Written by: Jared Casazza, PT, DPT
It’s currently the 2019 marketplace health insurance open enrollment period, so naturally there is a lot of interest in health insurance options and alternatives right now. I’ve seen a ton of posts recently in various travel healthcare groups regarding health insurance options, alternatives, and people asking for general advice. Navigating the various health insurance options can be tough, especially with the many changes in the past decade and likely many changes to come in the future. Rising healthcare, and therefore health insurance, costs are a major concern for most Americans currently.
For travel healthcare professionals, health insurance is a particularly common topic since our contracts are generally only 13 weeks at a time, and figuring out what to do about health insurance after a contract ends can be confusing. I want to explore the various options here and hopefully give you some insight to help you make a decision regarding your own health insurance as a travel therapist.
Company Sponsored Health Insurance
Usually the cheapest and easiest option for a traveler is to take the company sponsored health insurance through the travel company that he/she is working with. The lower cost compared to other options is due to the fact that the company sponsored health insurance is partially paid for by the travel company as part of your total benefit package. The company pays a portion of your health insurance premium (in some cases 75% or more of it) so that it’s more affordable for you. If you pass up this benefit, in some cases the company will be able to give you slightly higher weekly pay based on the money they save from not having to pay for a portion of your health insurance, but this can have potential legal implications for the company if done incorrectly so it is not a common practice. We have never talked to a travel company that doesn’t offer health insurance, but it’s possible there are some small companies out there that don’t. The company would have to be very small though, because any company that employs more than 50 people is required to offer health insurance to all employees.
Most companies offer 2-3 different plans based on your individual needs. There will likely be at least a high deductible plan that offers a relatively low premium and a lower deductible plan with a higher premium. Which plan you choose depends on your own needs, but in general, those who are young, healthy and therefore unlikely to meet the deductible of either plan are better to choose a high deductible plan with the lower premiums, while those with more medical needs or perhaps growing families can often come out better with a lower deductible plan while paying the higher premiums.
In my experience, the premiums on these plans are pretty affordable no matter which plan you choose. I’ve paid anywhere from $5-$25/week for my company provided health insurance coverage over the past few years. Luckily, I rarely have any need to use the health insurance, but when I have needed it the coverage has been sufficient for my needs.
Signing up for a company sponsored plan should be very straight forward with guidance offered by your recruiter or by the benefits department of the travel company. You should be eligible to sign up for the coverage any time that you start a new contract with a company. Most companies offer health insurance benefits starting on the first day of your assignment, but some require you to wait for 30 days or until the first of the month before they take effect, so make sure to ask your recruiter about this to avoid any problems or confusion.
Affordable Care Act (ACA) Marketplace Plans
Some travelers choose to go with one of the ACA marketplace options available to them and forego the company sponsored options. The marketplace plans will almost always cost more than the employer sponsored plans and, as mentioned above, this shouldn’t be a surprise since in this scenario you will be responsible for the entire premium amount instead of having the travel company pay for a portion of it. For some, the increased cost of the plan is offset by more variety with plan options that can allow the traveler to find a health insurance plan better suited for them. Since the marketplace offers subsidies based on the individual’s income from the previous year, there are cases where the subsidy amount will be high enough to actually make these plans even more affordable than the employer sponsored coverage. I’ll cover the income levels and subsidies available in the marketplace plan in depth in another article in the near future. Since the amount of subsidy you qualify for can drastically change the amount of various plans for you, it’s always a good idea to get some quotes for potential marketplace plans even if you will likely take the employer sponsored health insurance. The vast majority of travelers will qualify for at least a partial income based subsidy due to the level of taxable income that we receive, but how big the subsidy is will depend on your Modified Adjusted Gross Income (MAGI).
Getting quotes for various plans and signing up for one through the marketplace is pretty easy. Visit the healthcare.gov website and follow the steps to get started on the homepage. I’ve spent a lot of time on the website and have found it to be user friendly. One thing to remember with these plans is that you can only enroll during the open enrollment period (November 1 – December 15) each year or when you have a “Qualifying Life Event.” This means that if you choose to forego employer sponsored health insurance and miss the open enrollment period, you could potentially have to wait until January 1st of the next year to have coverage! Make sure to watch the dates and don’t miss the November 1st – December 15th window if you choose to go this route.
