Health Insurance For Loofiers!

[Hesh Breakstone]

This is a discussion that I have been wanting to have because frankly I am personally pretty excited about a change here in US law.

Although I know that some will be capable of making this discussion political I ask that you please don't.  Instead I wanted to relate my own experiences with the health insurance topic, Lutherie, getting into the biz, etc. and not be a shill for the affordable care act aka Obamacare.

When I left the stinkin desk job and wanted passionately to someday hang out my shingle and do repair/restoration work the one single issue that I could not overcome and find a solution for was affordable health insurance.

In the states our insurance tends to be connected to our employment and as such doing anything unconventional or as an individual leaves one subject to the wild, wild west of brokered individual health plans.  These plans often sucked.... did not cover much of anything, and cost a fortune as well.  And you could be cancelled, capped, denied for previous conditions such as being nuts like me.

But no longer and this morning I ventured onto the Health Insurance Exchange and purchased the very best plan offered here in Michigan for less than half it's retail price.  I have pre-existing condition(s) as well and every quote that I received in the past was north of $2,200 monthly....  Now I'm enrolled in a "gold" plan that has to cover most everything, can't be cancelled, can't be capped for just under $395 a month!

There is more too.  Because I can now solve my own health insurance problem we, our business is in a position to provide meaningful work to others as well.  There are five of us in our business.

As such for those who ever fancied going pro, severing the bonds of corporate America, the health insurance issue is no longer impossible to solve.

I'm wondering if others here are seeing this new change in US law AND the availability of quality, affordable health insurance as I see it which is as something that is a pretty good deal for Luthiers?

[Josh Fuller]

What's your deductible?  If I were to do what you did, my out-of-pocket premium would go up about $20 a month, but my deductible went from $1500 a year to $12,600.  Not very affordable.  Premium+deductible=$17,000 in a year out of your own coffer-if you have a major medical emergency it's probably going to bankrupt a small operation.  If you only have minor problems, the insurance won't pay anyway.

I still work a day job, mostly for insurance.  Just got a letter last week from the parent company that cryptically states, more or less, that we'll be losing our insurance after the first of the year.  I guess if I won't have insurance either way, I may hang my shingle out full time as well.

[Hesh Breakstone]

Hi Josh: Plans vary from state to state but for the first time ever they are now regulated by the Feds and have to include a bunch of stuff that benefits us all.  Things such as wellness visits, some number per year where there is NO deductible, coinsurance, or even a co-pay.

Anyway my specific gold level plan (platinum plans are not offered in Michigan where I am....) has a $1,250 annual deductible, $20 co-pays for doc visits beyond the wellness stuff, 20% coinsurance but here is the really good part.

Once deductibles are satisfied and one reaches yet another number/metric the "maximum out of pocket amount" the insurance pays 100% for all covered services, surgeries, etc. with NO more coinsurance, co-pays, deductibles, etc.

So for me if I need surgery for say a hernia and the cost including the hospital stay will be north of $25,000.00 my share will be that maximum out of pocket number for my specific plan or in my case $2,000.  This is huge for me where $2K is doable but $25,000 would most certainly ruin me....

Here's more in terms of the rub:  Health insurance premiums have been increasing by double digits for the past 15 years.  It was out of control and employers have been pushing more and more of the premium costs onto employees every year.  In the individual insurance market, us lone wolves so-to-speak.... it's been estimated that on average only about 14% of these policies didn't get cancelled anyway from year to year.  This policy cancelation thing has been going on for decades with massive premium increases as well.  And most of these plans sucked anyway and covered very little.

Now you can't be cancelled, can't be capped, have a preexisting condition, no problem you still can't be denied insurance and you also do not have to pay more for the preexisting condition.

Of course it all depends on what plan one selects from the exchange in terms of co-pays, coinsurance, deductibles, etc.  But again there are no minimum standards and that "maximum out of pocket" number is pretty important too in so much as it's the total extent of one's financial liability in a given policy year.

