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How to Get Health Insurance in the U.S.

How to Get Health Insurance in the U.S.

One of the most common questions that independent management consultants have is how to get health insurance as self employed, independent consultants and small businesses in the United States.

This resource provides detailed information on:

  • How more than 160 consultants obtained their current insurance (i.e. through a spouse’s plan, COBRA, the ACA marketplace, through a broker, etc.).
  • What company and insurance plan they have, grouped by state, along with the monthly premiums they pay.
  • A directory of brokers and HR/Professional Employer Organizations.
  • Experiences and/or helpful advice for others on how they navigated the process.

The short answer is that getting health insurance in the U.S. as an independent professional depends largely on whether you are a sole proprietor or have employees, with two main avenues of approach:

  • Sole proprietor: If you operate a one-person business and has no full-time W2 employees, the only current option is to obtain insurance through the Affordable Care Act Marketplace or directly with an insurance carrier or broker.
  • Firm with two or more W2 employees: You can obtain small group insurance plans, either directly through a insurance carrier or broker; or through a Professional Employer Organization. One of the W2 employees can include the owner.

Here we’ll break it down piece by piece, as well as sharing specific guidelines on the possible routes for obtaining health care as an independent consultant, and directories of the actual insurance plans (by state) and brokers that members have used.

If you are aware of insurance companies or brokers we haven’t listed, or would like to share with us updated information about one of the firms in our directory, please send us a message on our Contact page.

Contents

How Umbrex Members Obtained Health Insurance

In a survey conducted with independent management consultants, more than 160 U.S.-based professionals shared their experiences obtaining health insurance.

Most respondents to the survey have health insurance through their spouse or partner (29%), with the second-most common option being insurance obtained through the ACA Healthcare Marketplace (21%).

In addition to these two routes, consultants obtained their own insurance policies either directly from the carrier, or through a broker.

A smaller percentage have current coverage through COBRA, retirement coverage from a past employer, or Medicare.

How independent consultants obtain health insurance

The majority of respondents to our survey have health insurance with a small group of providers, largely consisting of:

  • Blue Cross Blue Shield of their state
  • UnitedHealth Group
  • Aetna (CVS Health)
  • Anthem
  • Cigna
  • Kaiser Permanente
  • 22% with other providers

Nearly two-thirds of independent consultants opt for a Preferred Provider Organization (PPO), with 15% with a Health Maintenance Organization (HMO).

More than two-thirds of the respondents have a plan covering more than one person: 44% have a family plan and 25% have coverage for themselves and a spouse or partner. 32% have an individual plan.

Approximately half of our independent consultants have a High Deductible Health Plan. An HDHP has higher annual deductibles and out-of-pocket maximum limits than traditional plans. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible).

A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes.

With an HDHP, the annual deductible must be met before plan benefits are paid for services, other than in-network preventive care services, which are fully covered.

HDHPs are meant protect you against catastrophic out-of-pocket expenses for covered services. Once your annual out-of-pocket expenses for covered services from in-network providers, including deductibles, copayments and coinsurance, reaches the pre-determined catastrophic limit, the plan pays 100% of the allowable amount for the remainder of the calendar year.

Frank Lacey says, “As my family is generally in good health, I opted for the low-premium, high-deductible plan. As my wife and I get older and my kids move out, I may switch to a higher premium, lower deductible plan.”

For more information on High Deductible Health Plans, HSAs and HRAs (as well as many other insurance terms), check this glossary provided by HealthCare.gov.

When it comes to costs, there is a wide range of monthly premiums that vary by several factors:

  • State of the U.S.
  • Provider and plan
  • Type of coverage
  • Individual, spouse, or family plan
  • Other factors

The typical ranges our consultants reported paying monthly are:

  • Individual plan: $500-950
  • Couple plan: $1,000-1,700
  • Family plan: $1,200-1,900

Next, let’s look at the specifics of what types of health care plans are available for independent consultants, and the various avenues you might take to obtain the best insurance for your needs.

Individual Insurance / ACA Healthcare Marketplace

If you are a sole proprietor, legally you are an individual and therefore not eligible for a business insurance plan. For those independent professionals who operate as a sole proprietor or LLC, without W2 employees, starting with the Affordable Care Act Marketplace is usually the best first step.

The Patient Protection and Affordable Care Act, referred to as the Affordable Care Act or “ACA” for short, is the comprehensive health care reform law enacted in March 2010. You can begin by looking up the health coverage exchange in your state at the HealthCare.gov website. 

If there is not a separate state website for your ACA marketplace, you would simply go through the federal site at healthcare.gov to obtain quotes and potential plans. Keep in mind that ACA insurance can only be obtained during the Open Enrollment period. This the only time of year when you can purchase or adjust your health insurance plan for the coming year. This year’s window is November 1, 2021-January 15, 2022. If you miss it, you’ll have to wait until next year.

You can also reach out to insurance carriers in your state to buy the insurance direct from them, says Molly Leeds, account vice-president at Brown & Brown of New York.

“That’s really the only option today for the individual,” Leeds says — either the ACA Marketplace or directly from an insurance company.

One member who researched insurance companies directly looked closely at insurer reviews, and researched which ones included their current doctors and dentists in-network.

Listen to Unleashed Episode 54 on Health Insurance

Business Small Group Insurance Plans

Once you have a company, meaning you have at least one full-time W2 employee besides yourself, that’s when you can get a group insurance plan for business.

To qualify for such a group plan, there are several scenarios that could exist:

  • Yourself plus one or more employees.
  • Yourself and a partner plus one or more employees.
  • Yourself and another independent professional who band together to form an LLC.

Leeds points out that to be considered a full-time employee, the federal guideline means that person works at least 30 hours per week. “Some insurance carriers will allow you to offer coverage for 20 hours a week, but the federal guideline is 30.”

While the requirement for a group plan is pretty consistent in all 50 states — at least one full-time employee — the maximum number of employees that falls under a small group plan varies by state.

“In New York, a small group is considered a company of up to 100 employees,” Leeds explains. “In New Jersey, a small group is defined as a company with up to 50 employees.”

