Health Insurance for photographers in United States

<p>I am considering moving to the United States from Canada, for the sake of my relationship. I am not sure where we would eventually stay, for now, probably somewhere in the New England area.<br>

I am quite new to the photography business, but would like to stay in the business after the move. I know the economy seems bleak, but my main concern is the cost of health care. How much does a freelance photographer have to pay annually, on average?<br>

I know that I could probably get covered by my partner through work, but what are the other options, especially if I would like to stay as independent as possible?<br>

I found that it already costs a lot to purchase equipment, to maintain a studio and to advertise. I just cannot imagine on top of everything else there is health insurance cost. Do you just simply charge more to cover this cost? Are you constantly afraid of getting sick, at risk of losing your business because of it?<br>

I don't want to get all political here, but it baffles me that universal health care is still something that requires debating.<br>

Any response would be great help! For better or for worse, it will ease my anxiety. Thanks in advance.</p>

<p> </p>

<p>You might look into some of the professional associations, which can provide discounts on such services, as well as on your <em>other</em> insurance costs, such as the liability insurance you're surely carrying (right?) and coverage on your equipment.<br /><br />Universal health care, in any form or variant, doesn't mean you don't have to pay for it. The cost would simply show up in your taxes, instead, if not in the form of a mandate that says you have to buy it, or face fines (as currently proposed).<br /><br />The only other option is to have other people pay for your healthcare for you, but the proposals that lean that direction won't let a working professional off the hook. If you generate enough revenue to stay afloat as a small business, your personal health care costs are just part of the picture (along with the other things you must consume to stay alive - like food, shelter, and energy). Legal fees, marketing costs, transportation, bounced checks ... all of that stuff needs to be part of your business plan. Is all of that already working for you in a profitable way in Canada, and it's only the health care costs you're worried about? That's expensive, but it's only part of your overhead, and yes you need to build all of that into what you charge your customers.<br /><br />If your relationship (marriage?) allows you to be a part of a an existing group plan, it's worth considerable trouble to participate.</p>

<p>Matt, you are right. Personal income tax is quite high in Canada. Though tax is connected to my annual income, not connected to my health care, which means if I get sick or decide to have children therefore can't run the business for a year, I would still have health care even if I make zero profit.<br>

I am sure it would somehow work out considering the legions of photographer living in US. This is just something I am not familiar with (comparing to other types of insurance cost), and it makes me anxious. I guess it is just difficult for me to factor the cost of health insurance in as a business cost.<br>

Thank you for your response.</p>

 

<p>Private insurance is quite expensive, which is why a private business owner is less likely to be well covered than a corporate employee. Also, those working part-time or at minimum wage jobs typically have no insurance, and fall under the "try not to get sick" health insurance plan.</p>

<p>My portion of my company's health insurance is somewhen around $1600/yr to cover myself and my spouse. I believe that if you are on your own, the annual premium to somewhere between $5000 and $15000, depending on how many dependents you have and what level of coverage you choose. Of course, you still have co-pays and deductibles to worry about.</p>

<p>You might be better off paying for doctor visits and minor surgeries in cash as they come up. If you are not going to get cancer or have any major surgeries, that's the cheapest way about it.</p>

<p>If it helps, Mimi, don't think of it as a business cost (since, really, it isn't). It's a part of your personal cost of living, and your business is how you fund your personal costs in life. Just like eating. Seen in that context, it's one of the reasons that some people balk at universal (goverment-handled) medical services ... just as they would balk at universal (government-handled) grocery services. <br /><br />There are many competing notions about how to go about altering the health care framework in the US. You'll probably want to at least brush up on them, even though none of them are going to materially impact how you buy a doctor's services any time soon.<br /><br />One change we can hope for will be a dropping of the prohibition against health insurance companies competing across state lines. For small businesses (especially independents, like photographers), the ability to form guild-like buying groups nation-wide could dramatically lower the per-customer risks that the insurance companies take on, and thus lower costs for people. We'll see!</p>

