Health Insurance for a Collective

Part
01
of two
Part
01

Health Insurance Options

We were unable to find health insurance options that are geared specifically to self-employed individuals in a co-working community in New York. In your other request in this project, "Association Health Plan," we covered that under the Affordable Care Act, Association Health Plans (AHPs) were converted to "small-group or individual plans." However, proposed federal legislation could again make AHPs an option for self-employed individuals.

As the law sits today, in New York the option for health care coverage for sole proprietors and their families is coverage purchased on the state's Individual Marketplace. We detailed New York's Individual Marketplace and how to access it in "Association Health Plans."

Below, we have highlighted one health plan off of New York's Individual Marketplace, Affinity Health Plan. We chose to do a deep dive on Affinity because they are unique in that they provide coverage for lower-income New York residents who are not eligible for Medicaid.

Additionally, we found two organizations that offer health and wellness benefits to the general public, 2BenefitU and Medi-Share.

Affinity Health Plan

Unlike 2BenefitU and Medi-Share, Affinity Health Plan is full-coverage health insurance. It is offered to lower-income New York residents who do not qualify for Medicaid.

1: $24,120
2: $32,480
3: $40,840
4: $49,200

Pros & Cons
Affinity Health Plan is full-coverage health insurance offered on New York's Health Plan Marketplace. It is available to anyone who meets the income requirements. The monthly fees for medical coverage range from $0 to $20 per person. Vision and dental coverage is available for an additional fee.

Case Study
Affinity does not list any testimonials or reviews on their website. We were unable to find any credible, recent reviews. (For example, we came across Yelp reviews from 2015.)

2Benefitu

Some professional organizations offer health and wellness benefits to their members. Your request doesn't mention what type of therapists would be in your co-working community, but we looked at the American Mental Health Counselors Association (AMHCA). Members can receive, "10% off all 2BenefitU's enhanced health and wellness plans."

2BenefitU describes itself as offering, "non-insured benefit programs featuring products and services for everyday use." There are three packages available: Basic, Plus, and Ultimate. Benefits include Teladoc, a nurseline, diabetes supplies, durable medical equipment, to name a few.

While AMHCA members receive 10% off 2BenefitU's plans, it is important to note that 2BenefitU is open to the general public. Depending on the package you choose, 2BenefitU's monthly fees range from $15.95 to $29.95.

Pros & Cons
2BenefitU's monthly fees are relatively inexpensive. The "Discount Lab Work Benefit" in not available to New York residents.

Case Study
2BenefitU posts customer testimonials on their own website. We were unable to find independent case studies or reviews of 2BenefitU.

Medi-Share

Medi-Share is, "a healthcare sharing ministry where members share each other’s medical bills." A member's monthly fee, called a "share," is matched with other members' monthly bills.

Group billing is available for "employers and employees," but Medi-Share's website does not further elaborate on these terms.

Pros & Cons
Members must agree to not use tobacco or illegal drugs; to not abuse legal drugs; and to abstain from sex "outside of traditional Christian marriage."

There are several services and procedures not eligible for sharing, including: "[m]aternity expenses for children conceived out of wedlock with an exception for pregnancy resulting from rape;" psychiatric and psychological care; and dental and periodontal services.

Case Study
Medi-Share posts member reviews on its website. A December 2016 post on Take Command Health details one father's experience with Medi-Share.

Conclusion

We were unable to find health insurance options that are geared specifically to self-employed individuals in a co-working community in New York. As noted in "Association Health Plan," the issues surrounding AHPs are dynamic as we wait to see if the proposed legislation is passed.

Affinity Health Plan is full-coverage health insurance available to New York residents that meet income requirements. Additionally, 2BenefitU and Medi-Share are organizations open to the general public.
Part
02
of two
Part
02

Association Health Plan

We found that Association Health Plans that provide group coverage to sole proprietors are currently not allowed by federal law, but proposed legislation may change that. Kaiser Health News recently reported, "[f]or the first time, the rules would allow sole proprietors with no employees to join such group coverage."

In New York, the current option for health care coverage for sole proprietors and their families is coverage purchased on the state's Individual Marketplace. Additionally, small businesses with 1-100 employees and at least one "common law" employee can organize small group coverage.

We have provided information on the current proposed legislation, but AHPs are in a dynamic state and this information could change in a short period of time.

Affordable Care Act

The passage of the Affordable Care Act changed how AHPs are defined and operated, converting them to small-group or individual plans. We found several sources backing up that AHP health coverage for self-employed individuals is currently not allowed by federal law. The Center on Budget and Policy Priorities reported that the proposed legislation would allow, "self-employed individuals to access AHPs." As stated above, Kaiser Health News also weighed in on the legislation.

AHP creation and state specific regulations

It is unknown how the proposed legislation would impact AHPs specifically in New York. Currently, in New York, sole proprietors "can buy health insurance coverage through the state's official health plan marketplace, where you may be eligible for tax credits that reduce the cost of coverage."

While you are looking specifically for information on self-employed individuals, we thought you may still find small business regulations helpful. As of 1/1/2016, the following rules have been set forth for small businesses wishing to purchase on New York's Small Business Marketplace:

"Has a physical business address within New York State

Has 100 or fewer FTE (Full-Time Equivalent) employees

Will have at least one common-law employee ENROLLED in coverage

Will offer coverage through the Small Business Marketplace to all eligible employees who work 30 or more hours per week

Is authorized to purchase health insurance coverage on behalf of this business for eligible employees"

setting up an AHP: step- by- step

Until and unless the proposed legislation passes, we cannot provide detailed information on setting up an AHP for self-employed individuals in a co-working community in New York. The Society for Human Resource Management states that AHPs would be a type of multiple employer welfare arrangement (MEWA), and thus would be required to file a Form M-1 and a Form 5500 annually, "unless otherwise exempt."

challenges & considerations

According to the Department of Labor, under the proposed legislation, 11 million people could be eligible for coverage under AHPs. AHPs "would not have to include benefits across 10 broad 'essential' categories of care, including hospitalization, prescription drugs, and emergency care." Additionally, they "would be exempt from an ACA rule requiring insurers to spend at least 80 percent of premium revenue on medical care."

A brief issued by the American Academy of Actuaries raises concerns that AHPs could be vulnerable to insolvency due to a lack of a government regulation and exemption from state consumer protection laws. According to Forbes, AHPs could keep their premiums low by reducing benefits. This may be attractive to younger, healthier individuals, but may not be appealing to older individuals and those with health issues. New York's Department of Financial Services has echoed concerns about insolvency and consumer protection.

Under the proposed legislation, AHPs would not be allowed to set premiums according to a person's health status, but they could adjust premiums based on "gender, age, and industry."

conclusion

To wrap it up, under current federal legislation, self-employed individuals are not allowed to obtain coverage through AHPs. However, if passed, the proposed legislation would change this. Currently, sole proprietors in New York may obtain health coverage through the state's Individual Marketplace.
Sources
Sources