I could have selected a lesser plan that shifts more of the expense if I make a claim to me but at 57 years old... and with preexisting condition(s) I went for the best insurance available and to my surprise my out of pocket will be 5.5 times less than before the exchanges were available.  I'm thrilled but still scared of table saws..... ;)

Hell my annual flu shot is even covered free of charge to me!

One of the reasons that I am bringing this up is because we speak of pricing, policies, insurance, accounting software, all things related to being in business as a Luthier but we rarely speak of the health insurance issue, an issue that I know others in the trade who have been struggling too with.  So I wanted to put this out there and see what others thought not about the politics of the affordable care act but of the opportunity for those who may have not been able to solve the insurance problem, like me, and it may be keeping them from hanging out a shingle too.

Mind you the exchange (federal one) still sucks and rarely works the way it should but you can get pricing and even enroll if you hang in there long enough.  I'm not known as a patient sort.... but I got through it....;)

If you think about the issues associated with NOT having affordable health insurance AND you are in the biz you will immediately see that access to affordable health insurance may positively impact the very decision to hang out the shingle as well as one's formal and legal business structure in so much as it is a potential liability limiting event.

[Josh Fuller]

It's hard not to get political in this, but I can't believe your deductible.  No one that I have talked to has had the option of a deductible anywhere near that low.  I've yet to use 17,000 dollars of insurance in one year, but now if that happens it'll be out of pocket and I still have to pay a higher premium.  Hard not to feel like I got screwed-and I'm not alone. 

[Mark Fogleman]

Like Hesh, it will be a huge positive for us and will allow me to work full time for myself at 58 years old.  Our insurance now is through the state high risk pool because of our medical history.  Both of us are healthy as horses but no private insurance plan would issue a policy for any cost..  We pay $1,800/month with a $5,000 deductible for an 80/20 plan.  Needless to say we're ready and waiting for January 2014.  After tax credit we are looking at sub $300/month for a silver plan.

BTW...Each state has a different cost structure for the different plans:

Market Watch Article on ACA cost by state:  

State	Lowest-cost silver	Second-lowest-cost silver	Lowest-cost bronze
Minnesota	$192.00	$192.00	$144.00
Tennessee	$235.00	$245.00	$181.00
Utah	$239.00	$266.00	$201.00
Oregon	$241.00	$250.00	$205.00
Arizona	$248.00	$252.00	$214.00
Oklahoma	$256.00	$266.00	$174.00
Pennsylvania	$259.00	$286.00	$229.00
Kansas	$260.00	$260.00	$197.00
Maryland	$266.00	$299.00	$197.00
Iowa	$266.00	$287.00	$212.00
Michigan	$271.00	$306.00	$222.00
Illinois	$274.00	$286.00	$203.00
New Mexico	$275.00	$282.00	$217.00
Idaho	$276.00	$285.00	$227.00
Texas	$287.00	$305.00	$211.00
District of Columbia	$293.00	$297.00	$204.00
Nevada	$295.00	$297.00	$227.00
Nebraska	$298.00	$312.00	$241.00
Alabama	$303.00	$318.00	$247.00
Ohio	$304.00	$321.00	$263.00
Florida	$304.00	$328.00	$257.00
Georgia	$304.00	$317.00	$265.00
Colorado	$305.00	$305.00	$232.00
Montana	$309.00	$316.00	$251.00
Missouri	$318.00	$334.00	$245.00
New York*	$319.00	$349.00	$276.00
Virginia	$323.00	$335.00	$237.00
West Virginia	$331.00	$331.00	$280.00
South Carolina	$333.00	$339.00	$267.00
Rhode Island	$341.00	$366.00	$264.00
South Dakota	$341.00	$357.00	$298.00
California	$341.00	$373.00	$278.00
Wisconsin	$344.00	$361.00	$287.00
Washington	$350.00	$352.00	$264.00
North Dakota	$350.00	$353.00	$281.00
Arkansas	$351.00	$366.00	$275.00
Delaware	$356.00	$360.00	$308.00
Louisiana	$356.00	$374.00	$265.00
New Hampshire	$359.00	$360.00	$282.00
North Carolina	$361.00	$369.00	$282.00
New Jersey	$382.00	$385.00	$332.00
Maine	$388.00	$403.00	$328.00
Indiana	$392.00	$403.00	$304.00
Vermont*	$395.00	$413.00	$336.00
Connecticut	$397.00	$436.00	$340.00
Mississippi	$403.00	$448.00	$342.00
Alaska	$474.00	$474.00	$385.00
Wyoming	$489.00	$516.00	$425.00
Weighted Average, 48 States	$310.00	$328.00	$249.00