“Off-Exchange” Health Insurance Plans
The above two options are by far the most common ways that regular employees and travelers alike receive their health insurance. There are a much smaller number of people that either forego company sponsored health insurance or aren’t eligible and choose to not get coverage through the marketplace. They instead may choose “off-exchange” plans, which are plans offered directly through the insurer themselves or through a broker. These options vary based on the state in which you’re located. These plans are not eligible for the subsidies offered based on income through the ACA marketplace, which will be a huge downside for most travelers and make this option unrealistic. Without the subsidies, the plans are often much higher priced than employer sponsored plans or insurance plans offered through the ACA marketplace. To partially make up for the higher price tag, these plans can occasionally offer better coverage options than those found on the marketplace.
These plans will rarely be a good choice for travelers and probably shouldn’t even be considered in most cases. If you’re interested in learning more about the “off-exchange” plans, this healthinsurance.org article is a good resource.
Health Care Sharing Ministries
Even though this option is not technically health insurance at all, I would be remiss to not include it in this list. Health Care Sharing Ministries are organizations created to share medical costs between a group of people that have the same religious views. These organizations are very careful to spell out the fact that they do not actually offer health insurance, since they do not offer any guarantee to pay. This sounds scary, but in practice, they seem to work pretty well, and most of what I’ve read about them has been positive written by those enrolled.
This is how it works: everyone enrolled in their organization has a monthly premium and a stated deductible amount, just like with a normal health insurance plan. The money is then pooled and paid out to anyone enrolled that makes a claim, after the claim is verified by the organization. They cover the same things as most insurers, although there are some things that may not be covered due to religious reasons, which can include things such as birth control pills. To be eligible to enroll in these organizations, you generally must be a Christian and be dedicated to living a Christian life, which means abstaining from activities such as smoking cigarettes, using drugs, drinking in excess, or engaging in extramarital affairs. They also generally do not allow major pre-existing conditions like the ACA marketplace plans are required to do.
Health Care Sharing Ministries offer much lower premiums for their coverage, which is largely made possible by the fact that they are able to exclude those with severe medical conditions. These organizations’ plans are also not eligible for the subsidies offered by the ACA marketplace like the “off-exchange” plans above. More people are choosing to enroll in these organizations as health insurance prices continue to increase, with estimated membership between all Health Sharing Ministries at 340,000 people.
These plans may be a viable option for travelers, especially those that aren’t eligible for any subsidies through the ACA marketplace and don’t want to take the employer sponsored coverage, assuming that the traveler meets all of the criteria and is willing to accept risk involved. For more information on Health Sharing Ministries or to compare companies, this article is a good resource.
Why Not Always Go With the Employer Sponsored Health Insurance?
Since employer sponsored coverage is often the easiest and the cheapest option, you may be wondering why a traveler would ever choose to go a different route. The two most common reasons have to do with coverage between assignments and meeting the deductibles of the health insurance plan.
For those that choose to take time off between contracts, the employer sponsored plans can sometimes prove difficult. Most travel companies will allow you to stay on their plan for somewhere between 14-30 days between contracts, but that’s only if you take your next contract with them as well. If you take more time off between contracts than the company allows, or you switch travel companies for your next assignment, then this will mean a lapse in coverage during that time. Whitney and I have found ourselves in this position a few times in the past, and going without health insurance, even for a short time, isn’t ideal. Luckily, COBRA coverage exists for this reason, but I’ve found that many travelers don’t know about it. Sometimes this causes them to choose to forego the employer sponsored plan due to these anticipated lapses in coverage.
