Health insurance for self-employed people in Oklahoma: Your options.

Navigating health insurance can be challenging, especially when you’re self-employed. As a self-employed individual in Oklahoma, understanding your options is crucial to ensuring you and your family are adequately covered.

In this guide, we will cover two primary types of health insurance options available for the self-employed in Oklahoma: the Health Insurance Marketplace and short-term medical plans.

The Health Insurance Marketplace

The Health Insurance Marketplace is an excellent option for self-employed individuals. You fall into this category if you run your own business and earn income without having any employees. This includes consultants, freelancers, independent contractors, entrepreneurs, and other self-employed workers.

Benefits of Marketplace Coverage

1. Tax Credits and Savings: Depending on your income, you may qualify for tax credits through the Marketplace, which can significantly reduce your premium costs. When applying for these credits, you must estimate your adjusted gross income for the current year.

2. Comprehensive Coverage: Marketplace plans must meet the Affordable Care Act (ACA) requirements, providing essential health benefits such as preventive care, mental health services, and coverage for pre-existing conditions.

Estimating Your Income

One of the challenges for self-employed individuals is estimating their income for the year. This estimate is crucial for determining your eligibility for tax credits. Speaking with a licensed health insurance broker can help you understand what counts as “projected income” on the application. For more complex scenarios, consulting your tax advisor is advisable.

The Marketplace Health Insurance: Frequently Asked Questions

What should I do if I leave my job and lose my job-based health coverage, becoming self-employed?

If you lose your job-based health insurance, you become eligible for a Special Enrollment Period. This allows you to sign up for a health insurance plan even if it’s not during the usual Open Enrollment period. During this special period, you might get your coverage to start sooner than usual.

What are my options if I’m self-employed but my spouse has health coverage through their job?

If your spouse’s health plan includes coverage for spouses and dependents, you typically won’t qualify for premium tax credits for a Marketplace plan. However, if your spouse’s job-based insurance doesn’t cover spouses and dependents, you can purchase a Marketplace plan for yourself and your dependents. Based on your household income, you might qualify for premium tax credits.

What happens if I’m self-employed and then get a job that offers health insurance?

You can cancel your Marketplace plan at any time and switch to your new employer’s health insurance. Once you have access to job-based coverage, you usually won’t qualify for premium tax credits on a Marketplace plan, whether you enroll in the employer’s plan or not. In rare instances where the employer’s coverage isn’t affordable or doesn’t meet minimum standards, you might still be eligible for premium tax credits.

Short-Term Medical Plans

Short-term medical plans are another option to consider for those who are healthy and don’t qualify for premium tax credits (or qualify for little tax credits) through the Marketplace. These plans are not required to offer Minimum Essential Coverage, but they can be a more affordable option compared to Marketplace plans.

Key Features of Short-Term Medical Plans

1. Duration: These plans typically range from one month to a maximum of three years (changing to a maximum of four months starting September 1st, 2024).

2. Flexibility: They offer customizable plans to fit various coverage needs.

Coverage Details

Short-term medical plans vary in coverage but generally include:

• Doctor visits

• Emergency care

• Hospitalization

• Prescription medications

Important Considerations

1. No Coverage for Pre-existing Conditions: Any medical diagnosis from the past few years won’t be covered.

2. Exclusions and Limitations: Always read the policy’s exclusions and limitations before purchasing.

Pros and Cons of Short-Term Medical Plans

Pros:

• Financial protection against significant medical expenses.

• No cancellation penalties.

• Customizable plans.

Cons:

• No coverage for pre-existing conditions.

• Potential denial of coverage with severe medical diagnoses.

• Limited coverage compared to ACA health plans.

Conclusion

Securing health insurance as a self-employed individual in Oklahoma is essential for your health and financial stability. Understanding the various health insurance options, including Marketplace plans and short-term medical plans, allows you to tailor your coverage to meet your specific needs.

By considering factors such as coverage network, premiums, deductibles, and out-of-pocket costs, you can select a plan that aligns with your healthcare needs and budget. 

If you’d like help determining what type of health insurance coverage is right for you, speak to one of our licensed brokers.