The firm's health plan stayed behind when you went out on your own. Here is how consultants are replacing it with coverage that fits lumpy fees and a week spent in a client's city.
Hi, I'm Sam Jaber, and I'm a licensed health insurance broker working out of Tampa. I help consultants of every kind: strategy, operations, HR, finance, and people who left a firm and now sell their expertise directly. I'm licensed in 36 states and I do everything by phone, which works well for people who rarely stay in one place for long.
When you go out on your own, the firm's plan stays behind. Whatever replaces it has to handle two things firm life never asked of you: income that comes in retainers and project fees, and a work week that might be spent in a client's city. Here's how consultants are handling both and paying less.
One question decides most of this: is your household income for the year going to be under the line for marketplace subsidies, or over it?
If you consult through an LLC or on a 1099, the marketplace counts net self-employment income, meaning revenue minus what it costs to run the practice. Travel your clients don't reimburse, software, a home office and professional fees all reduce it. A spouse's income gets added on top.
Four times the federal poverty level is where the subsidy ends. For a one-person household that's just past $60,000, and it goes up as the household gets bigger. Established consultants are often over it. In a launch year or a slow one, you might not be. Pick your situation.
Without a subsidy, the marketplace charges its full rate, and you'll often find the local plans are HMOs or EPOs. Those generally don't cover care outside their network except in an emergency, which becomes a real problem when your client is three states away for a month.
Healthy consultants have another option. Private plans with medical underwriting ask about your health when you apply and set your price from the answers, so a healthy applicant often pays noticeably less than the marketplace's full price. They're built on nationwide PPO networks, which cover out-of-network care at a higher share and don't make you get a referral to see a specialist.
The trade is simple to state. The underwriter can approve you, decline you, or approve you with a condition left out, and each plan's benefits are its own. We go through them together before you decide.
Next step: Book a call and I'll show you a nationwide PPO quote against the marketplace's full price for your household.
Your employer coverage usually ends with the job. That loss gives you a special enrollment period, usually 60 days, to enroll on the marketplace outside open enrollment. You'll also be offered COBRA. If you elect it and then cancel early by choice, that doesn't open another window, so pick your route before you elect.
Underwritten plans don't depend on an enrollment window, but they take time to approve, so start early. Your first-year income will be a guess, which feeds into the subsidy question above.
Next step: Call me while you're still on the firm's plan and we'll have the next one lined up to start the day after it ends.
Launch years and slow years happen to everyone. If your household comes in under the line, the marketplace is usually where the most affordable plan is, because that's the only place the subsidy works.
Lumpy retainers make the estimate tricky. Give the marketplace your best guess for the year and update it when a big engagement starts or ends. If you earn more than you reported and never updated it, you can owe part of the help back at tax time.
Next step: Send me what's signed and what's in the pipeline, and I'll help turn it into an estimate and a plan.
If you, your spouse or a child manages an ongoing condition, the marketplace is usually the safer home even without a subsidy. It has to accept every applicant and can't price by health, while an underwritten plan may decline or exclude exactly what you need covered.
The savings then come from choosing the marketplace plan that keeps your family's doctors in network and covers their prescriptions, with a deductible you can carry through a quiet quarter.
Next step: Tell me the doctors and medications that matter, and I'll show you the marketplace plans that cover them.
Many consultants assume leaving the firm means leaving the PPO behind, especially where the marketplace only offers HMOs and EPOs or prices its PPO out of range. It doesn't have to. Healthy consultants can still get a nationwide PPO through me, in any of the 36 states where I hold a license. If you're on the road for clients, let's price one.
There's no fee to work with me. I'm paid by the insurer when you enroll.
Straight answers, no sales pitch.
You can continue the old plan through COBRA, enroll on the marketplace during the special enrollment period that losing coverage opens, or, if you're healthy, apply for a private underwritten plan. The right one depends on your income and your health.
It depends on the network type. HMOs and EPOs generally cover only emergencies outside their network. A PPO covers out-of-network care too, at a higher cost, which helps when your work moves around.
Often. The self-employed health insurance deduction is limited to net profit from your business, and it doesn't apply to months when you could have joined an employer-subsidized plan, including a spouse's. Your tax preparer can confirm the details.
Not in the usual sense. With no employees, your coverage comes from the individual market: a marketplace plan or a private plan outside it.
What you netted last year, what's signed for this year, and where your clients are is enough to begin. I'll tell you which path fits and what it costs, and if your current plan is the sensible choice, I'll tell you that as well.
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