<p>One other thing to take into account is that most health insurance companies in the US will decline to insure you as an individual if you have ever had <em>anything</em> , and I mean <em>anything</em> , wrong in the past. This puts you into a high risk pool with high rates and low coverage. It's a pretty pathetic situation, speaking as someone who can only go into the high risk pool despite not having anything wrong currently. Small organizations often have restrictions in this area. Also, in the US, pre-existing conditions are not covered automatically. At least here in California, as long as you have continuous health care coverage, the insurers are forced to cover pre-existing conditions.</p>

<p>Jeff is right: Even if you aren't worried about the cost of health insurance, you may not be able to buy it at all.</p>

<p>The best thing is to contact some private insurers directly to get a quote for your age/health/expected location. I would have guessed getting a work visa would have been harder than health insurance. But if you got that handled, you will probably be able to find something that would work. Personally, I went with a high deductible policy, which makes premiums more affordable.</p>

<p>So you want to board the Titanic? Welcome aboard, but don't say you weren't warned! We will continue to watch 45,000 Americans die each year because they don't have access to health insurance / care. We will continue to see outrageous spikes in rates such as in California, while Well Point's profits DOUBLED last year. For all the talk about small businesses being the backbone of the economy, imagine the numbers of businesses that are not started because the cost of health care absolutely cripples such entrepenurial initiative. Until we are capable of having a rational discussion about real issues and real solutions, in an atmosphere not corrupted by crooked politicians and lobbyists and Fox " News ", our country's " greatness " will be hollow rhetoric.</p>

<p>First of, i moved to NYC for love (from Paris) and never regretted a day.<br>

That being said, check out the ASMP, APA or similar associations that will enable you to purchase access to group health insurance plans (and other business insurance). Also, in NY we have the "Freelancers Union" which has plans spec'd out for members. All along with contact info etc, to start your research.<br>

The most cost effective way of insurance is via your partner's corporate plan but the "group-individual" costs are manageable as well.<br>

And don't forget, you might have to contribute to workers compensation as well (check on the respective state's website).</p>

<p>In Massachusetts, where I live, you must have medical insurance or else you get fined. The accounting is done at the end of the year when you do your State income taxes. You must be able to show proof, including policy number, that you had medical insurance for the entire previous year. The amount of the fine is a good percentage of the cost of insurance so if you live here you might as well get it.<br>

If you have a low income, and I believe in Massachusetts that is something like $85,000 per year for a single person, the State contributes to the cost on a sliding scale; the less you earn the more the Sate contributes. If you earn less than I think $24,000 per year the State pays the entire premium. This arrangement was enacted by Republican Mitt Romney who was governor when this law was enacted.<br>

I read in the newspaper not long ago that Massachusetts also provides free medical insurance for imigrants who are not yet citizens.</p>

<p>Mimi your best bet is to get on your partner's plan through his or her employment. Second best bet is through a group to which you belong. Third choice is individual insurance which you will find expensive indeed. And they won't take you on unless you are healthy. They may exclude pre-existing conditions, and pregnancy and its complications. All this varies state by state. Just as an example, I pay $200 a month [quite reasonable actually] but I pay the first $2,000 each year, and after that I pay a chunk of everything [co-pay]. Rates vary by age, sex [i think] and location. And by the particular plan you pick.</p>

<p>Mimi,</p>

 

<p>A not-bad rule of thumb is to expect private health insurance to cost you not quite as much as your

housing.</p>

 

<p>But that’s just the beginning of the story. As many have observed above, private insurance

basically isn’t available to anybody except those in perfect health.</p>

 

<p>And, should you be in perfect health now but later develop a condition which requires treatment,

you should be prepared for the all-too-common situation where insurance companies drop you cold, for

no good reason. They’ll find a typo on your original application form, call it a material

misrepresentation on your part, and simply refuse to pay a dime.</p>

 

<p>As it stands today, health insurance — not health care, but insurance — in America is

entirely a scam. Costs are outrageous and payouts are marginal. Worse, the companies are actively practicing very bad medicine, by routinely overriding physician’s treatment orders in order to “contain expenses.”</p>

 

<p>It is truly no exaggeration that the least-insane financial decision is to do entirely without health

insurance. Pay out-of-pocket for your annual physical and minor ailments. Your physical will cost a

fraction of a monthly payment, and only a few times the co-pay that the insured themselves still pay.