*Same price for all ages

[Hesh Breakstone]

Thanks Mark and congrats to you too for now having access to affordable health insurance.  Thanks for posting the chart too - very interesting in many respects!

After posting I spent the afternoon down the street at a friend's place who is building a 24 X 24 out building that will one day house his own CNC milling stuff.  He works for others, for now... but dreams of doing his own thing.  He's an Iraq vet, a great guy, and my friend.

I told him about the affordable care act and what I was able to score on the exchange and then we spent the next hour in front of his computer with his wife looking at insurance plans.  He was and is beside himself and the discussion at his home as shifted from "some day" in terms of starting his own business to "Hesh will you help me write a resignation letter....."  Not kidding and this is again why I am bringing this opportunity up because for we Luthiers who may not be married to a working spouse with health insurance it's sure to be very well received.  That is, of course, if folks can get past the crap in the news, the poorly rolled-out web site, and take an honest look at what is available to them.

By the way I am unfortunately a smoker too, for now... and smokers are penalized on the exchanges because they want everyone to have skin in the game as to their own good health.  Prices quoted for me include the smokers penalty for my insurance company and state.

Josh my suggestion to you is to go to the exchange site for your state or the federal one if your state is like mine and did not throw up a site and you can click on a button on the home page that will provide you with pricing in your state without needing to register or provide personal information.  You will see for yourself and won't need folks such as I to relate this stuff to anyone.  The pricing is excellent, the product by now being regulated for minimum standards is vastly improved, it's easy (beyond the poorly written site) and there is far more competition at least in my state for a change too - all good things.

Again I am avoiding anything political here but for entrepreneurs this is huge too.  It's been said how does one make a million dollars in Lutherie?  Answer:  Start with two million dollars.  Well now affordable, quality, available health insurance for those of us too young for Medicare and without a day job or spouse with insurance have a very welcome option and not a day too soon either.

Also worth noting I went large with my insurance since I have some issues and am an old fart but for the young and invincible plans are available that are subsidized to in some cases 100% depending on what one earns, family structure, etc.  More specifically decent coverage for those less breakable than I is available in some cases with no cost for premiums.  

Again not trying to get political but once I spent hours and hours researching how this all works it was clear that the benefits have not been well sold to any of us.  For example when I think of a "tax credit" I think of something that can, once I file a return and at the end of the year only, be applied to my tax liability and reduce same.

The ACA tax credit is different and it can and will in most cases be applied in real time, month by month while still IN the tax year in question against your health insurance premium.  So what ever that premium is the insurance company that you select will be getting some portion up to and including the total premium in some cases from the program and not from us.  We are responsible for the balance.  This is something that I personally did not understand until I read it over and over and actually called and spoke with some of the insurance companies.

One more thing too - let's not lose site of perhaps the greatest benefit of all here.  Since the insurance offered is quality insurance that WILL pay for things, cost little, and is now regulated by the feds we all have an opportunity to get healthier and stay that way too.

For many years my one overriding dream was to someday be an old man who is a Luthier spending his days toiling endlessly and selflessly to keep musical instruments singing, performers performing, tunes playing, and music students not struggling with a poorly set-up instrument.  The issue of affordable health insurance was a potential deal-breaker for me but no longer AND because of this I can afford to employ others too.  This is huge for us and I am excited as can be about it all.

