Shop Affordable New York Self-Employed Health Insurance

Everything you Need to Know about New York Self-Employed Health Insurance Plans Including:

Where can you Purchase a Self-Employed Health Insurance Plan in New York
- Explore options through the New York State of Health marketplace and other local providers.
Tips for Saving Money While Shopping for a New York Self-Employed Health Insurance Plan
- Discover tips and strategies specific to New York to find the most affordable coverage.
What Qualifies a person for a Self-Employed Health Insurance Plan in NY
- Understand the eligibility requirements and necessary documentation for New York residents.
Different self-employed health options in the State
- Compare various plans available to self-employed individuals within New York State.
Changing your Self-Employed health plan to another in NYS
- Learn the process and considerations for changing plans within New York.

The Number of Self Employed in New York Rises

In recent years, the self-employed workforce in New York has been on the rise, mirroring a national trend. Currently, around 16 million people across the United States are self-employed, with a significant portion residing in New York. This means approximately 1 in 10 workers are their own bosses, but is this lifestyle everything they imagined? With the freedom to set their limits and shape their futures comes the weight of added responsibilities.

Unlike traditional employees who clock out at 5 pm (well, most of the time), self-employed individuals in New York often find themselves working well beyond a typical 40-hour workweek. They juggle various roles, from bookkeeping and office management to handling supplies and even janitorial tasks. Amid these challenges, finding a cost-effective and comprehensive health insurance plan becomes crucial.

We’ve put together a straightforward guide specifically for self-employed individuals in New York to help you navigate the best policy options available. Continue reading to learn about self-employed health insurance plans and the impact of health care reform on self-employed individuals since the Affordable Care Act (ACA).

Where can I Buy a New York Self-Employed Health Insurance Plan?

At Vista Health Solutions, we have been assisting the self-employed in obtaining affordable and comprehensive coverage for over 25 years. Feel free to call us to discuss any of the following options:

The State marketplace– If you find the coverage adequate and affordable, the New York State marketplace is an excellent option. Subsidies can be a very attractive and cost-effective benefit if you qualify. Even if you don’t qualify for the subsidy as a self-employed individual, you can still write off the cost of your health insurance premiums on a pretax basis. However, be aware that marketplace prices have increased, and the range of available plans has significantly decreased.

Association health plans – Association health plans are specifically designed for sole proprietors and are found in most industries within New York. While the numbers of these plans may has decreased, you can still find affordable options. Associations are typically professional organizations with common interests related to your industry. They often have large membership bases, which attract insurance companies, especially if the membership pool is healthy. These associations contract with insurance companies to offer self-employed health insurance plans, often with competitive pricing.

Union Health Plans – Union health plans in New York share many similarities with association health plans. However, to enjoy union benefits, you’re required to join and pay union dues. These plans often provide richer benefits and almost always offer PPO and POS options, providing the flexibility of coverage that many self-employed individuals are looking for in a health insurance plan.

Chamber health plans – Chamber health plans in New York cater to members within specific geographic regions. These plans are similar to association health plans but usually require you to be part of a local chamber of commerce. While they may not have the same purchasing power as larger association plans, chambers at the city, state, and national levels can still offer competitive health insurance options. However, since the implementation of the ACA, many chamber plans have shifted to offering insurance similar to marketplace plans.

Ministry Health Insurance Plans in New York – Unlike traditional insurance plans, ministry health plans are not designed to make an individual whole. These plans might be suitable for affirmed Christians who attend church regularly, as they operate on a faith-based system. Instead of monthly premiums, members contribute a monthly share fee and an annual fee. Medical expenses are paid from a collective pool known as the “Share Box,” but it’s important to note that the ministry can deny any claims, as they are not contractually obligated to cover medical bills like traditional insurance plans.

PEO health plans in New York – Several Professional Employment Organizations (PEOs) offer health insurance options for sole proprietors in New York. However, to access these benefits, including health insurance, payroll, and other business-related perks, you must become an employee of the PEO. This typically requires being on the PEO’s payroll for a minimum of thirty hours per week. The clear advantage is that these health insurance plans are cost-effective and often parallel the coverage options provided by union plans. Additionally, you still qualify for the sole proprietor tax write-offs.

Before you Buy a NY Self Employed Health Plan

Assessing Your Needs Before Purchasing a Health Plan

Before you decide on a health plan, it’s crucial to evaluate your specific needs. Consider these vital questions:

Do I have any pre-existing conditions?

While it may seem unnecessary to consider pre-existing conditions given that Obamacare plans cover them, it’s still crucial to find a policy that adequately addresses your specific health needs.

