Going Long - Part 6

Buy a high-deductible policy and pay cash for visits to the doctor. Perhaps the most common solution among the self-employed is to shop around and purchase a high-deductible policy to cover serious illness or accident. Then set aside a savings fund — either self-managed or with a health savings account (HSA) — to cover doctor's visits and preventive care. It's best to compare quotes from an independent broker, and in some cases a local or national group may offer a discounted policy. Several people mentioned the Freelancers Union, for example.

Join a concierge program. A concierge program is the opposite of a high-deductible policy that covers only serious problems. For a monthly fee ($150 to 300 on average), you can visit the same doctor for most primary and preventive needs. You'll also get the doctor's email address and “call anytime” cell phone number, and the doctor will act as an advocate and referrer if you need more serious care. Some people combine a concierge program with another policy to ensure that both short-term and disaster prevention needs are met.

Get insured through your partner. A number of business owners wrote to tell me that they relied on their spouse or partner's job to cover both of them while they worked full-time or part-time in the business. Courtney Carver was diagnosed with multiple sclerosis in 2006, and her medical bills would be $8,000 a month without insurance. “I feel fortunate that my husband works for a company that has group insurance,” she says. “For now, starting a business together with him leaving his job is not an option because of my medical condition. We are looking at other out-of-state options for the future but are tied to his job for the insurance for now.”

Of course, this option isn't available to you if you're single or if your partner doesn't have a job that provides insurance benefits, but if you do have the option, it may very well be the best one.

Stay on COBRA as long as possible. If you have lost your job, COBRA allows you to continue receiving the same health-care coverage for a certain length of time at the same price your former employer paid. You have to pay for it, but because it originally was based on a group rate, the cost is often lower (and coverage may be better) than that of any plan you could purchase yourself. Several people spoke of extending COBRA coverage for up to three years as they built their businesses.

Self-insure or use an HSA. “My health-care plan involves prayer, vitamins, and avoiding sharp objects,” Amy Oscar told me on Twitter.

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