Ask HN: What do founders do for health insurance?

The best solution was (for me anyway) to treat insurance as insurance instead of a health care plan, and take advantage of all the tax breaks I could for doing so. I put my family on a $10k deductible plan, primarily to cover catastrophes. This gave me two things: negotiated rates for health services (typically a 40-60% discount) and eligibility for an HSA. The plan ran us $190/mo.<p>Now, $10k is kind of a scary number for something like that, but I felt comfortable with it given that we'd never have to write a $10k check. At the very worst we'd rack up a $10k debt to a hospital or something, which (given the current state of healthcare) we could reasonably expect to pay off over like 15 - 20years. It seemed reasonable to me, for what we needed.<p>The HSA is helpful because it's effectively another IRA you can use for pretty much any medical expense. So for normal health care, we ended up paying about 40% of the "list" costs for things, and pre-tax.<p>Doing this requires that you be a little aggressive about getting good deals on care, though. My daughter broke her arm about three months in to this, so we took her to a minor emergency clinic. I told them what was up and they "coded" the visit at a much lower rate than it would have been. The next day, we actually called around to find out what people were going to charge us for a real cast to replace the splint the clinic put on. It worked out to be about $600 total, including the minor emergency clinic visit.<p>So in summary: get coverage for catastrophic health events with a "cheap" plan, abuse the negotiated rates that plan gets you, get an HSA, and be an intelligent consumer of health care. Oh, and minor emergency clinics are your friend.

Been there.<p>$1,500/mo is a typical quote for "normal"-deductable health insurance. If you're a young family, that's not what you want; you want high-deductable health insurance, which has a low monthly payment but effectively means you're paying for all your doctors visits and medications out of pocket.<p>The real goal of insurance is to keep you from going bankrupt over appendectomies and broken bones. You can afford to pay your pediatrician yourself.<p>If you have a qualifying high-deductable plan, you can also create an HSA account and fund it to pay for routine health expenses; those costs are then tax-advantaged.<p>I agree with the other posters that recommend brokers. Especially for a family, you can wind up in a rats nest of preexisting coverage denials if anyone has ever been to the hospital before. I got the sense that insurers simply don't like covering women who might have children. Brokers will not resolve this problem for you, but they'll make most of the paperwork go away.<p>Couple more thoughts.<p>First, there may be an engineering union style group you can join to get health insurance from. Jeremy, one of my NYC partners, had a group like this he got coverage through. So look around for things like that.<p>Second, beware of temporary/month-to-month insurance, which reputable insurers offer very cheaply. It doesn't take a lot of thought to see why this is a bad deal: they're under no obligation to pick you up once the term ends. If you get sick April 29th and your plan runs out April 30th, you're completely fucked.<p>Matasano got group coverage (through United, and I'm not a fan) a couple years ago. It made hiring <i>much</i> easier; health insurance was often the first question candidates asked, before base comp. Be aware that group coverage isn't a magic bullet either. What it does is make preexisting condition issues go away. But it isn't cheaper than what you can get on your own.

I don't know what part of the country you're in, but you should contact a broker. They can give you a bunch of options and tell you what all of the options mean.<p>Personally, I'd prefer an independent broker than someone who worked for a big firm like State Farm or the like.<p>As an additional note, you don't pay anything extra for using a broker; the carrier pays them additional money directly. All the carriers will have similar override agreements with a broker, so you don't have to worry about the broker being shady. They only get paid for as long as you have the policy, so it is in their interest to match you with a policy that you will actually keep.<p>If you're concerned about costs, ask about an HSA. Make sure you understand what an HSA actually is before you decide to go with one, though.<p>[Edit: I forgot to mention that I'm in the the brokerage portion of the health insurance industry; before I worked here though I used a broker and he saved me about 500 bucks a year.]