COBRA stands for Consolidated Omnibus Budget Reconciliation Act, and it basically gives an employee the right to continue his/her employer health insurance coverage after losing his/her job (which would be the case for a traveler between contracts). This coverage can last for as long as 18 months or until the employee finds a different health insurance plan. This is perfect for a traveler who is switching companies between contracts or taking an extended period of time off of work. It is important to note that when switching to COBRA coverage, your premium will increase due to your employer no longer paying a portion of it, but the cost should still be a reasonable, especially for a short duration.
My personal favorite part about COBRA coverage is that you have 60 days after your loss of employment to sign up for the coverage, and any medical costs incurred between the date you lost your coverage and the date you sign up for COBRA will be retroactively covered. What that means in practice is that if you have a month off between contracts, and you’re switching travel companies, you could wait the 30 days between contracts to see if you have any medical expenses. If you don’t, then you can skip signing up for the COBRA coverage altogether and save the money on the premium since you didn’t need the health insurance during that time anyway. If you happen to have a big medical expense come up during that time (not unreasonable if getting to the next assignment involves driving across the country), then you can sign up for COBRA afterward and have it retroactively cover that medical expense. This is the best of both worlds since you’re protected either way, but you only have to pay for the coverage if you actually end up needing it during that time off.
The other big reason a traveler may choose not to take the employer sponsored health insurance is that he/she plans to usually meet his/her deductible amount throughout a normal year. This can be a problem if switching between companies, because each time you leave one plan and start another, your progress toward the deductible starts over and you lose the progress you’d made toward the deductible on the old plan. For someone with a lot of medical expenses (usually a chronic medical condition requiring expensive treatment or medication), having to start over on the deductible with new plans can mean a lot more money out of pocket than the money saved by using the employer sponsored plan. In this situation, I think it makes a lot of sense to go with a plan through the ACA marketplace and keep it while traveling, instead of switching plans often through different employers.
What’s My Choice When It Comes to Insurance?
Over the past three years, Whitney and I have always chosen to go with the cheaper employer sponsored health insurance plans through the travel companies. We generally choose the highest deductible plan offered since we don’t use our insurance often anyway and would rather have a lower premium. Between contracts, we forego insurance knowing that we can sign up for COBRA as needed. So far we have never actually incurred any medical expenses between contracts to make it worth it for us to sign up for the COBRA coverage retroactively. It does give us peace of mind knowing that it’s available if we needed it though.
Although that’s been our strategy in the past while working almost continuously throughout the year, in the future we will likely sign up for a health insurance plan through the ACA marketplace. This is because we plan to take several months off at a time to travel internationally, making the employer sponsored plan + COBRA combo not nearly as appealing.
For the average travel therapist, going with the cheaper health insurance offered by your travel company and using COBRA coverage for any gaps between contracts probably makes the most sense financially and logistically. For some cases it can be more reasonable to sign up for a plan through the ACA marketplace and decline the coverage offered by the travel company. This is especially the case with travelers who plan to take multiple months off between contracts or that often meet their deductibles and will have to start over on the deductible each time they switch between companies. “Off-Marketplace” plans will rarely make sense for a travel therapist since most of us will qualify for subsidies through the ACA marketplace that wouldn’t be possible with an off-marketplace plan. But, these are still another option to consider based on your individual situation. Health Sharing Ministries usually offer a lower premium than insurance plans offered through the marketplace, but they are more risky since they aren’t actually health insurance and therefore don’t offer any guarantee to pay. In practice, most people enrolled in the Ministries seem to be pretty happy with the coverage based on reviews for them. The requirements to be accepted into the Health Sharing Ministry you choose can be restrictive, and anyone that isn’t a Christian isn’t allowed to join.
Hopefully this helps to clear up the health insurance options available to you as a travel therapist. Keep in mind that health insurance (and healthcare in general) is likely to go through many changes in the near future, so make sure to check that things haven’t changed between the time I wrote this and when you’re reading it. I’ll do my best to keep this up to date as well.
If you have any questions about this or anything else travel therapy related, feel free to reach out to us. If you are new to travel therapy and would like help getting started or recruiter/travel company recommendations then we can help with that as well! Thanks for reading!