Some insurance carriers require at least one full-time W2 employee no matter your ownership or partner situation. In other words, for these carriers, an LLC or partnership with several independent professionals — but no employees — would not qualify.

Leeds says it just depends on the underwriting guidelines for each carrier.  “But there are plenty of options out there for small groups, so generally our clients won’t have too hard of a time finding one even if one carrier won’t allow for their specific type of setup. There is another one that will.”

She also cautions about one situation where more than one partner or employee in the firm would not qualify.

“The only situation that can prevent it is if the two business owners or the owner and employee are a married couple. They would then be considered a company of one. So if that was the case then they would need a third person at the company to make it really a company of two.”

One Umbrex consultant with company employees has provided group health insurance benefits to himself and his team for a few years.

“We offer an HRA and FSA — but no HSA as we don’t offer HSA/HDHP plans (anymore). We used to, but the coverage and experience through United / Oxford was absolutely shocking so we switched to a self-insured style plan. The compliance needs were insane and they wanted to 4x our costs on year two, so we dropped that and went with Blue Cross Blue Shield and now everyone is really happy with their coverage — even thought it’s expensive,” he reports.

In order to obtain a business health insurance group plan, you typically would need to provide certain documents establishing your business, such as:

  • Tax returns
  • SS4
  • Articles of incorporation

“If you have a few full-time employees, group insurance would be the way to go,” says one Umbrex consultant.

Another reports that she plans to convert her 1099 contractors to W2 employees and seek a full-service group plan for the company next year.

ACA Marketplace vs Small Group Plan

While Leeds advises starting with the federal or state health care exchange under the Affordable Care Act is usually the best place for an independent professional to start their health insurance search, they can then expand to explore small group plans outside the ACA program, and compare to see which is the best fit for their needs.

She explains that there can be several big differences between an ACA plan and a private small group plan.

Network

“One of the big differences can be the network. A standard carrier in New York, whether it be Oxford or Blue Cross or Emblem, they’ll have a network for their group plans — and then there’s a network for the exchange plans. There could be more doctors within the group plan network versus the individual exchange plan network. I would say that is one of the big differentials.”

Ease of Use

You also typically have more ease of use when you have a group plan — rather than calling an individual insurance plan and possibly having to call the exchange, or jumping around through HealthCare.gov and the carriers’ website —having a small group plan keeps it all together and is usually more user-friendly to manage.

Rates

Costs can also differ because the individual exchange plan rates are based on where they live, while the group insurance rates are based on where your company is located. That is often one and the same, but not always. Leeds says there are sometimes other variables depending on where the company is based.

On group plans, depending on the location, pre-existing conditions and factors such as age and gender are not factors. It doesn’t matter how old you or your employees are, or how healthy you are — all companies get the same rate.

“New York City has a small group rate called community-rated,” Leeds offers as an example. “The rates are not based on age or gender. They’re based on the plan design — meaning the deductible, the copays, the network, and where the company is located. The rates are filed with the state of New York and once they’re approved those are the rates that everyone has.”

In effect, there could be two companies next door to each other in the same office building — one could have five 25-year-olds, and one could have five 45-year-olds, and if they’re on the same plan and renew at the same time, they would get the same exact rates.

“It wouldn’t matter on their age or usage. And an employee’s health does not come into question any more anyways. Neither do pre-existing conditions,” she clarifies.

The healthcare.gov exchange for individuals, on the other hand, does ask some basic questions to determine your rate:

  • Age
  • Gender
  • Where you live
  • If you smoke

Plans and rates in the ACA exchange marketplace are also going to depend on what carriers are available — not all insurance carriers are available in the marketplace.

There are a lot of variables, and Leeds says the only way to find your best personal coverage is to start with the ACA exchange and then compare that with quotes for a private individual or small group plan. A 25-year-old nonsmoker might find a better rate through ACA, while a 55-year-old smoker might get a better rate through a small group plan.

“It’s an exercise to do. A lot of times you get better coverage and a better network when you’re on a group plan,” she says.

For the Umbrex consultants who responded to our survey, about half conducted five hours or less of research before deciding on a plan. 27% did about 10 hours of research, with some spending 15-20+ hours researching health care plans.

Choosing a Plan

Leeds says that the best way to get started with finding the best health insurance plan for your firm’s needs is to talk with an insurance agent, carrier, or broker.

“When I get introduced to people that would fit this type of model, it starts with a conversation — just to understand their setup, who’s there, who’s involved, what kind of documentation they have. And then that’s when we would go to the market to see who would be the right fit for them based on the state that they’re in, their size, and the makeup of their company.”

There are several different types of plans:

  • HMO: Health Maintenance Organization — an in-network plan that requires you to get a referral to see a specialist.
  • EPO: Exclusive Provider Organization — in-network plan that doesn’t usually require a referral to see a specialist.
  • PPO: Preferred (or Participating) Provider Organization— in-network plan that also allows for out-of-network benefits (at a higher deductible or out-of-pocket cost). Generally don’t require a referral to see a specialist.
  • POS: Point of Service — an in-network plan that requires you to get a referral to see a specialist.

There are also three other programs that can be part of an insurance plan:

  • HSA: Health Savings Account — A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
  • HRA: Health Reimbursement Arrangement — Employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. 
  • FSA: Flexible Spending Account — An employer arrangement that lets you pay for many out-of-pocket medical expenses with tax-free dollars.

When choosing your plan, several important factors should be considered:

  • Budget (what plans fit your needs on cost?).
  • Network physicians (are your preferred providers covered?).
  • Deductible and out-of-pocket expenses.
  • Co-pays, wellness visits, prescriptions, dental/vision, etc.

In addition to health insurance, 27% of consultants who responded to our survey have a prescription discount card. The vast majority of these use GoodRx, though a few have others such as OptumRx and CVS Caremark.

Some also report having a separate dental plan, such as Aetna Dental Vital Savings Discount Plan.

In the end, it takes a bit of research and due diligence, combined with doing a little math, to determine the best plan for you.

“You could say, ‘I need to save money on my premium, I want a really high deductible’,” Leeds says. “But once you add in the premium plus the deductible or the max out-of-pocket, if you happen to meet it, you might be really close to that other plan that was a little bit more money per month but a lower out-of-pocket. So there is math work.”

