As a sole proprietor, Mary Phillips couldn't qualify for a group insurance plan, nor did she have an employer to help her shoulder the premium cost. Her budget only allowed $100 for premiums, and this limited her options in terms of benefits and cost sharing obligations. Mary’s only option was a high deductible plan or “HSA” that required her to pay for all costs up to $7,500 annually. After that she still payed 30% of her health care costs. In addition, the plan does not cover pregnancy or prescriptions.
Fortunately, Mary has been healthy and hasn’t had any major medical costs. In her 8 years of participation on this plan, she’s paid for all of her medical costs out of pocket and never reached the deductible to claim benefits. However, business has been sluggish in November and December. “If I was to get sick and need to visit the emergency room or receive other expensive medical services”, says Mary, “I would have to think hard about whether I could afford to go at all. I fear by delaying care, I’d be putting my health in jeopardy.”
With concerns like these, it is hard for Mary to focus on growing her business. “I don’t expect health care to be free, but if I’m going to be paying a premium for health insurance, I want it to cover the health care I might need,” says Mary.