Hey, Sharon Pierce, how are you today? I'm good. How are you doing, Jeremy? Oh man, it's hard to feel bad on such a pretty day. Well, it's not pretty where I'm at, but- It's beautiful where I'm at. So, you know, you, maybe the clouds are following you today, Sharon. Maybe they are. This is a topic that they ought to follow you on, health insurance options. Holy cow. You know, this is one of the biggest reasons that people don't go 1099, right? And that would be me. You know, this held me up. This held me up for so very long. And then finally, whenever I did go 1099, then of course my husband develops renal cell carcinoma. But we got it all taken care of, so. Yes, all good. But yeah, I mean, health insurance is a big issue. It's a big issue for anybody, but for independent contractors going 1099, especially if you have a family, you know, that you're supporting and you don't have a spouse or significant other that can carry the insurance, this is a big issue. And it's pretty complex. And we're gonna try to break it down a little bit today. We're not gonna go in specific detail about everything. We're gonna talk about some options and no 1099 course would be complete without at least talking a little bit about health insurance, so. So Sharon, you know, I mean, I have seen CRNAs that go 1099 that carry no health insurance at all. It's very surprising, but I have seen it. You know, either they didn't wanna pay the cost of, you know, a healthcare plan, or they had some preexisting conditions and they did not want to go through underwriting with another company. But, you know, the first thing is we all know that healthcare is expensive. And if we had one issue, it could be hundreds of thousands of dollars. So health insurance is not only just about the insurance and getting care, it's also financial security for you and your family. So that's a, you know, a big deal. These expenses can become overwhelming, especially if you have something, some sort of major issue. You also, you know, get access to care. You know, if you don't have insurance, there are a lot of physicians in a lot of places that will not see you. You know, it's interesting that in this day and time that they can kind of pick and choose, but they can. And I'll talk about, you know, a personal situation here in just a minute. And then really having the peace of mind that if something did go wrong, you've got at least this piece of the puzzle taken care of. You know, when we have folks transition in 1099, you know, I tell them, it's like, you know, it's like really covering bases. You know, you've got to get this base covered. You've got to get that base covered. You've got to get that base covered and that base covered. And then once you do all that, then you can start to enjoy the fruits of your labor and do some of the other things. But this is one of those solid base hits that you've got to get done. So health insurance is important and we all know that. And there are different ways to cover this. And Sharon, you and I have talked about this ad nauseum. The first was the Affordable Care Act. And I guess we thought it was so important that we had to put ACA up there twice. I have tried to get rid of that on the slide like 20 times. And for some reason it keeps coming back. So people must think that's pretty important. The Affordable Care Act or Obamacare or whatever you want to call it, those plans came into place. And really it was meant as kind of a move towards government run healthcare. They couldn't get it passed, a complete government run healthcare. So this was kind of the happy medium. Now it has changed the health insurance industry. It's changed obviously your industry, Sharon. A lot more people are covered now than they were 15 years ago. The plans are offered through the ACA marketplace or healthcare.gov. And often, not for our CRNA clients, but often people are getting subsidies. And their subsidies were really meant for the lower to middle income brackets. And Sharon, you know, CRNAs are, they're really not the lower middle income. You guys are kind of seen as the lower tier of upper income. So a lot of CRNAs aren't going to qualify for subsidy. But it does mean that the cost of these plans, you know, they're pretty expensive because they really cover almost everything in every situation, no preexisting and so forth. Then you've got private insurance and you can buy these directly from insurance providers. You can tailor them. You can, you know, say I want this, I don't want that. I don't want maternity, you know. But the problem with that is that there could be underwriting if you're fairly healthy and you know, you've had a hysterectomy and you're not going to get pregnant. You know, maybe you don't want maternity on this plan, but those you can kind of pick and choose. And again, it gets something, it's kind of like a band-aid, but some of those plans, obviously if you had something super major, they wouldn't cover some of those expenses associated with it. And Sharon, I know you've been down this road. You mentioned, you know, the situation with Pierce earlier and you know, we've got to, you got to be cognizant of that. There's another arrangement called health sharing. And you know, we actually did this for years. And typically you basically are a member who, usually there's something that binds you together. A lot of religious organizations have these. You agree to send each other money on a monthly basis to cover other members' health bills. It is not insurance. It is a true sharing plan. In fact, under the Affordable Care Act, this did not qualify for insurance. So back when you had to pay the penalties for not having insurance, which you don't have to do anymore. That's gone? That's gone. This plan did not qualify as insurance. Now I'll tell you, we used this for years. It worked fine for our family. There are some hiccups. There's no golden parachute there, but the premiums were much more, or the sharing, you really don't call it premiums, were much more economical than going the private insurance route or the ACA route. Now, let me ask you a question. Did you still pay a monthly fee? Which, I mean, you slipped up and said a premium. So that makes me believe that you did. Yeah, so every month, depending upon the number of units or the number of people in your family, you pay an amount, they call it a gift amount instead of premium, per individual in your family. Is it tax deductible? It is not tax deductible. That's another scenario that you've got to be aware of. But when I ran the numbers, the premium, or the amount we shared was