Health Insurance FAQ: Navigating Coverage for Business Owner

Small business owners (typically 2–50 employees) can access Group Health Insurance through the SHOP (Small Business Health Options Program) Marketplace or private brokers. Options include traditional HMO/PPO plans and Health Reimbursement Arrangements (HRAs), which allow employers to reimburse employees tax-free for their own individual premiums rather than buying a single group plan. 

Yes. If you are a freelancer, consultant, or independent contractor with no employees, you can enroll in an individual health plan through the Marketplace. As a self-employed professional, you may also be eligible to deduct 100% of your health insurance premiums from your gross income, providing a significant tax advantage that isn't available to traditional employees. 

The primary differences are cost and flexibility:

• HMO (Health Maintenance Organization): Usually has lower premiums and requires you to choose a Primary Care Physician (PCP). You must get a referral from your PCP to see a specialist, and out-of-network care is generally not covered.
• PPO (Preferred Provider Organization): Offers more freedom to see specialists without a referral and provides some coverage for out-of-network providers, though at a higher monthly premium.

A Health Savings Account (HSA) is a tax-advantaged savings account available to those enrolled in a High Deductible Health Plan (HDHP).

• Triple Tax Advantage: Contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free.
• Ownership: Unlike an FSA, the money in your HSA rolls over every year and stays with you even if you change insurance plans or retire.

Don't just look at the monthly premium. You must evaluate the Total Cost of Care, which includes your deductible, copays, and the "Out-of-Pocket Maximum." If you visit the doctor frequently, a plan with a higher premium but lower deductible may actually save you money. If you are generally healthy and want to save on taxes, an HSA-eligible plan might be the better fit.

Yes. Under the Affordable Care Act (ACA), insurance companies cannot bridge coverage or charge you more due to a pre-existing condition like diabetes, cancer, or heart disease. All ACA-compliant plans are required to cover these conditions from day one of your policy. 

Answered by: Jeremy Hayes, Licensed Insurance Broker 

NPN: #19778881 

Credentials: Specializing in health and life solutions for the self-employed and small business community. Disclaimer: Health insurance availability and subsidies are based on household income and zip code.