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Ask HN: How do you cover healthcare as a founder? (US Only)

20 points by deputychina ↗ HN
Got a family of 3 while I work on my startup. Somehow we are surviving for Month over Month but healthcare costs are through the roof.

I am seeing premiums from $1170/mo for basic plan that must meet family deductible of $12k (or individual $6k). That means total out of pocket will be around total out of pocket cost are $18k to $26k. There are two cheap plans but appointments and in-network coverage is non-existent.

We haven't raised VC round. That is another battle.

How do you cover for healthcare in the US? Just cost of healthcare stressing me out while I build the company.

Are there any cheap cost care available? We are in Washington state if that matters.

Let me know if you know anything that I might have overlooked.

12 comments

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gregjor
I moved out of the USA partly because of health insurance and medical care costs. Something to consider.
big-green-man
Do you bring home a salary/are you profitable? If you make just above the IRS reporting threshold you can get a free or almost free plan from the marketplace (deadline is tomorrow), and if you don't make much it can be pretty cheap. Net worth doesn't factor in here, only income.
refurb
This.

If you income is below the ACA threshold, you pretty much get a free bronze plan through a tax credit. Or in the states that expanded Medicaid, you can qualify for it.

And this would cover your entire family.

Brzone plans will have significant deductible and co-pay/co-insurance, but it will cover you for catestrophic issues.

Medicaid is generally very low cost-sharing.

daemonologist
Yep, this. For non-expansion states (not applicable to you OP, you're good in WA!), if you find yourself with an income too low to quality for ACA subsidies, you may be able to for example do 401K -> Roth IRA conversions to raise your MAGI.

Also ACA eligibility is based on your estimate for next year's income. If you make more than expected you may have to pay back subsidies, but if you make less than expected - provided it was an honest best-effort estimate - my understanding is they historically don't try to claw it back or anything.

More about states without expanded medicaid: https://www.cbpp.org/research/health/the-medicaid-coverage-g...

ACA self-employed income: https://www.healthcare.gov/self-employed/income/

deputychina
It's complicated. I don't take salary. On paper, I am paid $50k but I invest that back into company and thus do not receive any cash amount. I am paying everything out of pocket.

We don't have much income through business.

I don't know if I can qualify for Apple Care (medicaid of WA).

It's hard to build business and have healthcare simultaneously.

daemonologist
If you're paid 50k, you're paid 50k - the feds don't care what you do with it (well, they do, but you know what I mean). You most likely qualify for significant ACA subsidies at that income level though, probably ~>50% depending on the plan; if you want to go this route the annual enrollment window is currently open and you have until January 15 to sign up.

Since it sounds like the income isn't actually doing you any good, you could potentially just reduce it (to ~<35k) and qualify for Apple Health. It would be basically free but might be accepted by fewer doctors. There's no enrollment window limitation for Apple Health so you can do this at any time.

(Not a lawyer or accountant.)

Oh also someone mentioned tomorrow being a deadline for ACA - that's only for coverage beginning January. You have one extra month and coverage will just start in February instead.

[dead] Onavo
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dpistole
I spent the last 18 months unemployed and on WA "Apple Care", wasn't terrible, got me into the doctor for an ultrasound and into the dentist for an extraction at no cost to me.
a_t48
Paying $1200 through COBRA for wife and I - hoping to slash that in half given I take no salary (no revenue), but CA claims on the website that I'm not eligible given I currently am eligible for COBRA. Will be calling them tomorrow. Good luck with the raise.