(Oh — didn’t I mention? Even if you have insurance, you’ll still be charged

outrageous fees at every turn.)</p>

 

<p>Should something catastrophic happen, resign yourself to the fact that you will face financial ruin.

This will happen with or without insurance. The good news is that, once you’re poor enough,

you’ll be eligible for free state-funded medical care (Medicaid), and that it’s actually

pretty damned good. The surgeon who put my right shoulder back together after an SUV ran me over on my bicycle was paid from AHCCCS, Arizona’s Medicaid program, and my right arm is now actually better than the left.</p>

 

<p>It would be wise to keep your finances in non-liquid assets. Don’t set up a retirement fund

for yourself; instead, put the money into additional principal payments on your mortgage. Once the

house is paid for, put a photovoltaic array on the roof, and so on. Eligibility for Medicaid is based

largely on recent income and liquid assets; if something bad happens to you, you’ll quickly burn

through your limited liquid assets and you’ll be unemployed at the same time (because your boss fired you

because you can’t work any more). Hey-presto! You’re eligible for Medicaid! But your

hose is paid off, so you’re not homeless, and you’ve got a lifetime supply of solar

energy, so the lights won’t go out.</p>

 

<p>Sad, and a terrible condemnation of our society and its values. But no less true.</p>

 

<p>Cheers,</p>

 

<p>b&</p>

<p>"...you’ve got a lifetime supply of solar energy,..." Does a solar panel work under two or three feet of snow?</p>

<p>(Nor does water evaporate below 32 degrees F, as I once found out in a physical science class when I helped correct a professor in his presentation.)</p>

<p> </p>

<p>Jerry,</p>

 

<p>Here in the Southwest, most places don’t even get flakes of snow, let alone feet of it. But those parts

of the country where solar isn’t practical are often good candidates for small-scale (home-

sized) wind or geothermal power generation.</p>

 

<p>And, yes, there are lots of places where there’s no practical means of energy self-sufficiency. I

personally would choose to not live in such a place, just as in past centuries I would have chosen to

not live in a barren wasteland incapable of supporting crops or livestock.</p>

 

<p>One very attractive alternative is a country such as France, where the nation as a whole has placed a collective value on energy self-sufficiency. I would be perfectly happy to rely on the French nuclear grid, along with the rest of their social infrastructure. Or, there’s Germany, where the government is heavily subsidizing private rooftop solar installations in a rapid effort to provide for energy independence for their own citizenry.</p>

 

<p>But such is not the case here in the States. Prudence and simple self-interest therefore dictates we heed the advice of the Libertarians, antisocial and selfish as they are, and provide for ourselves. It’s highly inefficient and grossly uncivilized, not to mention short-sighted, unwise, and bad fiscal policy…but it’s not like there are many practical alternatives, given the prevailing political climate.</p>

 

<p>Cheers,</p>

 

<p>b&</p>

<p>The laws in this area are very complex. Each state in the U.S. creates and maintains its own health insurance regulations. Health insurance companies organize networks of providers (doctors, hospitals and other health practitioners and professionals) which must be located in each state, and for borderline regions, in nearby states, to satisfy state requirements that any network member who gets sick will have access to adequate care. You cannot shop for insurance until you know where you'll be.</p>

<p>The largest health insurance companies own networks in many states. Anthem, for example, owns provider networks in nearly all of the contiguous 48 states except for the sparsely populated northern midwest. On the one hand this provides leverage and some consistency for internal policy and company practice, but on the other, as each network cannot cross state lines, the specific details for plan benefits and who is qualified to join will vary. You will want to make sure that your resident alien status is rock solid.</p>

<p>Employees through an assortment of group insurance plans they may select get the best coverage at the most reasonable cost although in recent years employee premiums have gone up dramatically. Private insurance costs much more because individuals do not have any pool of people to use to spread (leverage) premiums the way employers do. Private insurance is harder to get than employee insurance because the insurance companies can be more selective in screening individuals. As a last ditch for qualified individuals who cannot get coverage any other way there are HIPAA plans. These government mandated plans provide help in extreme circumstances. HIPAA plans are expensive. I have heard of one in my local area that has a premium of over $600/mo for an individual only (not a family) with a $1,500 deductible. Deductibles are the portion of your care you must pay for yourself before you can draw any plan benefits.</p>

