Your phone rings off the hook in July and January and goes quiet in between. Here's how HVAC techs who work for themselves are pricing health coverage around a seasonal year.
Hi, I'm Sam Jaber. I'm a licensed health insurance broker in Tampa, licensed in 36 states, and I help people over the phone, which is handy when you're stuck in an attic in August.
Most HVAC techs start out working for a heating and cooling contractor, and that's usually where the health plan comes from. Federal labor figures say roughly two of every three techs work for plumbing and HVAC contractors. Once you go out on your own, with your own truck and your own service agreements, the plan is yours to figure out.
What makes your trade different is the calendar. Summer and winter carry the year, spring and fall can be thin, and that shapes the right health plan more than people expect. Let me walk you through it.
Before we compare a single plan, I need to know one thing: will your household's income for the year fall under the limit for marketplace premium help?
That limit is four times the federal poverty level. A single person hits it at a little over $60,000 of income, and households with more people have a higher limit. For an owner, the income that counts is net self-employment income, meaning after the truck, refrigerant, parts, tools, licensing and insurance. Employed HVAC techs typically earn close to that limit as a single person, so plenty of owners sit near it too.
The trouble is you're enrolling before the busy seasons have shown their hand. A hot summer can push you over. A mild one can keep you under. Find yourself below.
If your household usually nets below the limit, the marketplace is likely your most affordable route, since premium help applies only to marketplace plans.
Seasonal income is where people get tripped up. You enroll using an estimate, and the marketplace expects you to correct it if the year turns out different. A record summer that you never reported can mean paying back some or all of the extra help when your taxes are done. You can avoid that by updating your income as soon as you can see the busy season was bigger than planned.
We'll build your estimate from what you made last year, adjust it for any new service contracts, and decide when in the year it makes sense to look again.
Next step: Send me last year's return and your service agreement count, and I'll help you set an estimate and choose a plan that fits it.
If you've built a shop with steady service contracts and a few trucks, you're probably above the limit. At full price, the marketplace can cost a healthy family far more than the care they expect to use.
That's where private plans with medical underwriting come in. You answer questions about your health when you apply, and if you're in good shape, the monthly cost is often well below what the marketplace charges at full price. These plans use PPO networks that reach nationwide, so you have room to choose your doctors and you're covered when you travel.
Underwriting cuts both ways. An insurer can decline you, or approve you but exclude something you've been treated for. Benefits also vary by plan, so we go through the details of each one together before you pick.
Next step: Call me and I'll show you a nationwide PPO quote next to the marketplace's full price for your family.
Hiring changes more than payroll. If you bring on at least one employee who isn't an owner or a family member, you may be able to use the marketplace's small business option to offer coverage. Helpers you pay as 1099 contractors don't count toward that.
Whether that's worth it depends on your budget, how many people you plan to add, and what your own household needs. Sometimes it makes sense to set up something for the team. Sometimes the owner's family is better off on its own plan for now.
Also, if you're setting up workers' comp for a new employee, remember it's for job injuries only. It isn't health insurance, and it won't cover anyone's routine care or illnesses.
Next step: Call me before your first hire starts and we'll talk through what makes sense for you and for the team.
When a family member manages a condition like diabetes or a heart problem, or takes a prescription every day, the marketplace usually wins even at full price. Marketplace plans must accept everyone, and they can't charge more because of someone's medical history. An underwritten plan could decline the application or leave that condition out.
The real work in that case is finding the marketplace plan that keeps your specialists in network and covers your medications without surprises at the pharmacy counter.
Next step: Share your doctors and prescriptions with me and I'll sort out which plans in your area actually cover them.
Some marketplaces don't offer a PPO at all, and others offer one at a painful price. People often decide that's the end of it. It isn't. Whichever of my 36 licensed states your shop is in, I can get you priced on a PPO whose network covers the whole country. If you're healthy, one phone call will tell you whether it fits your budget.
Have these handy and the call goes quickly:
I don't send you an invoice. The insurance company takes care of my pay after you're signed up, and your plan's price is no different for it.
Straight answers, no sales pitch.
Start from last year's net profit and adjust for anything that's changed, like new service contracts. Report that estimate when you enroll, and update it with the marketplace if your peak season turns out much busier or slower than expected.
Having at least one employee who isn't an owner or family member may make your business eligible for the marketplace's small business option. Workers you pay as 1099 contractors don't count.
You might. If your actual income ends up higher than your estimate, the difference is settled on your tax return. Updating your estimate as soon as you know helps avoid a large bill.
Yes. If you're healthy and over the subsidy limit, I can price private plans that use nationwide PPO networks in any of the 36 states where I'm licensed.
Share roughly what you netted last year, whether you have techs on payroll, and who's in your household. I'll tell you which route makes sense, what it costs, and whether the plan you're on already does the job.
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