Often, she adds, she will advise her clients to look at their past usage. One way to do this is to get a report from your current insurance carrier of claims over the past 12 months. If you use that as a projection for the next year, you can figure what you can expect and what plan works best for your actual medical needs and usage.

You may also have changed medical needs, or perhaps know you will have a procedure or surgery coming up soon. This can be factored in to determine if another type of coverage will suit you better.

Overall, the majority of Umbrex consultants reported being satisfied or very satisfied with their health care plan and insurance coverage.

Using an Insurance Broker

When getting quotes for a small group plan, you can go directly to the insurance companies themselves. A broker isn’t required, but they can often provide several advantages:

  • Advocacy
  • Guidance
  • Relationship
  • Knowledge of your situation

“One of the benefits of having a broker is you have an advocate,” Leeds says. “So when issues come up, you have someone you can call. And really when you need the guidance from someone who’s trained to read through these plans and understand these plans, it’s a huge benefit.”

Having an employee benefits broker can also make the renewal process easier. A broker already knows you and your company and can provide a proposal with various options because they understand your needs.

“A lot of times with our clients, sometimes if they have claim problems or a billing error, they don’t really necessarily want to call the insurance company, they don’t have time to call the insurance company. And that’s just some of the other services that brokers can do. They can help out with the day to day stuff as well as understanding the plan and all the compliance rules around it.”

Many Umbrex members do use a broker (see directory below), and find it helpful.

One consultant says, “I explored in two directions: getting a plan on my own through the state exchange, and through a broker who came in via a reference from a friend. I decided on the one with the broker so that I can have a real person to ask questions in the process. Plans through exchange were a little harder to wade through, and there is just way too much irrelevant advertising on the sites that I didn’t want to deal with. “

Eric Eskey offers the following advice. The ideal broker/insurer would:

  • Make accurate risk assessments available to everyone.
  • Help us to overcome biases, e.g., “it will not happen to me”.
  • Premiums reflect my risks (We invest significantly in our health and believe we are at lower risk than most. Our premium should reflect that. i.e., avoid premium averaging).
  • Help us avoid under purchasing, i.e., insurance with reasonable premiums.
  • Help us avoid over purchasing, i.e., paying excessive premiums for a given risk.
  • Help us to avoid insurance benefits that aren’t worth the cost (e.g., service add-ons we’ll never use).
  • Provide multi-year policies rather than annual.
  • Provide access to alternatives to insurance, such as health shares (especially new options free from religious doctrine).

“Find someone you can talk to, someone you trust, someone that’s available when you need them. Because it’s really about the service,” Leeds says.

To find a broker, one consultant started with brokers in the ACA exchange, then did their own research on Google.

“We found a broker [Doug Deavers] who had been in business in our market for over 10 years. He was very helpful and did a lot of the initial heavy lifting,” he says.

Other Approaches

No matter how you go about obtaining health care or insurance, and what you end up with, there’s no denying that it requires research and due diligence to obtain adequate coverage as an independent professional, rather than through an employer.

That said, most Umbrex consultants say that this added level of difficulty is not a significant barrier to being an independent professional. Only 17% strongly agree that the barrier is so significant, it has caused them to consider taking full-time employment.

“Having a spouse with an employer-sponsored insurance plan that covers our family was a major factor in my decision to become an independent professional,” says one consultant.

Insuring through other work

There are also some other interesting routes that a few independent consultants have taken. One teaches at a university as an adjunct, because the university allows adjuncts to buy its insurance through a union contract.

David Edelman also uses this approach. “I teach at Harvard Business School, and as long as you are over 40% employed by them, you get health insurance. It is a nice deal.”

Dave Faircloth partnered with another consulting firm through which he was able to get health care benefits.

Joining an association or union

Jonathan Paisner was able to join a local trade union through broker Michael LaValley and participate in their plan. 

“The plan has changed once or twice over the past few years. The plan was originally with Magnacare; the current plan (which started this year—EmblemHealth PPO) generally seems to be better coverage and more user friendly,” he says. “This approach worked better for our needs than what we could find on the ACA marketplace.”

Using cost-sharing plans 

A few consultants report getting plans from companies that are cost-sharing networks rather than insurance.

“A fellow independent consultant pointed me to medical ‘sharing’ plans,” says another member. “These act like insurance but are very clear they are not insurance. There is no regulatory body evaluating these plans which does create a risk that a particular medical incident may not be ‘shared (aka ‘covered’).”

This consultant researched the option, Medi-Share, by  consulting with several insurance brokers.

“Many expressed a high confidence in these plans and have detailed past experiences with clients that have had major medical expenses and have had them covered. Most of these are religiously affiliated and require you to attest to certain behaviors,” he says.

“I continue to have a lingering concern that the sharing plan won’t be there for my family when I need it but the cost benefits have, so far, outweighed that concern.”

Barry Witonsky also uses Medi-Share, stating that it’s a Christian-based cost-sharing plan rather than a typical insurer.

“It basically has a deductible you select and for costs above that kicks in. Providers view it more as a self-pay but we at least have the deductible as a blanket. We heard about it from a friend, researched, and selected it.”

A third member says a broker, Robb Fittro, recommended Medi-Share, though they ultimately decided not to move forward with the option.

Outsourcing benefits

Another option for independent consulting businesses with W2 employees is to utilize an outside company to handle payroll and benefits, such as health insurance.

“I stumbled onto a different solution,” reported one consultant. “WeWork, at that time, had a deal with TriNet (the payroll benefits administration company) that allowed WeWork members to join the TriNet group plans with Aetna, Blue Cross, and other payors. The WeWork/TriNet/Aetna plan seemed better for us than the United plan from my university, so we took Aetna and have renewed for two years.”

See more about this option, and a listing of such companies, in the next section.

HR/Professional Employer Organizations 

For consulting companies with two or more W2 employees — which can include the owner — an outsourced PEO company can offer human resources benefits including health insurance.

If you pay yourself as a sole proprietor with an owner’s salary or draw, or you are the only W2 employee, this option isn’t a viable one.

