Important new update, October 2016: “Group of one” small group health insurance may no longer be an option for self-employed individuals in Washington state because of federal ACA law, though you can still purchase individual insurance either inside or outside our state’s health insurance exchange. I recently spoke with an analyst at the Washington State Insurance Commissioner’s office, who confirmed that though Washington’s “group of one” law is still on the books, it has been preempted by federal law (ACA and ERISA) and a legal challenge from an insurance company. Now you must have at least one employee on payroll to qualify as a group (and business owners are no longer counted as employees), so self-employed individuals or sole proprietors without employees don’t qualify for small group health insurance and must purchase insurance through the individual market.
I’ve updated my 2010 health insurance post, “If you are self-employed and live in Washington state, read this,” with some new information and links because of a recent increase in views.
My original post was about Washington’s “group of one” law, which allows self-employed individuals or sole proprietors to apply for small group health insurance if they meet certain criteria. These plans offered better coverage, without health screenings, and you could cover your family as dependents.
That information is still accurate, but you now have more options to buy health insurance for 2014:
- You can buy individual health insurance on the Washington state exchange (Washington HealthPlanFinder). If your family income (modified adjusted gross income) is below 400% of the federal poverty level, you may qualify for subsidies (tax credits) to help you pay for health insurance purchased through the exchange.
- You can buy “group of one” small group health insurance outside of the exchange, if you qualify.
- You can buy individual health insurance outside of the exchange.
If your income qualifies you for a subsidy, you’ll have to buy insurance inside the exchange to get it. Whether you apply for insurance inside or outside of the exchange, you can’t be denied because of pre-existing conditions, and specific “essential health benefits” (including hospitalization, maternity care, and prescription drugs) must be covered. You should do your research and carefully compare plans and provider networks. Many of the individual plans in the exchange have limited doctor and hospital networks, so depending on your circumstances, you might be better off in a small group plan or individual plan outside of the exchange.
See my original post for more information.