Different policies offer varying levels of coverage, and selecting a plan with a lower monthly premium often results in higher out-of-pocket expenses. If you take medications, ensure the policy covers your specific prescriptions, as not all plans that include prescription coverage will cover every medication.

Who Will Be Covered Under This Policy?

Consider the number of dependents on your health insurance policy, as it directly impacts your premium cost. Generally, the more individuals covered, the higher the premium. However, the Affordable Care Act (ACA) positively caps costs through “multiples.”

Policies only charge based on age and multiples. For instance, if two parents are covered, premiums are determined by their respective ages. If those parents have multiple children, the insurance company can only charge for up to three children, regardless of the total number of dependents.

How Often Will You Need to See the Doctor?

If you have ongoing health conditions, it’s prudent to consider a plan with lower deductibles to save on medical visits. These plans generally come with higher monthly premiums compared to those with higher deductibles. Conversely, a high deductible health plan may be more suitable if you don’t need regular doctor visits. This principle applies to all health insurance policies, including self-employed health insurance plans in New York.

What is my financial situation?

When seeking health coverage, assessing your financial situation is crucial. Self-employed health insurance for individuals in New York can vary significantly, ranging from $75 to $3000 per month, depending on your specific needs and location.

With the advent of the ACA, the concept of insurance subsidies was introduced to Americans. These subsidies are determined based on your annual income and where you fall on the Federal Poverty Level (FPL) chart. This is particularly important for self-employed individuals, as their income often incurs higher deductions than those who are not self-employed.

Deductions for business travel, office expenses, and equipment can greatly affect the final amount you pay for your self-employed health insurance policy. While subsidies can be highly beneficial, many sole proprietors may not realize that their earnings are typically based on the prior year’s income, while the government uses estimated earnings for the current year.

It’s essential to consider how these deductions and subsidies impact your overall financial situation when selecting a health insurance plan that fits your needs.

Required Tax Forms to File.

Navigating Self-Employed Health Insurance Subsidies in New York

If you’re expecting a subsidy for your self-employed health insurance, be ready for Uncle Sam to require at least one health care tax form. The most common form for sole proprietors is 1095-A, which comes from the marketplace where you bought your insurance.

Form 1095-A outlines how much you paid for insurance last year and the amount of subsidy you received. It also includes details about the SLCSP (Second-Lowest Cost Silver Plan), used to calculate your subsidy. This standard helps the marketplace determine policy costs relative to the subsidy provided.

Once Form 1095-A is completed, your accountant (or tax software) will transfer those numbers to Form 8962, the IRS form for the health insurance premium tax credit. Depending on your health plan and who is covered, you might need to file Form 1095-B instead of Form 1095-A. Form 1095-B is similar but applies to non-individual coverage, like family plans.

Tax Deductions for Self-Employed Health Insurance Premiums

It’s essential to remember that the subsidy mentioned earlier is only available for plans bought through the marketplace. However, if you purchase a self-employed health insurance plan outside the marketplace, you’re still allowed to write off 100% of the health insurance premium cost. This deduction is pre-tax and can significantly benefit self-employed individuals by lowering your overall adjusted gross income and reducing your tax liability.

Here are some key considerations for this deduction:

Spouse Coverage: If your self-employed health insurance plan covers your spouse, and your spouse was offered health insurance through their employer but chose not to participate, you cannot write off the portion of their premiums.
Income Limits: Your deductions cannot exceed the income you earned from your business. For example, if you had a bad year and claimed a loss, you cannot claim the deduction because the business did not generate any positive income.
Partnerships and LLCs: If you are part of a partnership or LLC that lists you as a partner, you are still treated as self-employed for tax purposes, so the points above still apply.

Does Anyone on my Policy Need Special Medical Attention?

Similar to the pre-existing condition section, if you or your dependents have special medical needs, it’s essential to understand the differences between policies that could impact your out-of-pocket costs and coverage. While all ACA plans must cover 10 Essential Health Benefits (EHB), your specific needs may not be fully addressed within those benefits.

Special needs don’t only pertain to the type of coverage but also its flexibility. For instance, if you’re a traveling professional who finds yourself in different states frequently, a standard policy might not be adequate. You may encounter situations requiring medical attention, like flu-like symptoms, that don’t warrant an emergency room visit but do need a doctor’s consultation in another state.

In such cases, finding a policy with access to a national network, such as a PPO health insurance plan, is crucial. It’s strongly recommended to review the Summary of Benefits and Coverage carefully and even request a sample contract to understand how your special needs will be covered and reimbursed.

Any Foreseeable Life Changing Events Expected?

If you’re anticipating major life events like having a child or getting married, these should influence your health insurance choices. Planning for such events is crucial when shopping for a policy because the window to purchase a self-employed health insurance plan has changed.