Please note that in the case of a married couple who are both W2 employees of the company and will be on one insurance plan together, they may or may not be considered as two, or just one, of the minimum employee requirements. If the couple will be on a “family” or “spouse” plan, then they may only count as one insured/employee.

If this is your situation, be sure to review with the PEO firm to get the correct details for your particular situation. Regardless, an initial consultation with any firm will provide specific details and plans for your specific needs. These consultations are provided at no cost from all PEO firms listed here.

These companies also provide many other HR tasks that can range from time tracking and payroll administration to obtaining and offering group benefits, including other insurance such as life, disability, auto and/or home, talent onboarding and management, and more. 

Here is a directory of HR/Professional Employer Organizations that our members have used or recommend:

Gusto

Minimum Number of W2 Employees: 2

Website: gusto.com

Gusto is a small group health insurance broker that provides clients with health insurance — as well as dental and vision coverage — through more than 30 carriers with 9,000+ plans, with licensed advisors to help through the process of selecting and setting up health insurance benefits as well as compliance.

Gusto’s all-in-one people platform handles full-service payroll, employee benefits, time-tracking and attendance, hiring and onboarding, talent management, and insights and reporting. Three tiers of service range from $40-80/month, plus $6-12/per employee. It also offers a Contractor-Only service, for independent contractor-only businesses who haven’t hired W-2 employees, for $6/month.

Member Experience: Several member consultants use Gusto, and Umbrex does as well.

Insperity

Minimum Number of W2 Employees: 5

Website: insperity.com

Eligible employees have access to Fortune 500-level benefits including medical, dental, and vision insurance under Insperity-sponsored benefit plans. As the plan sponsor and administrator, Insperity handles the benefits process from beginning to end.

Other benefits include life and disability insurance, FSA, and HSA. Insperity can also handle HR admin and support, payroll, risk management, compliance, and talent management. 

Member Experience: Several members recommend this service. One says, “Aggregators of small businesses like Insperity, TriNet and Rippling are advantageous to businesses with N+1 employees because they bring thousands of businesses together, and through economies of scale, can offer better benefits at lower premiums than individuals would receive on their own.”

Rippling

Minimum Number of W2 Employees: 2

Website: rippling.com

The Rippling platform lets you effortlessly manage your employees’ payroll, benefits, devices, apps, and more—in one place. Benefits include medical, dental, vision, FSA, and HSA with more than 4,000 plans from the nation’s leading carriers, including Aetna, Humana, and Blue Cross Blue Shield.

Rippling is the only HR platform that supports every broker, giving you the option to work with their brokers or your own. You can even give your broker access to the Rippling platform for additional guidance when choosing new coverage. It also automates compliance and offers a suite of customizable templates for everything from benefits enrollment to new hire paperwork.

Member Experience: “I have used Rippling, Insperity, and TriNet to get insurance quotes and have used each of them as professional service firms for outsourced HR administration and management. The medical, dental, vision, and 401k plans are all better premiums that individuals can get because each of those firms bring together economies of scale by combining the needs of thousands of small-mid size businesses and their employees.”

TriNet

Minimum Number of W2 Employees: 5

Website: trinet.com

TriNet allows small companies to offer their employees access to the benefits of large corporations, including health insurance through a number of carriers and policies. 

TriNet’s employee benefit plans go beyond access to health coverage to include additional benefits such as dental, vision, life, disability, access to auto and home policies, commuter benefits, retirement benefits, and more.

TriNet also helps navigate compliance and administration requirements, provides training on sensitive issues, and offers talent/recruitment services to help companies compete and grow. 

Member Experience: “I reviewed PEOs that provide services including group medical coverage with national carriers such as Aetna and Blue Cross Blue Shield to self proprietors / dual member LLCs. I use TriNet and utilize one of their medical coverage options (Empire BCBS). The downside is that TriNet charges a minimum $1,000 monthly service charge to all clients, so this extra monthly fee must be taken into account when considering the total cost of medical coverage.”

Directory of Member Insurance Plans 

Legend of plan types:

  • EPO: Exclusive Provider Organization 
  • HMO: Health Maintenance Organization
  • HSA:Health Savings Account
  • POS: Point of Service
  • PPO: Preferred Provider Organization

These health insurance plans are those used by our members who report being satisfied with the plan. We have provided the monthly premium amounts as reported by our members. They are organized by state, as policies and premiums differ according to state. However, a number of the insurance companies are nationwide or multi-state.

Multi-state Insurance Companies

  • Ambetter (Arizona, Arkansas, California, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington)
  • CareSource (Arkansas, Georgia, Indiana, Kentucky, Ohio, West Virginia)
  • Cigna (Arizona, Colorado, Florida, Georgia, Illinois, Kansas, Missouri, Mississippi, North Carolina, Pennsylvania, Tennessee, Utah, Virginia)
  • HealthPartners (Minnesota, Wisconsin)
  • Kaiser Permanente (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, Washington D.C.)
  • Kemper Health (Nationwide except New York)
  • Medica (Arizona, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Wisconsin, Wyoming)
  • Oscar (Nationwide)
  • Sidecar Health (Nationwide)
  • UnitedHealth Group (Nationwide)

California

Company: Blue Shield of California
Plan: PPO
Monthly Premium: Family ($1,800 – 2,100); Couple (unknown); Individual (unknown)
Website: blueshieldca.com

Company: Kaiser Permanente
Plan: HMO
Monthly Premium: Family (unknown); Couple ($800); Individual ($550)
Website: kaiserpermanente.org
Comments: One member says, “My family and I had PPO health care for 20 years but switched over to Kaiser 20 years ago because of the high degree of integration. Hugely satisfied with the decision.” Another says, “Kaiser NorCal can be a very good choice. My prior plan canceled all individual plans prior to ACA. Even though I had what was then considered a preexisting condition, Kaiser was the only plan to accept me.”