[Josh Fuller]

I did go to the site, Hesh.  That's where I got the numbers.  I'm not making this stuff up.  Nothing you're saying is jiving with what I got directly off the Federal site.  It's like we're talking about two different things.  I'm looking at over 17 grand out of pocket PER YEAR if I take the plunge and my health goes south.  No way I can open a small business with that kind of nut to crack every month, especially if it's a lutherie shop. 

I'd hate to see you guys quit your day jobs, and find out all is not what it seems.  Tread carefully, my friends. 

[Hesh Breakstone]

Josh pricing is dependent on one's situation, income, dependents, etc.  For me the numbers reported are accurate as I am sure that what you see for your situation may be accurate as well.  It's possible that what you have in your day job is pretty good, considering what it would cost to go it on your own.  I can't and won't ask you any personal information regardless of the fact that one's personal situation is the criteria for subsidies and even eligibility.

I'm insuring one person with no dependents, my income likely is different from yours, my location is different, and my preferences for the level of coverage may be different too.  Summarily dismissing the possibility of an opportunity for all others regardless of the situational dependencies of the program is not an accurate assessment of the program.

No one is advocating that anyone quit their day job based on anything shared here by me - far from it and that really did not have to be said....  But what I am relating, truthfully and a little miffed too that your comments are bordering on questioning my creditability.... is that for me and for others too, situationally dependent again is that this may be an opportunity to pursue a dream.  Of course your mileage may vary as mine will too.

I'm now enrolled, it will cost me far less AND be available to me of which no insurance was available to me that I could afford prior, and as such I wanted to share the opportunity with our friends here.  If it's not for you no problem but please attempting to discredit me or the entire opportunity for others is not sharing valid information and a disservice in my view to all.

Some pricing has been posted here as well - is this not accurate as well, Josh?

Again it is requested that the political aspects of the ACA and one's personal positions not be addressed here.  It's something that we all owe our host and I for one do not want to have to apologize for even mentioning the opportunity as I see it because some can't keep politics out of the mix.  Not saying that your biased Josh but I do have to wonder why what may be an opportunity for me and others and may not be an opportunity for you and yours has to be described by you as possibly misrepresented....  That's not my way and your warnings to others was and is not appreciated.

[Hesh Breakstone]

Josh it's entirely possible that what you are describing that you see is correct if 1) the insurance that you had prior sucked in terms of only being catastrophic coverage and 2) you did not register and have your subsidy determined or go to the Kaiser family foundation and use their calculator to determine your subsidy with no personal info required.

The lowest level of plan available here in Michigan has the highest deductibles, co-pays, co-insurance but none of them have numbers as high as you are reporting.  If you are trying to match your costs out of pocket with what you have, have not applied any available subsidies, and are only interested in minimal coverage it will cost you more in terms of deductible, co-pays, co-insurance.  That's how insurance works, or, depending on one's perspective, doesn't work...

I hope that you are noticing that I am trying to work with you, Josh and get back on track here.  I have the site open for Michigan, where I am and the worst, most expensive cost to us potentially if one gets sick.... bronze plan available here has a "maximum out-of-pocket" annual number of $6,300.00.  Again this is for my situation, family of one, etc.  The deductible that you reported is way north of the this maximum out-of-pocket which, by the way, is indeed the maximum out-of-pocket for this plan.  

What you are reporting would not be very affordable I'm sure but I also am not sure that you have applied subsidies, what level of insurance you are interested in in terms of the quality of the product in respect for how much it pays and how little you pay, and your family size, situation, etc.

[Ernest Kleinman]

Hesh, now that  I have read more in depth  about your specific need for  healtcare I can see where you are coming from.My wife/s insurance covers me , otherwise I would have to shop around . too. So we are fortunate. I/m not very knowledgeable about the healthcare plans , but it seems  to me that everyone/s needs an finances are different.So  I/m guessing that it is not a walk in the park for everyone. Specificallly young people who may not want insurance . e.g.  a budding young luthier, say who is in excellent health will be penalized with a tax that he/she will have to pay .While older farts like  me I turned 66 on fri. Will not be affected.Another concern is that some doctors will opt out of plans and charge cash.This is already happening here in KC.MO . Furthermore I believe and feel that  this health care plan is really another form of a tax, which will scare off potential grads from entering the medical field and ergo create a mediocore health care system , which I experienced in Canada. I  will spare you the gory details of many cdns who have had to come to the usa or elsewhere to get medical treatment those  without funds ,just have to wait if they have major medical problems and wind up dying before gettting treatment. So while I/m glad that you have an affordable healthcare plan .I am extremely concerned about the long term ramifications of this so called affordable health care.