<p>Prepare to be confused. The combination of plan type and benefit packages is truly confounding. Many plans support domestic partners as opposed to married partners now, and you will want to make sure that the plan you and your partner choose is one of these. It will help a lot to be settled down in the US with the actual choices you may make in front of you.</p>

<p>Thank you everyone for your valuable responses. I now have some idea of how health insurance works if I choose to get in the photo business in US. I have a lot of research to do.<br /> The complexity of the system is part of life like it is anywhere else, will take some time to get to know it well. I will just have to get used to it if I decide to go there. Maybe I will be so used to it, one of these days I would think that the whole US health care system is actually reasonable.Or it is just better to stay in Canada.</p>

<p>May I suggest that you fall in love with someone from Europe, where most countries have centrally funded health services. Being ill is then a matter of going to a doctor or hospital, who make you better and you then get on with your life. No complications, no financial ruin.</p>

<p>Viewing people's health as another consumer item does have its drawbacks. Assuming my suggestion is a step too far for you, good luck in the US.</p>

<p>Regards</p>

<p>Alan</p>

<p>The system is very complex.<br>

The leaders folks worship have these laws such that if You live in state #2; you cannot buy insurance from state #34.<br>

The moats keep prices high.<br>

Thus is you live in a state with alot of medical problems and lawsuits; there will be a subset of providers; and even a subset of plans. For one of my companies the healthcare plan is 2028 bucks per worker per *month.* My own plan is based in California; it is only 520 per month with a 2000 buck deductible. It was only 58 bucks every 90 days in the mid 1980's; about 20 per month. That is for a plan with ZERO claims EVER; since it started in 1985; ie 25 years ago. If I join the plan of my other company; it goes to sweet 2 grand per month too; which is nuts. The 2000 buck per worker was 1400 last year; and only 1200 the year before on a per month basis. Back 10 years ago the same type of plan was only about 300 per month per worker. Now I am faced with not hiring anybody and probably firing some; because the 100 buck per day cost per day per worker is not sustainable.</p>

<p>What fees one pays is based on your age; where you live; ie state; county and zip code too. EVEN what deductables is controled. One might have a nice low cost plan in state #15 with a 4000 buck deductable; and one moves to state #17; and with luck one can get the same provider: BUT they onely allow a 1000 buck deductable; and thus one premium doubles or triples in cost.<br>

The bum of the elected leaders is worshiped and these moats are scared to most folks; it keeps competion down and prices up. With my own here I cannot afford a high end plan; thus I self insure; I pay for all the small stuff.<br>

Trial lawyers bums are worshiped here in the USA too; it is a massive industry. Doctors often due alot of extra tests to reduce lawsuits. This sacred cow group is in bed with one political party; a major giver; thus this moat is taboo to be lanced.<br>

Medical plans vary in coverage; my 500 buck per month plan covers teeth if they are knocked out in a big auto accident; while others have plans that cover cleaning and maintenance. Get get the premium down I ame goping to bump up the deductable again.<br>

Just to talk to providers one speeds a massive amount of time. To change a works plan last October took ONE MAN WEEK of phone tag. You spend eons of time explaining the same damn thing to somebody in a 3rd world country; then the next time you call you explain it all over again. Then when you get the fax with the corrected plan; it is all screwed up and you talk with goofball #37 again after being on hold for 1/3 hour.</p>