Company: Sutter Health
Plan: HMO/Sutter Health Plus
Monthly Premium: Family ($1,500); Couple (unknown); Individual (unknown)
Website: sutterhealth.org

Colorado

Company: Kemper Health
Plan: Undisclosed
Monthly Premium: Family ($550); Couple (unknown); Individual (unknown)
Website: kemperhealth.com
Comments: One member initially had insurance through Freedom Life, but found the coverage lacking. After recently checking around, he still couldn’t find anything through traditional plans that would work. He was then contacted by a broker, Brian Gray, about Kemper Health, which he says “seems like a step up from what we had.”

Company: Medi-Share
Plan: N/A
Monthly Premium: Family ($550); Couple (unknown); Individual (unknown)
Website: medishare.org
Comments: Barry Witonsky says, “Medi-Share is not a typical insurer. It basically has a deductible you select and for costs above that kicks in. Providers view it more as a self pay but we at least have the deductible as a blanket. It’s also a Christian-based plan so maybe not for everyone, but fine for us. We heard about it from a friend, researched, and selected it.” Another consultant’s broker, Robb Fittro, recommended Medi-Share but ultimately he decided not to move forward with this option.

Connecticut

Company: Connecticare
Plan: POS/Choice Bronze Standard
Monthly Premium: Family (unknown); Couple (unknown); Individual ($600)
Website: connecticare.com

Company: UnitedHealth Group
Plan: EPO/United Oxford OHI EPO Non-gated (Freedom Network)
Monthly Premium: Family ($2,200); Couple (unknown); Individual (unknown)
Website: uhc.com
Comments: David Boxenbaum says, “I got introduced to a broker (Michelle Brown) who held my hand during the entire process. Took a lot of the pain out of it.”

Delaware

Company: Highmark Blue Cross Blue Shield Delaware
Plan: POS Silver
Monthly Premium: Family ($1,780); Couple (unknown); Individual (unknown)
Website
: highmarkbcbsde.com
Comments: Keith Polak says, “Cost of the plan balanced with included services like prescriptions, copays, vision, dental, etc.”

District of Columbia

Company: CareFirst Blue Cross Blue Shield
Plan: BluePreferred PPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($780)
Website: carefirst.com

Florida

Company: Florida Blue
Plan: BlueSelect Silver PPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($450)
Website: floridablue.com
Comments: “This year they raised my deductible and monthly substantially because I estimated higher income to be about $20,000 more than past years. It increased my monthly by $250 a month, and changed it from a no deductible plan to a deductible of 10K. The shift seemed dramatic so I appealed it and it got a bit better.”

Company: UnitedHealth Group
Plan: UnitedHealthcare Choice Plus Network
Monthly Premium: Family ($1,800); Couple (unknown); Individual (unknown)
Website: uhc.com

Georgia

Company: Ambetter
Plan: PPO/Ambetter Secure Care 5
Monthly Premium: Family (unknown); Couple ($980); Individual (unknown)
Website: ambetterhealth.com

Company: Caresource
Plan: PPO
Monthly Premium: Family (unknown); Couple ($1,600); Individual (unknown)
Website: caresource.com

Company: UnitedHealth Group
Plan: Not specified
Monthly Premium: Family (unknown); Couple (unknown); Individual ($1,000)
Website: uhc.com
Comments: One member selected UnitedHealth because it was integrated with Gusto, his payroll provider. 

Illinois

Company: Blue Cross Blue Shield of Illinois
Plan: Blue Precision BronzeSM HMO 205
Monthly Premium: Family (unknown); Couple ($1,500); Individual (unknown)
Website: bcbsil.com
Comments: Alan Walker, on this plan, discloses that the annual deductible is $17,000.

Company: Blue Cross Blue Shield of Illinois
Plan: PPO
Monthly Premium: Family ($1,900); Couple (unknown); Individual (unknown)

Website: bcbsil.com

Maine

Company: Anthem Blue Cross and Blue Shield Maine
Plan: Undisclosed
Monthly Premium: Family (unknown); Couple (unknown); Individual ($350)

Website: anthem.com/
Comments: “We chose Anthem because of the providers we spoke with, its agents were the most accessible and helpful. In choosing our supplement option, we dealt with a very helpful Health Navigator at York Hospital here in Maine.”

Maryland

Company: CareFirst Blue Cross Blue Shield
Plan: BluePreferred PPO Gold
Monthly Premium: Family (unknown); Couple ($1,000); Individual (unknown)

Website: carefirst.com

Massachusetts

Company: Blue Cross Blue Shield of Massachusetts
Plan: PPO
Monthly Premium: Family ($1,200); Couple (unknown); Individual (unknown)

Website: bluecrossma.org

Company: Blue Cross Blue Shield of Massachusetts
Plan: HMO Blue
Monthly Premium: Family (unknown); Couple ($1,200); Individual (unknown)

Website: bluecrossma.org
Comments: Barry Horwitz says, “I signed up for Blue Cross programs as a small business many years ago, and so I didn’t shop around when ACA came around. It was an expensive plan, but had great coverage. I focused on the quality of coverage and didn’t shop around for a less expensive plan until my wife and I both reached the ripe old age of 65 and are now on Medicare Advantage.”

Company: MassHealth
Plan: PPO/Preferred Care Clinical
Monthly Premium: Family (unknown); Couple (unknown); Individual (unknown)

Website: mass.gov
Comments: “Initially it was a frustrating process of filling information and then getting bombarded by brokers; there is a lack of transparency and there are many third party aggregators, that navigating and deciding becomes tiring. During the pandemic it became easier to opt directly for the plan offered by the state and this process was fairly straightforward.”

Company: Health New England
Plan: HMO Silver
Monthly Premium: Family (unknown); Couple ($1,000); Individual (unknown)

Website: healthnewengland.org
Comments: One member says, “I used to have a plan that I purchased through a small business group but during the pandemic when ACA had tax incentives and open enrollment, I signed up with my state’s exchange. I was essentially looking for a plan that was similar to what we had before and thankfully found it with the same provider and, thus, could also keep my doctor. Since both spouse and I are healthy, I was happy to have a higher deductible and lower monthly payments.”