Before the ACA, self-employed individuals could purchase health plans year-round. However, marketplace plans have changed this, limiting purchase options to specific periods. For non-marketplace plans, this restriction doesn’t apply. (For more information on non-marketplace health insurance plans, please see the section below titled “Post-ACA Self-Employed Health Plan Options.”)

The federal government has restricted the open enrollment period to just 45 days each year. The Open Enrollment Period (OEP) is the official time to shop for marketplace health plans, typically running from November 1st to December 15th.

While you can always add dependents and drop coverage, some policies may be better suited for family plans, while others are more appropriate for individual coverage, particularly in relation to foreseeable life events. Outside of the OEP, you cannot switch from policy A to policy B unless you qualify for a Special Enrollment Period (SEP), which usually doesn’t include foreseeable life events.

How the ACA Changed the Way New York Residents Shop for a Self Employed Health Insurance Plan

With the introduction of the ACA, new health insurance markets have emerged, including the New York State marketplace. These marketplaces are designed to provide affordable coverage to individuals and small business owners. To qualify for group policies, small business owners must have between two and one hundred employees. However, self-employed individuals often find themselves directed towards individual policies, which may not always be the ideal fit.

The ACA was created to insure the uninsured, and sole proprietors—considered generally healthy and less likely to utilize benefits—were not the primary target. This raises the question: Are the NY state exchange health plans truly suitable for the self-employed? Many would argue they are not, especially when considering the unique needs of sole proprietors in New York.

Changes that have arrived for New York’s Self Employed Since the Creation of the ACA

Since the implementation of the ACA, self-employed individuals in New York have experienced three major changes:

Reduced Options: Almost all major carriers have exited the individual marketplace, leaving half of all states with two or fewer health insurance companies to choose from.
Decreased Plan Types: The availability of plan types has significantly declined, including the disappearance of Preferred Provider Organization (PPO) and Point of Service (POS) plans from the marketplace. This change has limited the ability to utilize doctors and hospitals outside the plan’s network.
Increased Prices: Health insurance costs have soared due to several factors, including mandatory coverage of previously uninsurable individuals, the public’s reluctance to fully embrace the ACA, and political agendas from both sides of the aisle.

FAQ:

How does NY Define self-employed?

It’s not a regional definition but rather a national one. A person is considered self-employed if their income is primarily generated as a freelancer or business owner, as opposed to being an employee of another company.

I live in New York and get paid with a 1099, am I considered self-employed?

Yes, receiving a 1099 form indicates that you are considered self-employed as an independent contractor.

I’m a self-employed New Yorker but I live in another country, do i need to buy a health Plan in New York?

as a New Yorker living abroad, you are exempt from the individual mandate for health insurance under the Affordable Care Act so no, you don’t have to buy a policy in New York State. However, it is wise to get a policy that covers you overseas, such as a travel insurance policy or an Expat policy.

I’m self-employed and living in the New York State but I have dual citizenship, how do I get a policy?

If you currently reside in New York State, then your first option would be to consider plans on the NYSOH exchange. Other options to consider are those listed above, such as a PPO plan, which may provider greater benefits

I’m here legally on a residency visa and self-employed, how do I get health insurance?

As a legally permitted resident of the United States, you are subject to the Affordable Care Act’s mandate and will be eligible to purchase health insurance through your state’s health insurance marketplace or any of the options listed above.

I’m undocumented immigrant living in New York that’s self-employed; how do I get health insurance?

Since your undocumented you’re not entitled to purchase a plan on the state exchange. However, private insurers that specialize in travel insurance may be a good alternative.

I’m self-employed and don’t have insurance now and I understand that I can’t purchase a plan on the exchange outside of open enrollment, so what can I do?

See below

Conclusion

Navigating the complexities of self-employed health insurance in New York can be challenging but understanding the available options and how they align with your specific needs is crucial. Whether you opt for state marketplace plans, association health plans, or even ministry health plans, it’s essential to assess your health requirements, financial situation, and potential life events. By doing so, you can make an informed decision that not only provides adequate coverage but also aligns with your financial goals.

Remember, being self-employed offers the flexibility to choose a plan that suits your lifestyle, but it also requires careful consideration and planning. Stay informed about changes in the health insurance landscape, and don’t hesitate to seek professional advice when needed. With the right plan in place, you can focus on what you do best running your business and enjoying the independence that comes with being self-employed.

Contact Us

At Vista Health Solutions, we specialize in the self-employed health insurance market and group insurance plans. With over 20 years of working with sole proprietors, our team has both the knowledge and the markets that make us the number one self-employed health insurance marketplace. Feel free to use our NY Health Insurance online quoting tool or contact our knowledgeable staff that can answer your self-employed health insurance questions at (888)215-4045