I'm in the employee benefits field up here in Canada. While we're different, I support small businesses and they have the same concerns regarding costs as you would, albeit at a much smaller scale.<p>Take this knowledge with a grain of salt, given the systems, but one way you could control costs is by looking into a Healthcare Spending Account (HSA) - I believe the US equivalent would be a Health Reimbursement Account (HRA).<p>This allows you to set a max contribution limit, but it automatically caps your claims to the money in the account. If you paired that with high deductible catastrophic insurance, you may come out ahead. Wiki has a good set of info: <a href="http://en.wikipedia.org/wiki/Health_Reimbursement_Arrangement" rel="nofollow">http://en.wikipedia.org/wiki/Health_Reimbursement_Arrangemen...</a><p>Other than that, I think you are SOL in terms of paying the big bucks. Health Coverage is one area where the US is simply lacking in my opinion, compared to the rest of the world.<p>Good luck to you. You should definitely contact a local broker or two and have them walk you through the different options. There is a lot of stuff out there that is simply too crazy to understand and is best handled by a pro.

I can't help with the family situation, but have you considered "catastrophic" insurance through a professional group like the IEEE or ACM?<p>They have plans as low as $90/quarter that have a $5k deductible. Not good if you come down with frequent colds, coughs, flu, etc. It is good if you're in a car accident and fracture your leg in 2-3 places. Or slip on ice and hit your head, etc.

Cross my fingers and hope I don't get sick. I do try to stay in shape(workout every day 1-1.5 hours) and eat healthy. But I just can't justify paying for health insurance at this point.

Living in Massachusetts, where you can buy group health insurance through the state, really helps.

Move to a country that takes public healthcare seriously.<p>I'm only half joking after reading the other comments here. The US. system is seriously broken.

I use Tonik. It may not be right for a family of four but for a young single guy it works well enough.<p><a href="https://www.tonikhealth.com/" rel="nofollow">https://www.tonikhealth.com/</a>

When I sold my company I had to break my family apart for health insurance. My children are in the state subsidized high risk pool and I was able to find one company that would take my wife and myself without the children.

For some reason the health insurance industry has settled on a model of "pay your health insurance company scads of money and pay relatively little for the rationed routine care you get". Since health insurance is a heavily regulated market, I doubt this is the most market-efficient solution. Maybe if you shop around for routine care and offer to pay with cash (or HSA) it won't end up costing as much, and I've seen informal studies done by friends that show, for instance, that certain prescription drugs cost hundreds of dollars less at different pharmacies (once you can coax the pharmacies to actually tell you the price, since they're so used to working within the insurance cartels).<p>It all depends on your health, too. If you have sleep apnea and want to get it treated, that's hundreds of thousands of dollars if you don't have insurance. Probably better to get a full time job for a few years until your apnea is treated. If you have hypothyroidism, you can take remarkably inexpensive prescription drugs and get an annual checkup for cash cheaper than you can get insurance to cover the thing.<p>My working hypothesis is that high-deductible catastrophic insurance is the best solution for broke, comparatively healthy adults. In this model, you're using health insurance as insurance qua insurance, to make sure you don't go bankrupt if a medical emergency costing more than $10,000 happens to you. (This of course requires you to be able to raise $10,000 if something DOES happen to you.) This does nothing for drugs or routine care, and needless to say there is no dental plan. I pay $40 a month for this. I don't get anything out of my $40 a month, but on the same token, insurance qua insurance is something you pay for but you hope you never have to use. An HSA is not a bad feature if you're going with this model.<p>Depending upon state law, you can leave out things like maternity coverage, or get further discounts if you're in good health. A good female friend of mine doesn't have maternity coverage but she is very aggressive about birth control and has no qualms about abortion, though, so I would carefully consider whether this also applies to you or your spouse. I would also hasten to add that if there's a possibility of having more children, the expense of health insurance is not your biggest problem here.<p>In fact, I don't know how well this model works if you have kids. Or how founding a startup works if you have kids, for that matter.

