You know dental benefits inside and out. Your own medical coverage is a different animal, and once you own the practice nobody arranges it for you. Here is how dentists are handling it this year.
Hi, I'm Sam Jaber. I help people buy their own health insurance as a licensed broker, from my office in Tampa and over the phone in 36 states.
Let me clear something up first, because it trips up a lot of dentists who search for this. This page is about medical coverage: the plan that pays when you, your spouse or your kids need a doctor, a hospital or a prescription. Your patients' dental benefits are a separate world, and so is any dental plan you carry for yourself.
When you work as an associate for a group or a corporate office, that medical plan usually comes with the job. Buy your own practice, or a share of one, and it doesn't. The dentists I work with tend to follow a short, predictable path to the right plan, and I'll lay it out here.
Here's the deciding question: is your household income under the cutoff for help on the marketplace?
That cutoff sits around four times the federal poverty level. In dollars, a single person crosses it a little past $60,000 a year, and a family of four crosses it much higher.
What counts for an owner is net self-employment income, the profit left once the practice's expenses are paid. Production and collections can look strong while your personal number is a lot smaller, especially in years when you're paying down a practice loan, buying new equipment or funding a partner buyout. So don't rule anything out based on what the schedule produced. Look at what actually reached you, then find your situation below.
Most practice owners I talk to are here. You've built up your patient base, your income clears the subsidy cutoff, and the full marketplace price feels steep for a family that rarely needs much care.
That's the case for a private, medically underwritten plan. When you apply, you answer questions about everyone's health, and the insurer prices and approves the policy based on those answers. For a healthy family, that often lands below what the marketplace charges at full price.
These plans run on PPO networks that cover the whole country, so your family can see doctors where you live, where the kids go to college, or wherever you end up for a dental conference. I'll check that the physicians you already trust are in the network.
The tradeoffs here are specific to this path. The health questions decide whether you're approved and what's covered, so honest answers protect you. And benefits differ from plan to plan, so before you sign we go through what the one you're leaning toward actually pays for.
Next step: Call me and I'll price a nationwide PPO for your family and put it next to the full marketplace number so the difference is obvious.
If anyone in your household has a chronic condition or relies on a medication every day, the math usually swings back to the marketplace, even without a subsidy.
The reason is acceptance. Marketplace plans must cover every applicant and can't raise the price because of a health history. A private underwritten plan can say no, or carve out the condition that brings you to the doctor most.
In this case my job is to make the marketplace work hard for you. We confirm your specialists and medications against each plan offered in your area and choose the one that keeps your family's care intact.
Next step: Give me the doctors and prescriptions that can't change and I'll go through the plans in your county with you, one by one.
Your employer plan likely ends on your last day as an associate. That loss opens a special enrollment period, generally 60 days, to get a marketplace plan outside the usual season. Practice transitions are full of deadlines, and this is one that's easy to miss.
If a private underwritten plan makes more sense for you, the application has to be reviewed before it takes effect, so start before your final day instead of after it.
Your first year as an owner is also when your draw might be at its lowest. Between the loan and the start-up costs, you could fall under the subsidy cutoff for that year, and then the marketplace with a subsidy is usually the most affordable answer. If that happens, give the marketplace a realistic income estimate and update it when the practice picks up, because extra subsidy you weren't entitled to can come back at tax time.
Next step: Call me a few weeks before you leave the associate job and we'll make sure your family's coverage doesn't skip a day.
A lot of dentists ask whether they should cover themselves through a staff plan. If you have no employees, you buy coverage the same way any self-employed person does. Contractors you pay, like a hygienist on a 1099, don't count as employees for this. Once you have at least one employee who isn't an owner or a family member, a small-business plan may become an option, and that's a separate conversation with its own rules. Either way, figuring out your own household's coverage is a good place to start.
In some counties the marketplace only offers HMO or EPO plans, and in others the PPO it does offer costs more than most families will pay. That doesn't limit you. As long as you're healthy, I can price a nationwide PPO for you in all 36 states I'm licensed in. A 15-minute phone call will show you what it would cost.
You can call with nothing, but these help:
There's no fee for working with me. I'm paid by the insurance company once you enroll, and your premium is the same with or without me.
Straight answers, no sales pitch.
It can be. With no employees, you buy individual coverage like any self-employed person. Once you have a non-owner, non-family employee, a small-business plan may be available, which has its own rules.
Usually, within limits. The self-employed deduction can't exceed the profit of the business, and months when you could join an employer plan, including a spouse's, are left out. Your tax preparer can confirm the details.
No. Contractors you pay don't count as employees when it comes to qualifying for a small-business plan.
That's the point of a nationwide network. If your household is healthy and over the subsidy cutoff, I can price private plans built on nationwide PPO networks in all 36 states where I'm licensed.
Give me a sense of what you draw from the practice, who's on your plan, and any doctors your family won't give up. I'll point you to the path that fits and price it, and if you're already in the right plan, I'll tell you to keep it.
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