Michigan

Company: Blue Cross Blue Shield of Michigan
Plan: Blue Cross Premier PPO Bronze Saver
Monthly Premium: Family ($1,670); Couple (unknown); Individual (unknown)

Website: bcbsm.com

Minnesota

Company: Blue Cross Blue Shield of Minnesota
Plan: Blue Plus Minnesota Value Gold $1000 Plan 205
Monthly Premium: Family (unknown); Couple (unknown); Individual ($500)

Website: bluecrossmn.com
Comments: “I contacted a local insurance broker (Hyatt Harper) when I left my prior firm. The broker helped me to purchase a Platinum BCBS plan at the time (several years ago) and it was a PPO. BCBS steadily raised the individual premiums and reduced the size of the network every year. The network became so narrow that I eventually bought a second plan from another insurer (Medica, below) to try to cobble together better overall coverage.  Now I pay for two plans and have the ‘best’ individual plans one can get in my state. When you have two individual plans you have to advise each plan of the other plan so that they can coordinate benefits. One is deemed primary and the other is deemed secondary; at least in my state the priority is based on which policy has been in place longer.

Company: HealthPartners
Plan: HealthPartners Individual Peak HSA
Monthly Premium: Family (unknown); Couple (unknown); Individual ($660)

Website: healthpartners.com

Company: Medica
Plan: Blue Plus Minnesota Value Gold $1000 Plan 205
Monthly Premium: Family (unknown); Couple (unknown); Individual ($500)

Website: medica.com
Comments: This member has two plans, one through Medica and one through Blue Cross Blue Shield of Minnesota.

Nevada

Company: Sierra Health and Life
Plan: EPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($475)

Website: sierrahealthandlife.com
Comments: “I knew I did not want COBRA as premium was crazy high. So I found a broker (Nathan Kamo), went to his office and reviewed various options that were more budget friendly.”

New Jersey

Company: Cigna
Plan: PPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($950)

Website: cigna.com

Company: Horizon Blue Cross Blue Shield of New Jersey
Plan: PPO
Monthly Premium: Family (unknown); Couple ($1,700); Individual (unknown)

Website: horizonblue.com
Comments: Several members in New Jersey have this plan.

Company: Horizon Blue Cross Blue Shield of New Jersey
Plan: PPO and EPO
Monthly Premium: Family ($2,200); Couple (unknown); Individual ($600)

Website: horizonblue.com
Comments: This member has this coverage and offers three plans (Platinum, Gold, and Silver) to their firm’s partners and employees. “We offer an HRA and FSA, but no HSA.  We used to, but the coverage and experience through United/Oxford was absolutely shocking so we switched to a self-insured style plan — but the compliance needs were insane and they wanted to 4x our costs on year two, so we dropped that and went with BCBS and now everyone is really happy with their coverage, even though it’s expensive.”

New York

Company: Emblem Health
Plan: PPO
Monthly Premium: Family ($2,200); Couple (unknown); Individual (unknown)

Website: emblemhealth.com
Comments: Jonathan Paisner worked with broker Michael LaValley to obtain this plan. “With Mike I was able to join a local trade union — and can participate in their plan. The plan has changed once or twice over the past few years, and (of course) price has increased every year. The plan was originally with Magnacare; the current plan (which started this year) generally seems to be better coverage and more user friendly. This approach worked better for our needs than what we could find on the ACA marketplace.”

Company: Empire Blue
Plan: Empire BCBS Blue Access EPO with HSA
Monthly Premium: Family ($1,900); Couple (unknown); Individual ($650)

Website: empireblue.com
Comments: 
I reviewed PEOs that provide services including group medical coverage with national carriers such as Aetna and Blue Cross Blue Shield to self proprietors / dual member LLCs. I use Trinet and utilize one of their medical coverage options (Empire BCBS). The downside is that Trinet charges a minimum $1,000 monthly service charge to all clients, so this extra monthly fee must be taken into account when considering the total cost of medical coverage.”

Company: Fidelis Care
Plan: HMO Bronze
Monthly Premium: Family (unknown); Couple (unknown); Individual ($450)

Website: fideliscare.org

Company: UnitedHealth Group
Plan: UnitedHealth Compass PPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($1,100)

Website: uhc.com

Company: UnitedHealth Group
Plan: United Healthcare Compass Platinum HMO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($1,600)

Website: uhc.com

North Carolina

Company: Blue Cross Blue Shield of North Carolina
Plan: HMO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($350)

Website: bluecrossnc.com
Comments: Sarah Brock says, “I did not feel like I had a lot of options in my state. I’ve gone through the Health Care Marketplace in two different states, with vastly different results in what was available. I’m not required on my plan to have a referral to see a specialist, which is a huge plus. In evaluating insurance plans, I weighed the deductible and amount covered in the event of an emergency. I went with as high of a deductible as I felt comfortable paying out of pocket should I need to, and in exchange have a high percentage covered for most unexpected things.”

Ohio

Company: Anthem Blue Cross and Blue Shield Ohio
Plan: PPO/Anthem Enhanced Choice 3500
Monthly Premium: Family (unknown); Couple (unknown); Individual ($1,200)

Website: anthem.com
Comments: “Learned about it through broker, but then bought direct from carrier. My plan is technically a ‘short term’ medical plan for 364 days per year. It is underwritten. It acts the same as the group plan I had in my corporate life in terms of deductibles, co-insurance, access, etc.”

Oregon

Company: PacificSource
Plan: PPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($500)

Website: pacificsource.com
Comments: One Umbrex member says, “I went onto the Oregon Healthcare exchange and selected the best plan that I could. I moved a couple times which created extra work to switch between states, but I never found the process to be too difficult. The hardest part was lining up the termination in one state with the start of coverage in the next to avoid double-paying or a gap in coverage. I addressed that by making sure I signed up for the new coverage and knew its effective date before terminating my old coverage.”