so much cheaper, it actually worked out better than if we had done it the other way and took the tax deduction on it. Well, we know you ran the numbers. Well, and these plans aren't right for everyone. So there are some limitations. One, you have to have, if you're with a religious organization, they ask you that you have these religious beliefs. We know everyone does not have that. So there's that. There's typically a period that they will not cover preexisting conditions. So if you went to them and you said, hey, I'm a diabetic, they might rider that out for 18 months and not cover any of your expenses for diabetes. So you've got to be aware of that. These plans are really meant for more healthy individuals looking for a plan that has some benefits, they're buying together by their beliefs and so forth. But it can be a really cost-effective option. And you also have to realize that not all claims that you submit are gonna be eligible for sharing. They control that. So you've got to really read through it and understand that. And then you've got these higher deductible plans and you can have these plans under private insurance, you can have it under the ACA, lower premiums because your deductible is higher, typically suitable for younger, healthier individuals. And we'll talk about why that matters in just a minute. But this kind of gives you some basis. There are some other things you can do. Well, let's talk about these high deductible plans because I have a high deductible plan, but I do that so I can have an HSA, which is basically a savings account for you, especially if you're wanting to retire early and you can save up for your premiums before you hit Medicare age, putting as much money as I can into a HSA because now you can roll that over. Used to, you had to spend it by the end of the year and that's all gone now. Well, that was an FSA, not an HSA. That was the difference there, but yeah. And we're gonna get to that in just a little bit in more detail about HSAs, but these high deductible plans do allow you to contribute money into a health savings account as well. So, and another option, let's say, Sharon, that you're working at a hospital or a group and you've got group insurance. There is a law called COBRA that allows you to continue that plan for up to 18 months for you and your family. I use COBRA whenever I left Carolina Anesthesia. Yeah, and you know, for some people, that's just an easy offload for them to get coverage for 18 months. There's so much going on. They're transitioning to 1099. They're setting up their corporation. They're getting malpractice. They're learning the 1099 route. You know, all these things that are going on when you transition, for some people, that's just an easy way to do it and keep the insurance that they've already got. You need to contact your human resources department, find out what that COBRA premium is. Remember, when you're working for a W-2 employer, typically they're subsidizing some of the costs for you. So when you're not working there, you have to pick up that cost, and that could be, you know, a reason not to do it. It could be cost-inhibited. It is very costly. Yeah, so that is another option here for people to transition, at least for the first 18 months. And then you've got, you know, these short-term insurance policies. And I don't give these a lot of time, but I've seen people use them. Typically, you're utilizing this in a situation for temporary coverage. You know, you've lost your coverage at work. You didn't immediately go in to the ACA within the right time period. So you need coverage between now and the end of the year. And this is kind of the Band-Aid to get you on the ACA, the Affordable Care Act, or Obamacare by the end of the year. Well, let's talk about that for just a minute, because if you change your employment status, you can automatically go to the ACA. So if you switch to 1099, you should still be able to go to the ACA and get a plan. Yeah, but what I've seen is people who have transitioned and thought maybe they weren't going to carry insurance. And they waited six months down the road. They quit in January and July. They realized, oh, this was probably not a good idea. I need short-term coverage because open enrollment's in December. So it's kind of a patch policy. The problem with it is, one, there are limitations on the amount of coverage. Two, it is underwritten. So they typically won't accept any preexisting conditions at all. And there are different plans out there. But it's really meant for that one to 12 months of temporary coverage for you to kind of get you a Band-Aid to somewhere else. I mean, there's all different types of these short-term insurance plans. But yes, I mean, these plans are really meant to kind of be a Band-Aid and a patch. So those are really kind of your options unless you're going to self-insure, which some people have enough money to self-insure. That's great. Or if the other option here is to just simply have a spouse and transition onto their coverage. A lot of times when CRNAs are transitioning to 1099, that's the first question I ask is, does your spouse have health insurance? Because if they do, this is a much easier transition for you just to hop on their policy. But that's not always the case, which is why we're having this conversation, right? You know, when you're evaluating health insurance plans, there's a lot of things to consider. I mean, Sharon, you know me and I'm somewhat analytical. Somewhat. And, you know, when we were looking at all this, I'm not kidding. I mean, Sarah was a big help with this as well. But, you know, we had a chart that had, you know, were there pre-existing conditions? You know, how much did they cover? What was the maximum amount? You know, what was the deductible? Were our doctors in network? Is it a high deductible? Can we contribute to an HSA? You know, if we spent the amount that we have spent the last three years on this plan, what would we come out to the good between the premium versus the other premium? I mean, we had, when I tell you, we had a whole spreadsheet laid out. It was, you know, it was kind of a little ad nauseum there, but you've got to look at it. You know, what coverage? You know, what do they cover? I mean, you know, are there things that are important to you or you think you're gonna need? What deductibles do you think? I mean, some people going 1099, you know, I'll just be honest with CRNAs, there's a reason some of them go 1099. That's because you don't have enough money working W-2. And if that's the case and you're transitioning and