Wow, it's much cheaper if you're a single male (no maternity benefits included) in Calif. at least (and Wyoming and Mass. from experience). I have a Blue Cross PPO right now for $85/month. They are upping the rate to $140. I will be leaving on principle.<p>I plan on getting a high-deductible/HSA plan. If the deductible is $X I will put $X into an HSA. Thus any care I might need over the next year will "feel" free. If I'm lucky and my current health trend continues I will not need to take any money out of the HSA. And it will simply be a tax benefit. In future years I'd replenish the HSA up to or over the deductible level of whatever my present plan is.<p>I would look at the high-deductible/HSA options. Assuming you have the cash around to buy the policy and stock the HSA with cash you'll not have to worry about health bills until next year. Psychologically, this could be comforting. Whether it makes sense probably depends on how much you and your family actually use insurance. And the specific costs of the plans available to you.

We got a Kaiser HSA. If you live near a Kaiser hospital they're a pretty good deal. I don't have any kids, but they seem like they're much more family friendly than some of the other low cost HSAs. They cover full maternity, and cover a few well checkups a year for kids, and one for adults without hitting your deductible.

It is worth finding out what your state's family services covers, especially if you are low income (about $45k/year). Depending on your income your kids and even you might qualify for medicaid. There are also dozens of other programs around. I live in Ohio and there are programs for pregnant women, disabled, blind and aged. There are programs for emergency care for aliens and the hospitals usually will give discounts for low income. If that is not enough there are lots of cheaper and even free clinics for health and dental care, around here they generally work on a sliding-scale based on your income.

I have a two year old that has 2 heart abnormalities. We thought she would need heart surgery, but the cardiologists don't feel this is necessary. The "leaks" in her heart are getting smaller each month. She looks like any healthy 2 year old. I have family members that are health insurance experts and they tell me I basically have to be a part of a group policy. The last 2 companies I have worked for have had minor increases to their 100+ employee group policy. The health company cited my daughter as one of the reasons for the increase. Luckily my coworkers don't know this.

You always can find something cheaper than that! You may want something more expensive for the kids, but for healthy adults you can pretty easy get away with like $300-350 for both -- use sites like ehealthinsurance and others -- they can do comparison for you. Of course, if you have some medical conditions/etc. - that can be an issue, as then the cost of insurance will be sky high.<p>After all, yes, health insurance IS expensive, but you can find the cheaper options. But well, the same way you can think about your rent, groceries, etc. You have to have them, and you have to pay for that.

We both were health young guys with no families that needed to be covered and just ended up getting Tonik health insurance.<p>During hiring we mentioned that we would cover up to X amount of personal health insurance. Since our hire had a family though we are now looking at getting a group plan even though the company only has 3 people, the man reason was getting family plans is much harder to get cheap personal plans while the group plans have better benefits for families.

There is no good solution. The American health care system is unfortunately presently designed to work against entrepreneurs and small business owners. In most states including California, you must have at least two full-time employees to qualify for group health benefits.<p><a href="http://www.aarongreenspan.com/essays/index.html?id=11" rel="nofollow">http://www.aarongreenspan.com/essays/index.html?id=11</a>

In New York State, try the Freelancers Union. <a href="http://www.freelancersunion.org/insurance/index.html" rel="nofollow">http://www.freelancersunion.org/insurance/index.html</a><p>I used this a few years ago while working for a startup and I got a full plan (comparable to the average full-time job's plan) for half price (at that time, around $250 a month).<p>Worth a look. They are always expanding and trying to provide more and more benefits for the W2-challenged.

My wife is an engineer at a large corporation, I'm covered as a spouse.<p>...but that won't cut it if/when I get to the point of needing to hire other people.

When I paid for private health insurance, My premiums were around $450/month for a family of 3. This was (if I recall correctly) and 80/20 plan with a $1000 deductible. I then dumped $1000 into my HSA and I was set.

Before I graduated college I got a year of health insurance under a student plan that keeps working after I graduated. I graduated in December and it runs out in ~August. So I'll be in the same boat soon enough..

When I started my own company I bought health insurance. If you can't afford it, you can't afford to start your own company. No different really from other expenses like equipment and such.

To follow up on this thread, what health insurance do contracts get? I'm looking for something for myself. Thanks.

This is one of the few big pluses Europe has over America for startups. Unfortunately it's not nearly enough.