Texas

Company: Baylor Scott & White
Plan: BSW Preferred HMO
Monthly Premium: Family ($1,300); Couple (unknown); Individual (unknown)

Website: bswhealth.com

Company: Blue Cross Blue Shield of Texas
Plan: PPO/Student Health Plan
Monthly Premium: Family (unknown); Couple (unknown); Individual ($250)

Website: bcbstx.com

Company: Blue Cross Blue Shield of Texas
Plan: BCBS Gold PPO Plus
Monthly Premium: Family (unknown); Couple (unknown); Individual ($1,080)

Website: bcbstx.com

Company: Sidecar Health
Plan: POS
Monthly Premium: Family (unknown); Couple (unknown); Individual ($680)

Website: sidecarhealth.com
Comments: Barbara Carkenord says, “In addition to being an independent consultant, I am a nomad so state plans won’t work for me. I found Sidecar Health which is a new company and is trying a new approach. The company allows you to design your own plan with respect to deductible amount. This plan uses the declaration of a cash payment at the point of service, to encourage providers to charge a lower price because they don’t have to deal with insurance. Sometimes this does result in a lower price. Sidecar also has a database of providers and looks for low cost options so if you can plan ahead, you can find more reasonable services. I am not totally happy with it, but it seems to be my best/only choice at this point; I am hesitant to recommend Sidecar to someone who has ongoing medical needs.” 

Company: UnitedHealth Group
Plan: PPO/United Healthcare Choice Plus
Monthly Premium: Family ($1,170); Couple (unknown); Individual (unknown)

Website: uhc.com
Comments: Jason Linkswiler says, “I was coming off an 18-month Cobra plan and a broker (Blake Terry) timely reached out on LinkedIn. I did my homework and researched various ACA coverages and the private coverage was a much better plan.”

Virginia

Company: Anthem Blue Cross and Blue Shield Virginia
Plan: PPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($1,200)

Website: anthem.com

Company: Cigna
Plan: EPO/Cigna Connect 2000
Monthly Premium: Family (unknown); Couple (unknown); Individual ($500)

Website: cigna.com

Company: Kaiser Permanente
Plan: HMO/KP VA Gold
Monthly Premium: Family (unknown); Couple (unknown); Individual ($750)

Website: kaiserpermanente.org

Wisconsin

Company: Common Ground Healthcare Cooperative
Plan: Common Ground Bronze EPO
Monthly Premium: Family (unknown); Couple (unknown); Individual ($430)

Website: commongroundhealthcare.org

Insurance Brokers

The following is a directory of employee benefits/insurance brokers used and recommended by Umbrex members.

Firm: Bankers Life
Contact: David Phillips
Email:
david.phillips@bankerslife.com
Phone
: 941-447-6455
Website
: bankerslife.com
Based in
: Sarasota, FL
Geographical area served: Nationwide

Firm: Benefits and More
Contact: Eileen S Falk MPA
Email: benefitsandmore@gmail.com
Phone
: 516-726-2658
Website
: LinkedIn
Based in
: Great Neck, NY
Geographical area served: New York, New Jersey, Maryland, Pennsylvania, North Carolina, Virginia

Firm: Brown & Brown
Contact: Molly Leeds
Email:
mollyl@bbinsnyc.com
Phone
: 212-818-9570, ext. 228
Website
: bbrown.com
Based in
: New York, NY
Geographical area served: Nationwide
Recommendation: Listen to our Unleashed podcast with Molly Leeds, where she discusses healthcare benefits, the various options for health insurance, and how to find and select a health insurance broker. 

Firm: Cotton’s All Lines Insurance, Inc.
Contact: Mike Cotton
Phone
: 352-338-1222
Website
: cottonsalllines.com
Based in
: Gainesville, FL
Geographical area served: Florida
Recommendation: Cotton was referred to an Umbrex member by their accountant, and the member says he is “excellent.”

Firm: Critical Path Advisors
Contact: Michelle Brown
Email
: mbrown@criticalpathadvisors.com
Phone
: 877-917-9355, ext. 143
Website
: criticalpathadvisors.com
Based in
: Jersey City, NJ
Geographical area served: Nationwide, with geographic concentrations in the New York tri-state area, California, and Florida.
Recommendation: David Boxenbaum, who ultimately got insurance with UnitedHealth Group, says that Brown held his hand during the entire process — taking a lot of the pain out of it.

Firm: Douglas Deavers Financial Services, Inc.
Contact: Doug Deavers
Email
: deaversanddeavers@comcast.net
Phone
: 239-947-2443 
Website
: deaversfinancialservices.com
Based in
: Bonita Springs, FL
Geographical area served: Nationwide 
Recommendation: Deavers helps clients navigate the complex and confusing insurance marketplace. The member who recommends him says, “He was very helpful and did a lot of the initial heavy lifting.”

Firm: Healthcare Solution Team
Contact: Karina Pagan
Email
: kpagan@myhst.com
Phone
: 407-962-6984
Website
: myhst.com
Based in
: Lombard, IL
Geographical area served: Nationwide 

Firm: Jaffe Insurance Agency
Contact: Craig Jaffe
Email
: craig@jaffeinsurance.com
Phone
: 310-827-5050
Website
: jaffeinsurance.com
Based in
: California
Geographical area served: California (also licensed in 32 other states, though prefers to take new clients only in California)

Firm: Kamo Insurance Agency
Contact: Nathan W. Kamo
Email:
nkamo@kamoinsuranceagency.com
Phone
: 702-425-5663
Website
: kamoinsuranceagency.com
Based in
: Henderson, NV
Geographical area served: Arkansas, Arizona, California, Florida, Iowa, Missouri, Nevada, North Carolina, Ohio, South Carolina, South Dakota, Texas, Utah
Recommendation: “I knew I did not want COBRA as premium was crazy high. So I found [Kamo], went to his office, and reviewed various options that were more budget friendly.”

Firm: Kassel Benefits
Contact: Jane Kassel
Email:
jane@kasselbenefits.com
Phone
: 602-279-5263
Website
: kasselbenefits.com
Based in
: Phoenix, AZ
Geographical area served: Arizona, Texas, and Illinois 

Firm: Katzman Insurance Services
Contact: Jack Katzman
Email: jack@katzmanins.com
Phone
: 800-967-5252
Website
: katzmanins.com
Based in
: Vero Beach, FL
Geographical area served: Nationwide 

Firm: Kemper Health
Contact: Brian Gray
Email
: brian.gray@kemperhealthagent.com
Phone
: 800.654.9106
Website
: kemperhealth.com
Based in
: Oklahoma City, OK
Geographical area served: Gray is licensed in Kansas, Nebraska, Colorado, Missouri, Oklahoma and Wisconsin; but Kemper serves nationwide.