you don't have enough cash in the bank, deductibles could be a big issue. You know, are your networks and your physicians covered? You know, some people have physicians and hospitals they like to go to or don't wanna go to. I worked there, I saw what happened. I will not go there to have anything done. I worked with that doctor. I'll never let him operate on me. Sharon, I've heard you say that. I'm not gonna mention any names. But, and then, you know, what is the cost, the premiums of all of this? And you've gotta make this plan come together. It's a difficult process, a difficult decision to kind of go through all this. But, you know, that's the way you evaluate it. Well, Pierce and I are on separate plans. Right. Yes, because of the network that he had to have for his doctor who did his renal surgery was not in the plan that I was on. And the plan that I am on, I had to change all of my physicians because it's a UNC alliance. So I can only go to UNC physicians. Yeah, I mean, and here are just some other things to think about, you know, medications. Are my medications covered? How much do I pay for a doctor visit? Am I gonna qualify for subsidy? I mean, if there's a way for you to qualify for subsidy, the ACA is a great deal. And really, if you think about the ACA and what it caters to, Sharon, think about the younger folks out there making 50 grand a year or 40 grand a year. They hop on that plan. They get subsidy. I mean, there's no political things here we know that they get on subsidy and they hop on and basically get their health insurance for free, you know, and so there's ideas out there about that. And then research- Well, the biggest thing about ACA is that you don't have preexisting issues. Remember, I had to switch Pierce's insurance and he had his surgery three days after I switched him to that healthcare plan because they could not deny him care. And that's why, you know, those policies or their premiums are so expensive. They have to cover pretty much everything, no matter what. So, you know, with the affordable care, it's, you've got a different pool of people. Those people who might not be as healthy or sick, maybe they've had a heart attack, they're diabetic, whatever, they've got cancer, they cannot be denied. So those claims that come from that, you know, that's what drives those premium costs. The marketplace can be hard to navigate, I will say. It takes a while to go through it, figure out what the options are. You actually have to fill out a whole questionnaire about you, your financial situation, and so forth, even to get on there and look at the premiums. So, and you can compare plans. Every state has different plans that, you know, an area that you can compare and look at those coverage and deductibles and so forth. And I'll be honest with you, sometimes you think you want this plan, but you want this plan. I've had it happen to me. You know, do I want a bronze plan? Do I want a silver plan or a gold plan? You know, where's that happy medium? It's a lot of work to evaluate this. Well, believe it or not, I still use, I think it's State Farm. They have agents who are navigators who know about the ACA. They do all of this for you. You're making it way too hard. Yeah, yeah. Well, you know, I need to know everything about it, so. Of course you do, but for me, it's easier for me to just go through my agent that I have all my other insurance with and he, we talk about this, he fills out all the paperwork and he does all of this. And that's an easy way to go and it's great. One of the things that you're able to do is eligible health insurance premiums can be deducted as a business expense and it can reduce your taxable income. So if you've got a health insurance plan that you're running through the business, that can definitely help out from the tax perspective. You get premium tax credits through the ACA. If you get those tax credits, like I said, most of our CRNAs are not qualifying for that, but that is another benefit to the ACA. I was talking to someone the other day who had a child on their plan and it was costing them X amount per month. And I said, they were in their 20s, because you keep them on their 26 now. I said, why don't you let them roll off onto the ACA? They're not making any money. So therefore they would basically get whatever plan for almost free and save you money over here. So just pay attention to those things. You don't have to keep them on your plan. And then as you mentioned earlier, the HSA accounts, those can be tax deductible to pay for qualified medical expenses, which is great. And you mentioned as well, if you don't use those, you also, there's a benefit to be able to be used for retirement of this year in 2024, an individual can put $4,150 into an HSA and a family can do a maximum of $8,300 into the HSA. And if you're over age 55, you can put in another $1,000 as well. So- Yeah, I was wondering why my limit was a little bit different than what you're quoting. That's why Sharon, you can reach the golden arches. But yes, I mean, so those are definite tax savings and ways that you can position this. But again, it's all gotta work together. It's gotta work for you and your family. And there are a lot of resources out here. We're kind of hitting the highlights. I mean, obviously every state has their own plan. Every state has their own different insurance companies that are working in it. I mean, unfortunately it's not a uniform thing, which is why the ANA can't offer a group policy to all of its members because every single state has their own insurance department. But you can get information on ACA on healthcare.gov. There is a place called the Independent Contractors Association, the Freelancers Union. And some people can get health insurance through that. That's another resource. The SBA has information that can kind of help you work through some of this. And then as you mentioned before, if you have an insurance broker, search for licensed insurance agents in your area, in your state, somebody that helps you with your property and casualty and so forth, great resources. And if they have a navigator that'll help you navigate the ACA, well worth it for sure. They're gonna get compensated a little bit, but you pay the same premium, whether you go directly to healthcare.gov or you use one of these folks. So Sharon, that's kind of a brief overview of health insurance. I know there's a lot there to unpack, but hopefully we've given people some ideas today.

health insurance

independent contractors

Affordable Care Act

coverage evaluation

tax benefits

insurance agents