says 11 November 2012 at 07:22

          The concept of the Christian group doing the ‘insurance’ together is not a ‘lifestyle’ (thinking here of no ‘fun’ activites). The thought behind it is that the Bible tells us Christians to take ‘care’ of each other. It is building what is a pool of people who are sharing the cost of healthcare amongst themselves, rather than hiring an insurance company to do the same thing. That should in theory cost each of them less than insurance does, but still gives them the choices of treatment that an insurance company may deny them. Again, the individual is still ultimately responsible to cover themselves. The problem with healthcare is the apparent expense. But as one post said, if you want healthcare at 1950’s prices, you’ll only recieve the same level of care that was available then.

        • Joanna Lahey says 11 November 2012 at 08:14

          Several other countries have exactly what you suggest– a minimal public insurance and more generous private insurance that you or your employer can buy into. (One of my colleagues is doing research on a Latin American country’s system with that set-up, and some European countries also have that system.) So not infeasible! Just difficult to get to given our current set-up. And here in the US, our Medicare system allows you to buy Medigap insurance which offers more coverage than regular Medicare. Like it said in last week’s post, the big health differences are between having no insurance and having any insurance, not so much in type of insurance.

  10. Anna says 10 November 2012 at 14:19

    After reading this very confusing list (but I’m sure it’s very inclusive!)of the many health care options available (or not…depending on circumstance!) in the US, I’m very happy to be living in Ontario, Canada with excellent medical coverage paid for by our taxes…and very happy that I have excellent insurance coverage for drugs/dental/paramedical services that form part of my benefits package at work.

    • justin@thefrugalpath says 10 November 2012 at 18:30

      I’m glad to hear from someone who actually has Canadian insurance. I whenever I talk to co-workers about the need for everyone to have health insurance they try to say that Canada’s system is so bad that people are dying ect… from waiting so long. Yet, i’m not sure that any of them have heard it from an actual Canadian. Most of it is political misinformation.

      • Anna says 11 November 2012 at 17:08

        While I won’t disagree that sometimes we have some long wait times (neurologists are in short supply it seems), I haven’t experienced that myself. To the contrary, twelve years ago when I was diagnosed with cancer, I was taken care of very quickly – within two weeks of seeing my doctor, I was having some more advanced testing done at a hospital, two weeks after that I was having some surgery related to the cancer, within a month after that, I was at one of our best cancer hospitals. All of my treatment and follow up cost me nothing over and above the money I already pay in taxes (whether or not I use our health care system), unless you count the money I had to pay for parking at the hospital itself.

        I haven’t personally known anyone who’s died while they’ve been waiting for treatment, nor have I heard from any of my friends that they’ve known someone who’s died while waiting for treatment. Treatment for life-threatening conditions is generally quite timely. I know that people wait a long time for knee replacements and other surgery/treatment that won’t save their lives. I think we’ve got a pretty good system here. I pay a lot in taxes, but I won’t ever have to go bankrupt or sell my condo to cover the cost of any medical expenses (unless things change for the worst!).

        As an aside…flu shots are free here (Ontario – not sure about other provinces but I think they are)…you can get one from your family doctor (free visit and the shot is free!), local pharmacy (free!) or a cliic (free!). I saw an ad for a pharmacy on a US TV station and they quoted 29.99 for a shot…WOW…that would definitely add up if you had a big family! I’ll keep what we have here thanks!

  11. Fred says 10 November 2012 at 15:10

    I see that limiting malpractice liability was mentioned as a way to control healthcare costs. It seems that is always listed at the top of cost control methods. We did exactly that in Texas. Our medical costs did not drop one thin dime. What we did accomplish was make it impossible for some people to even consider suing for malpractice.

  12. Chris says 10 November 2012 at 15:47

    Thanks again for a useful article. I’m interested in the transition between what we have now and what we will have under ACA. I’m hoping to join my husband in retirement midway into 2013 and my very personal question is should I COBRA to 2014 when the ACA kicks in – or should I try to buy health insurance on the open market for that half year?

    I’ll be 60 and I’m healthy but who knows what could happen to my health between now and then. I know enough people who have faced health challenges at this age to be very aware that health is unpredictable no matter how well you take care of yourself.

    • Joanna Lahey says 10 November 2012 at 20:23

      Gosh, this sort of thing is the kind of thing that you should really talk over with a financial planner. (I am not a financial planner and any advice is for entertainment purposes only or whatever it takes to cover myself legally if my advice is bad!)

      So the question is should you do COBRA for 6 months and then get a private plan or just start out with a private plan?

      On the one hand, I want to say there’s no harm in shopping around, and at age 60 you may find COBRA still to be your best option (though as a woman, your costs have flattened with age more than a man’s would have, because your expected expenses no longer include childbirth). On the other hand, if you’ve been denied coverage, that can make it harder to get coverage in the future and COBRA cannot deny you. However, upcoming provisions of the ACA should make that less of a problem. But we’re not 100% sure what kinds of crazy loopholes insurance companies will find, though it may be too early for them to have found any yet at that point.

      So I guess my answer is I don’t know. :/

    • SLCCOM says 10 November 2012 at 23:18

      Your definition of “healthy” may differ from that of the insurance companies, though.

  13. jessica says 10 November 2012 at 23:49

    Joanna, I really wish GRS would make your articles a regular thing. I really enjoy them, but I think I enjoy your responses in the comments most of all. I have learned a lot these past few weeks. thank you for being willing to share your knowledge.