<p>Comparing health care costs today to costs from decades past is part of the problem, here. Health care today is practically science fiction, compared to even twenty years ago. A single difficult premature birth can cost a hundred thousand dollars. Why? Because equipment, technology, practices, and human skills are brought to bear in a way that they never previously were (or even could have been). More such babies (or accident victims, etc) live, but at huge, huge costs. That's the elephant in the room here, folks.<br /><br />Likewise with cancer treatments, and all manner of maladies and injuries that simply used to kill more people, and more quickly. Combine that with a much older population, and an epidemic of obesity that produces more medical costs for one person's cardiovascular and metabolic problems than an entire small town's routine care would have racked up in the 1960's, and you're at the heart of the problem. People want state of the art medical options, but simply want someone else to pay for it. And they want the right to sue doctors, hospitals, and staff into oblivion if miracles aren't performed like clockwork. <br /><br />If everyone was willing to consume medical services the way they were provided thirty years ago, we'd have costs that resemble something like thirty years ago, too. Instead, we have a situation where the lawyer-proofing application of fantastically expensive tests and defensive medicine are deployed every time, all the time. And families insist that their dying 90 year old grandmother receive $25,000 worth of radiation and chemo and $100,000 worth of supporting care. Where does everyone imagine the cash comes from to pay for all of that? The bill is passed along to the people who actually can pay for their own medical care, and that part of the population that pays taxes. Rendering those people, of course, increasingly unable to do either. <br /><br />The answers include healthier people in the first place (this obesity thing, for example, is simply staggering in its cost implications), a more rational set of expectations about being able to hit the million-dollar lottery whenever a doctor turns out to not be omniscient, and the ability to break out of the state border cages in which health care administration/financing operations are locked. Laundering all of that economic activity through a government bureaucracy isn't the answer, either.<br /><br />The folks saying, "Just go to Europe, where it all works perfectly," need to look at the health of those systems, too, relative to the taxes required to keep them afloat ... and imagine applying that tax burden to the US, where a minority of people pay the majority of the taxes. The US is not Europe - culturally, demographically, or in most other ways. That's not a light switch we can flip, and I'm pretty sure I wouldn't want it done, even if it wouldn't be as instantly ruinous as I suspect it would be.<br /><br />The biggest factor in this debate is that people want 21st century medicine, on demand, at a mid-20th-century share of their income ... or they want it to come out of a bigger share of someone <em>else's</em> income. These things are irreconcilable. Politicians who say they can provide even more medical services (at 21st century levels of sophistication) to tens of millions of more people, and have the whole thing somehow cost the economy and each doctor's customer and taxpayer <em>less</em> ... are lying. And badly, too.</p>

<p>Matt,</p>

 

<p>I’ve heard that argument before and remain utterly unconvinced.</p>

 

<p>An iPhone is more powerful than the furniture-sized Cray and IBM supercomputers that ASU had when I was at

school there, and the iPhone fits comfortably in your pocket. It is every bit the miracle of modern technology that

modern health care is. Supercomputers in the ’80^{<small><u>s</u></small>} cost as

much as a mansion, but an iPhone costs a fraction of a single middle-class mortgage payment.</p>

 

<p>The pocket-sized digicams you find in the impulse aisle at the drug store would have been too

fanciful for James Bond to have used in the early movies. And those cameras are jokes compared to the ones so many of us here own — most of us, more than one.</p>

 

<p>Wall-mount HDTVs are right out of Bradbury’s <i>Fahrenheit 451</i> and yet are a common feature

in middle-class homes.</p>

 

<p>Granted that cars don’t fly, yet a not-unusual modern car, with a hybrid motor, GPS voice

navigation, airbags, ABS brakes, remote keyless entry, TVs in every seat back, iPod docks, and so much more,

would have been over-the-top ridiculous for <i>Lost In Space.</i></p>

 

<p>By now you should get the point. Medical technology has advanced at a comparable pace to all

other areas of technology. Yet, the prices for medical technology have skyrocketed while the prices for

all other technologies have plummeted.</p>

 

<p>There is no intrinsic reason why this should be so. Indeed, it can be explained entirely by

introductory economics: supply and demand. Charge what the market will bear.</p>

 

<p>People are, quite understandably, willing to pay absurd amounts of money to live and to be healthy.

What other rational choice is there? To suffer and die — needlessly?</p>

 

<p>I can understand — barely — the unabashed greed of the health insurance industry.