[Ned Knepp]

I have no intention of carrying on a debate but I feel that I need to respond to some of what you wrote.

 Health insurance is not a tax, it's insurance. By definition, you don't need it until you  NEED it.  Young people may feel that they don't need health insurance because they are "healthy" but they also tend to think that nothing will happen to them either. I've been in the position to hear about and, sometimes, witness the results of too many instances of a young person suddenly NEEDING health insurance to believe it's useless to them.

Tens of thousands of young "healthy" people turn up on clinics and emergency rooms on our country every year. Young "healthy" adults are subject to broken bones, torn tissues, sickness and accidents. They can be cut, burned, punctured, bashed, they can have broken skulls, broken backs, debilitating disease. I've, personally seen examples of all of these in people under age 25. There are many thousands of "young" people in our country that have preexisting conditions and will need continued treatment over the course of their lifetime. They've needed insurance most or all of their life and, at age 26, Mom and Dad can't carry them on the " family" policy anymore. Unfortunately, that fact doesn't suddenly remove their need for medications and/or treatments. I'm not talking about severely disabled or handicaped people. I talking about young people you see in shops and stores without ever considering that they are trying to function with out badly needed medication because it cost hundreds of dollars a month AND require a doctor supervision and prescription. They don't exist in small numbers. 

None of this explores the fact that young people can use preventive care and treatment, just as well as old people can. In fact, these programs are proven to be much more beneficial to young adults than they are to old people. Some of the benefits include early detection for heredity conditions and diseases as well as educational programs to help them remain healthy longer and living better lives in the process. In my opinion, most young people don't want to pay for health insurance because they don't actually understand what it can do for them. It's not a tax, it's insurance.

As I stated, it's not my intention to start a battle and with that in mind I have no intention of responding to "Con" arguments to my post. IF I need to clarify a point I've made I will but I do not want to argue the point. 

[Frank Ford]

Indeed, young folks can get a surprise and need medical treatment with little or no  warning.  I was lucky to have enrolled in the Kaiser health plan through my wife's brand new job a few weeks before I discovered a lump in my throat that turned out to be a malignant thyroid tumor.  I was 26 at the time, and my out of pocket expense for the thyroidectomy and hospital stay was seven bucks - they charged a dollar or two a day for the phone in those days.  Never saw a bill or learned what it would have cost without the coverage. 

I figure there's a good chance that without the plan, my bills would have sunk any hope of continuing my self-employment as a luthier, which had begun only months before. . .

[Mark McLean]

Hi Folks. 

It is astonishing to me to read your discussion of this issue. I can see how this must loom as an enormous issue for self-employed folks in the US.  In Australia we have universal health insurance for all citizens and permanent residents and the cost is a 1.5% levy on income tax.  This covers the cost of all hospital treatments and most of the cost of visits to doctors.  There is also generous subsidization of the cost of prescription medications.  I work as a doctor here - a specialist in diabetes and thyroid disorders like Frank's cancer.  I don't charge patients a cent for seeing them - I get paid by the government.  Some specialists and family docs do charge an out-of-pocket surcharge, but it is still much more affordable than the costs that your countrymen face.  We do have fairly long waits for non-urgent things, like a hip replacement, and there is a small private hospital sector that will do that job for you at a price.  But if you have an urgent problem here you will get immediate care, at no direct cost. 

I am not trying to be political here - it is just a striking point of difference between our countries, which are very alike in lots of other ways.  It is not too late for you to consider emigrating.  We could use more luthiers here!

Cheers, and good health...

Mark