The Health Insurance Gauntlet For Locum Tenens Doctors
I find it ironic that a doctor looking to start locum tenens work might think that acquiring health insurance would be an obstacle on their journey. It’s like the insurance companies are giving us one last gut punch as we walk into the sunset, as if to say, we still own you! Well, those constant prior authorizations and rejections haven’t faded from my memory, and I am here to break down all the options to maintain high quality, reasonably priced health insurance while practicing locum tenens. We are on our home playing field, let’s not let the health insurance companies come into our house and push us around!
As a locum tenens doctor, you are a self-employed, independent contractor. This means you pick where you want to work, how much you want to be payed and how you structure your days. However, it also means you are running the business called YOU and as CEO, you need to provide benefits to your one employee. Health insurance can be one of the most important decisions you make as a locum tenens doctor, and these days it can be the most complicated. There are multiple aspects to the discussion of health insurance and we are going to take our time with one main issue, where you get your coverage. We understand that how much coverage you want is also a big factor in this decision but think that depends on individual concerns and health. We will leave it to you to pick the best coverage but want to provide a framework for where you can find it. Our goal is clear, allow you to find health insurance, take advantage of some tricks and wrap it all together so you, the doctor, come out on top!
Where Can I Find Coverage?
Short term health policies are available from most major insurance carries but come with a lot of red tape and downside. These are mostly used by locum tenens doctors who are transitioning between permanent jobs or are suddenly in need of healthcare. COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985, is a law passed by congress to support employees in the event that they were temporarily out of a job. In theory, if you lost or were transitioning to a new job, you should be able to continue your current employer sponsored health plan for a maximum of 18 months. Sounds simple enough, but wait, we forgot to mention the most important thing, cost. COBRA plans can be incredible expensive, and for most doctors considering long term locum tenens positions, it isn’t the best options. COBRA plans will feel like a huge price increase for the same coverage for two reasons. First, you will be responsible for the full cost of the health plan, and any prior employer contributions will be added cost. In a 2016 Kaiser Foundation study, it was determined that 82% of all employee health care costs were covered by the employers and only 18% fell on the employee. That 82% of the cost will now be solely on you. Second, COBRA adds a 2% service charge. Together, this is definitely going to hurt the wallet. We recommend using COBRA only for short spans and when it’s your only option, otherwise you are paying too much and can find better options elsewhere.
Are you married? Often times a physician who is transitioning into locums can take advantage of the health insurance plan of their significant other. This is commonly used by locum tenens doctors who take long term assignments close to their home, where their spouse continues with their current job, or with doctors who have spouses with jobs that are mobile and can take their plan on the road. Another group who can take advantage of spousal plans are those doctors who travel periodically for short term assignments but spend the majority of their time in a central location. Keep in mind, if you plan on utilizing your spouse’s plan, it is important to check the policy’s options and costs. Just because your significant other has coverage with their employer does not mean it will be the best available option or even the cheapest. One other catch, if you have access to a health insurance plan through your spouse, but choose to purchase your own individual plan, your premiums may not be tax deductible.
Your next option may not be one you would think of, but it’s right in front of your eyes. Often times if you are a member of a large organization, you are entitled to utilize their negotiating power in your favor. The American Medical Association, American Association of Retired Persons, The Freelancers Union, National Association for the Self Employed, and many specialty specific societies have reduced rates for members. As an independent contractor, locum tenens doctors fall into many groupings not utilized by doctors practicing in private practice or for a health system. Lastly, there has been huge growth in religious based health insurance organizations. These Christian Health Sharing organizations operate to provide health insurance to its members in a slightly different model. These plans do not cover preventative care, typically will have a deductible for every visit or issue, and often require you to pay up front and get reimbursed. They tend to be dramatically cheaper but have an upper limit of coverage that may scare any practicing physician who knows how high medical bills can run. When asked why one would switch to one of these, the most commonly cited reasons we found were the decreased costs and the ability to utilize “other physician friends” for basic issues. When pressed, we found that locum tenens doctors who are using Christian Health Ministries were doing so with the idea that they can ask their colleagues basic questions and avoid visits non-physicians might require. This was something we never quantified before. Regardless, utilizing the leverage of others who are similar to you can get you access to different plans or at lower rates. Maybe it’s time to actually pay that AMA bill you get in the mail every year!
The Affordable Care Act (ACA), in theory, was designed to require states to either set up their own government-run marketplaces, also known as exchanges, or use the federal government’s marketplace. These exchanges would provide a platform on which private insurers can sell health plans to Americans who were in need of coverage. Sounds simple enough, no? Recently lawmakers have removed several key parts of the legislation including the individual mandate and the cost-sharing reductions. Regardless of your opinion of the ACA, they are becoming less and less of a viable option for locum tenens doctors as the options are decreasing and the costs are skyrocketing despite relatively strong interest from consumers.
If the previous options aren’t in your wheelhouse, locum tenens doctors may choose to utilize private insurance carriers and select a plan to their liking. There are two ways this can be approached, utilizing a health insurance broker to shop plans for you or going through the big insurance agencies yourself. Like home or auto insurance, there are numerous health insurance brokers who can shop around for a plan that is best for you. Having a knowledge of the local markets, the laws and available plans, brokers often can produce big savings. On the other side, like any broker, they don’t work for free. The additional costs need to be weighed in relation to the benfits they provide. Where to find an agent? Start with reviewing several of the web-based brokerages that sell health insurance, including Insure Monkey, eHealthInsurance, and Health Plan One. You can get estimates based on limited anonymous information on these sites and often implementation is handled for you. If you don’t find what you need or what the human interaction, local agents can be found in your area by word of mouth or by searching for a local broker online at sites similar to HealthMarkets. Additional benefits to using a health insurance broker are their ability to handle the paperwork associated with insurance, addressing any issues you have, assisting with the renewal process, and servicing the account for billing, eligibility and claims along the way.
If you plan on shopping for insurance on your own, it is best to get a feel for what is out there before you get started. There are several websites that offer an overview of the market before you even begin to take a deep dive into each carrier’s plans. A very useful site is the Federal Governments Healthcare tool, which allows users to compare all plans in their area. Any doctor will appreciate the complexity of choosing a health insurance plan, and the goal is to find the coverage you need for the cheapest price. If you go at it on your own, it’s important to keep a file of important documents and dates. Each year review your current carrier and compare it to the marketplace as drastic changes happen in a short time frame when it comes to health insurance.
Health insurance coverage can be daunting if you don’t know where to look. On average, we found the majority of locum tenens doctors we surveyed were using brokers they were familiar with. Knowing where to get started is key, and a trusted broker is incredibly valuable. With all this information, it is important to shop around and find the plan that’s right for you.
~The Locums Life~