    • Joanna Lahey says 11 November 2012 at 07:58

      Awww, thanks.

      Actually, I chose not to audition for doing a regular slot when JD suggested it because there’s no way I can commit to writing regular articles when the school year is fully underway.

      However, if you’re interested in learning more about these issues or actually becoming involved in government or non-profits, we offer a wonderful 2 year masters program in public policy or public administration (technically the degree is “public service”, but those are our tracks). We’re a best value and everybody gets in-state tuition. We also offer pretty generous scholarships for top applicants. And we give folks a great education. Health policy is one of our concentrations and we just hired another amazing health economist from Wisconsin. (We also have concentrations in education policy, energy policy, and state and local policy among others.)

      I’m on the domestic-policy side, but we also offer options in international economic development and national security as well as the aforementioned administration.

      If you or anybody else is interested in learning more about our program, our admissions webpage is here:

      (Thanks for the opportunity to plug my school!)

  14. chris says 11 November 2012 at 04:13

    We vacationed in Canada this summer and met a Canadian couple who by almost all measures held very conservative views BUT they loved their national health care and could not understand why those from the US didn’t want something similar. They were in their early 60s and didn’t seem to have any trouble getting care.

    • Ramblin' Ma'am says 12 November 2012 at 09:47

      This seems to be one big difference between conservatives in the US and in the rest of the world. Conservatives in Europe and Canada may be in favor of reducing other forms of government benefits, but universal healthcare has support across the political spectrum. In other countries, members of all parties seem to recognize that, no matter how careful and responsible one is, sometimes catastrophic illnesses and accidents happen. Staying healthy is not simply a matter of “personal responsibility.”

  15. Linda says 11 November 2012 at 08:27

    My husband was injured and lost his job and with it, his insurance. We tried to do the COBRA thing and looked into insuring him through my job’s insurance. Also looked into the state plans and private insurance. And the upshot is – he is currently unnsured because we cannot afford $600-700 a month to cover him. He just got a new job that offers insurance after three months. We are crossing our fingers until then.

  16. Sean says 12 November 2012 at 07:55

    There’s a glaring omission in this post: Employers with less than 20 FTEs are NOT subject to COBRA. Sometimes insurance companies will allow former employees to remain on a plan after they are no longer employed, but only for a limited time (usually three months) and only if the former employee reimburses the employer for the cost of the premium. So COBRA is not really an option for a lot of US citizens.

    • Joanna Lahey says 12 November 2012 at 09:58

      That’s a very good point and should have been included.

      Although these days companies with fewer than 20 employees are unlikely to offer health insurance in the first place.

      Small firms are exempt from a *lot* of federal laws, so if you work at a small firm, check with a lawyer before making any drastic changes. In some cases state law will pick up where federal does not, but in many cases it will not.

  17. Courtney says 12 November 2012 at 08:39

    I’m trying to figure out what Diablo 3 has to do with health insurance… I can’t wait to get home and play!!

    • Joanna Lahey says 12 November 2012 at 09:54

      That was supposed to have the caption, “Not this kind of a guild” and I meant to download a WoW screenshot, but must have gotten Diablo instead! Alternatively I was considering getting a screenshot from The Guild, but I wasn’t sure what the copyright restrictions are on those.

  18. Corinne says 12 November 2012 at 13:31

    I am self employed and I pay for my own insurance. I was able to join a group plan available though my alma mater (Boston University). I’m so glad I saw the pamphlet right before graduation!

    The premiums have more than doubled in the past 5 years, but I think I’m still getting a pretty good deal. $212/month $3000 deductible (I am under 30).

    I don’t know if insurance discounts is something that other university’s offer, but I would encourage people to look into it.

  19. Thad says 13 November 2012 at 05:33

    Samaritan Ministries is not insurance. It is “medical sharing”, in that the members “bear one another’s burdens”. It also is exempted (along with other medical sharing organizations) as opposed to having only a waiver. The PPACA exempts the groups in the law itself.

    An option that “wraps around” savings benefits arounds with Samaritan Ministries is The Health Co-Op (

    All of these are very cost effective for those who meet the guidelines, especially in light of PPACA’s impact on religious organizations and their objections to some parts of PPACA that conflict with their religious beliefs (contraception, etc.).

  20. Levi Blackman says 13 November 2012 at 16:53

    As a self employed Type 1 Diabetic health insurance has always been a challenge for me. I am going on my wife’s insurance next month but this last year has been tough trying to pay for all my meds and doctor visits. I support the ACA simply because of the preexisting conditions part of the act. Living in Texas most people around here hate it but it gives me a lot of hope that the future will be better!

  21. Adrian says 22 November 2012 at 00:39

    Joanna could you clarify the part about married children still qualifying for parent’s insurance? I checked that just a week or so ago and the website I landed on (no clue which one it was) said that they are NOT qualified after marriage.

    If this is true, it’s GREAT news for our family because our son plans to propose to his girlfriend over the holidays and I was concerned about having both of them lose their parent-provided coverage after marriage.

    It wouldn’t cause them to not get married, but it would certainly require some adjustments to their budget.

    Right now their insurance is free because both our families have younger children already covered, so there’s no extra premium involved to cover our adult children also. That may be a situation unique to Utah as coverage for 1 to 10 children is the same price, I believe.

    If they were to have children, would they have to buy separate insurance for them or would we be able to provide coverage for them as well?

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