Firm: Mutual of Omaha Advisors
Contact: Hyatt Harper, CFP®
Email
: hyatt.harper@mutualofomaha.com
Phone
: 816-453-7676
Website
: mutualofomaha.com
Based in
: Bloomington, MN
Geographical area served: Nationwide 

Firm: Opus Private Client, LLC
Contact: Stefan Carpentieri
Email
: SCarpentieri@opus-pc.com
Phone
: 914-825-1000
Website
: opus-pc.com
Based in
: Rye Brook, NY
Geographical area served: New York 
Recommendation: Comes highly recommended by a member, who says working with Carpentieri was awesome.

Firm: Park Avenue Benefit Planning, Inc.
Contact: Michael LaValley
Email
: mlavalley@parkavebenefits.com
Phone
: 914-409-4022
Website
: parkavebenefits.com
Based in
: Elmsford, NY
Geographical area served: New York 
Recommendation: Jonathan Paisner has been working with LaValley for several years and says, “With Mike I was able to join a local trade union — and can participate in their plan.”

Firm: Pollack Services Group
Contact: Lynn Pollack
Email
: Lynn@pollackservices.com
Phone
: 914-833 – 8900
Website
: pollackservices.com
Based in
: Larchmont, NY
Geographical area served:  Nationwide

Firm: Potomac Companies
Contact: Joseph A. Appelbaum
Email
: ja@potomacco.com
Phone
: 301-840-0770
Website
: potomacco.com
Based in
: Rockville, MD and Fort Lauderdale, FL
Geographical area served: Nationwide

Firm: Rose Insurance Group
Contact: Christine Vose
Email
: info@roseins.com
Phone
: 800-760-4883
Website
: roseins.com
Based in
: Mill Valley, CA
Geographical area served: California (Nationwide for Medicare)
Recommendation: “I explored in two directions: getting a plan on my own through the state exchange, and through a broker who came in via a reference from a friend. I decided on the broker so that I can have a real person to ask questions in the process. Plans through exchange were a little harder to wade through, and there is just way too much irrelevant advertising on the sites that I didn’t want to deal with.”

Firm: Ross Insurance Brokers
Contact: Robb Fittro
Email
: rob@rossbrokers.com
Phone
: 816-453-7676
Website
: rossbrokers.com
Based in
: Aurora, CO
Geographical area served: Alaska, Arizona, Arkansas, California, Colorado, Georgia, Hawaii, Idaho, Illinois, Kansas, Missouri, Nebraska, Nevada, Ohio, Oregon, South Dakota, Texas, Washington, Wyoming

Firm: Terry Family Insurance
Contact: Blake Terry
Email
: blake@terryfamilyinsurance.com
Phone
: 682-268-0520
Website
: terryfamilyinsurance.com
Based in
: Hurst, TX
Geographical area served: Texas

Firm: The Insurance People
Contact: Alexandra Eidenberg
Email
: alexandra.eidenberg@insuranceppl.com
Phone
: 773-697-8082
Website
: insuranceppl.com
Based in
: Skokie, IL
Geographical area served: Illinois
Recommendation: Alan Budovitch was referred to  Eidenberg by another independent professional and says she is “amazing.”

Firm: US Health Group
Contact: Tomas Trabuco
Email: tomashealthinsurance@gmail.com
Phone
: 954-826-9123
Website: ushagent.com/tomastrabucco
Based in: Tennessee
Geographical area served: Nationwide

Insurance Marketplaces

CBC Health Insurance Marketplace from Costco

This marketplace is for Costco members, and requires active Costco membership. It saves time and energy in finding an insurance plan by allowing you to browse, compare, enroll, and manage your health care plan. The CBC Health Insurance Marketplace can also connect you with licensed Healthcare Ambassadors to make signing up and managing your business’ health insurance easier than ever.

Website: costco.com

Acknowledgements

We would like to thank the following members who contributed to this survey and agreed to have their names shared in the acknowledgements. Many other members completed the survey and asked not to be named — we thank them as well.

James Agres
Carlos Amaral
Karoun Bagamian
Brenda Batista-Mollohan
Michael Bendit
Jim Bowen
David Boxenbaum
Adam Braff
Bill Braun
Stacye Brim
Sarah Brock
Alan Budovitch
Marcos Buelvas
Tim Burns
Clemens Buss
Greg Calaman
Barbara Carkenord
Martin Carrica
Laura Chaise
Soumya Chakraverty
Rod Cherkas
Jon Cobb
Sam M Cohen
Ashutosh Dalvi
Darshan Dave
Rick Denton
Tim DeRoche
Keith Downham
John duHadway
David Edelman
Christine Esangbedo
Eric Eskey
Greg Essner
Dave Faircloth
Claudie Fanning
Becky Foster
Christopher Fox
Gennadiy Goldenshteyn
Julie Gupta
Joe Gwozdz
David Hane
Andrew Hartnett
Barry Horwitz
Wendy Huang
Paul Hutyra
Yazad Jal
Sai Teja Joginapally
Steven Johnson
Monty Kosma
Mona Kosseim
Frank Lacey
Graham Leary
Ilene Leff
Jason Linkswiler
Tom Lu
Wendy Manning
Brad Margol
Jay Martin
Frank Mendoza
Matt Meyers
David Miller
Jim Miller
Lance Miller
Asma Mohiuddin
Shraddha Munver
Perry Naik
Steve Newman
Jonathan Paisner
Amit Patel
Fred Pennic
Eric Peterson
Liliana Petrova
Whit Pidot
Keith Polak
Marc Rahlves
Karen Ridenour
Derek Robinson
Chris Roland Holst
Penny Rossano
James Schoen
Laura Schooler
Luke Secosky
Jared Simmons
Dan Smith
Gale Sommers
Parag Soni
Beiker Sven
Greg Taffet
Bruce Thompson
Eric Torigian
Alan Walker
James Wall
John Warren
Gay Wayland
David Weinberger
James Weiss
Don Werkema
Jim Winett
Daniel Wiser
Barry Witonsky
Joe Yalch