Does your health insurance need a tune-up?

By Kyle Niederpruem posted 11 days ago

As solo practitioners, we may have limited options for healthcare coverage. With health insurance documented as one of the higher costs for your business (based on annual IPA surveys), we know it’s a pain point. If you get sick, there isn’t often a back-up for clients. And if a long-term care situation creeps into your reality, it can wipe out your business and take you a long time to rebuild.

The average U.S. consumer spends more than $10,000 a year on healthcare. That's 50% more than consumers in other countries, according to Americans spent $3.3 trillion on healthcare or about $10,348 per person – an increase of 18.9% in just five years. Healthcare spending in the U.S. accounts for 17.9% of the gross domestic product.

I talked with a licensed agent who has been in business since 1984 to review some practical implications for a solo practitioner. Here’s what we found in a conversation with Bob Dennis, who is licensed in several states including my home state of Indiana.

Why should a solo seek out a licensed agent? “It helps to have an agent who speaks the insurance language. That’s no different than working with a doctor or an accountant. Every professional group has their own language. You can find agents on Or you can search with the National Association of Health Underwriters if you want to find someone local. On, you can also call 24/7 and they’re very responsive.”

How about business travel and health insurance – are you covered? “Insurance is state specific and your coverage often stops at the state line. In most cases, though, if you have to go to an emergency room, you’ll be covered.”

What happens if we lose all of our income (aka clients)? “That’s a special enrollment situation – a drastic loss of clients that results in loss of income. Losing your income is one of those situations. But you have to move quickly – and you have to enroll within 30 or 60 days. I frequently get calls about people who lost coverage because of divorce. But they wait too long to act.”

Does moving to another state also trigger a special enrollment? “Yes, it is a qualifying life event. Most state insurance policies are state specific. It doesn’t travel with you, except in the case of an emergency. As you look for insurance options, you should ask if it’s state or national (coverage). I have children in college, so opted for a policy with national coverage.”

What’s a small group business plan? “Small group business plans can be offered if you have two full-time employees or FTE equivalents. A lot of associations offer these are many are getting back into offering these types of policies again.”

What do most people neglect or fail to do? “Most people are unaware of the enrollment period each year, which is November 1 to December 15. It’s only 45 days. Plans may not be available until November. Insurance companies are providing pricing to the marketplace earlier, but the Center for Medicaid and Medicare Services decides the final plans. So it’s a short window. There’s no longer a penalty for failing to have health insurance as of 2019, but you may lose your window to enroll.”

Can you find out network pricing for comparison shopping? “It’s difficult. The public is trying to get transparency. With a car, you see the sticker price. Unfortunately, we don’t know that price (easily) when we see a doctor. There are even different billing types for the same visit – Type 1, Type 2 or Type 3. A hospital office charge (where a doctor is affiliated with a hospital) is much more expensive than a private practice doctor.”

How do you find a private practice doctor? “Most insurance networks have doctor finder tools where you can search. If (a doctor) is listed as a preferred provider, that’s a doctor who has good outcomes and good pricing. That means their rates may also be lower if they’re given preferential treatment with those rankings.”

What about cost comparison tools on procedures? “Every insurance company has a cost comparison tool for procedures. Procedures and outcomes should be listed. These tools exist, but sometimes people don’t use them.”

Can you negotiate cash discounts and payment plans with providers? “Absolutely. You can even get a better rate. Talk to your doctor. Say you can pay cash. You might be surprised how much they’ll reduce their rate. Even if you do have insurance, you should negotiate.”

Here’s a great list from about how to go about negotiating your costs. Also, if you’re looking for different options – such as faith-based networks where members share costs, one of our solos recommends Medi-Share. As always, do your due diligence. Check with your state insurance regulators for complaints and resolutions. I did this when checking my options in Indiana and it definitely pushed me on my final choice.