But my understanding can only lead to the utmost contempt. Health so-called “insurance” is no more and no less than extortion, pure and simple. Buy insurance and you’re paying Danegeld.</p>

 

<p>If you still think medical treatments are the result of technological advancements, just compare the

advertising budgets of the major drug manufacturers with their R&D budgets. It’s enough to

make you cry.</p>

 

<p>Now go look at how much those same companies are spending on bribing Congress.</p>

 

<p>Cheers,</p>

 

<p>b&</p>

<p>Ben: have you ever counted the man hours involved in taking and handling (and recording, in a legally defensible way, etc) a full-spectrum blood test? Have you noted how much more often that's done, these days, for every minor complaint? It's not that we can now analyze blood with a $400,000 machine instead of a crew of twenty lab specialists ... it's that we're analyzing it for trivial reasons at a hugely higher frequency than ever before, and usually for no good reason. It's like pulling a car's transmission out every time you're in for a wheel balancing.<br /><br />And: do you have any idea what all of those medical imaging devices cost? CAT/MRI hardware involves heavy-duty Laws Of Physics stuff that precludes it from ever being iPod-ized, or used by lightly-trained technicians. These rigs costs millions of dollars, and are used for every bruise and bellyache. My wife had a bout with an intestinal virus. A few days of misery, to be sure. She went in to chat with a nurse practictioner about the best way to stay hydrated and deal with the usual metabolic side effects. Hey presto, it was deemed prudent (she was actually told that once she talked to them in person, they couldn't skip any of this, but could have if she'd just called on the phone) to run a battery of radiological/imaging tests. $4,000+ invoice from the crew using the million-dollar imaging hardware and lab gear was the result. No treatment required, it was a passing virus, exactly as expected.<br /><br />There is no pocket-sized, $500 iMRI from Apple. And there is no medical practice that's willing to gamble on a law suit by sending someone home with the advice to drink water and wait for the virus to pass. One idiotic judgement call like the anecdote above cost more money (and tied up more equipment and personnel) than would be needed to provide decent pre-natal care and delivery of a typical baby. Absurd. Talking to the doctor about this, we're told that the problem is, "Now that we <em>can</em> do all of that stuff, we <em>have</em> to, or risk losing our liability insurance."<br /><br />And why is liability insurance so expensive? Because guys like John Edwards are multi-millionaires from squeezing huge sums of cash out of the system in court. It's a vicious circle, ending only in unsustainable costs passed along to a dwindling number of people who can actually pay for it. The insurance companies aren't practicing extortion, the John Edwards-types are the experts at it.</p>

<p>Ben; who do you think pays for the folks who man the telephones that I spent ONE MAN WEEK on hold and talking to last October about one of my employees simple insurance issue? To resolve an issue took 1 month of calls; emails; faxes; letters. Each person one talked to handed the problem to another; then one spends 1/2 with the issue again. To get the issue solved I had to get the issue fixed I had to get the State insurance comissioners office involved. One has an insurance company who gets US post office certified letter with a signed receipt; then they claim they "do not know who signed it" ie they do not know the person who signed the post office receipt.<br>

<br /> The USA has a bloated fat workforce.</p>

<p>Some health care plans cover Viagra; hair transplants and simple depression that were unheard of eons ago.<br>

<br /> The area of medical claims with insurance is a very lossy area. The cost of lawsuits is very costly too. When I grew up cigarettes were called coffin nails. Later in 1963 the suregon general declared they were bad. Folks still worship lawsuits in the USA and fail to understand they bump up costs.<br>

<br /> iPhones and Crays do not have huge costs due to dealing with people; forms; or lawsuits.</p>

<p>Mimi, my suggestion is to pay cash for all minor medical problems. Forget the insurance. For anything major, do what so many Americans do, go to Canada for better care. The statistics show that there is a better nurse to patient ratio, better transplant success and overall superior care, all at around half the cost of US care. Yes it is called medical tourism. Australia and NZ also have good care at low prices.</p>

<p>I have no practical information to add, just a comment. I was born and live in Canada and worked in the private sector in software development for 25 years in a series of high-tech firms that have all basically disappeared after being relatively successful. Lately, I've been working for a government agency that's about to be spun off as a private company. Because of what I personally saw in private companies and the kinds of stories I read in this thread, whenever someone says that the private sector is more efficient, it just makes me laugh out loud.</p>