FREELANCE HEALTH INSURANCE DECISION CHECKLIST ============================================== SoloStack | solostack.madethis.app/resources/freelance-health-insurance Free to use. No signup required. ============================================== PART 1: PRE-SHOPPING CHECKLIST ============================================== Step 1: List Your Current Healthcare Needs ------------------------------------------ [ ] My primary care doctor (name, practice, health system): _______________ [ ] Specialists I see regularly (name, specialty): _______________ [ ] Preferred hospital or health system: _______________ [ ] Current prescriptions (drug name, dosage, monthly cost without insurance): 1. _______________ 2. _______________ 3. _______________ [ ] Planned procedures or surgeries in the next 12 months: _______________ [ ] Mental health / therapy coverage needed? Y / N [ ] Maternity / family planning coverage needed? Y / N [ ] Out-of-state coverage needed (travel, remote work)? Y / N Step 2: Estimate Your Annual Healthcare Usage --------------------------------------------- Low usage (healthy, rare doctor visits, no prescriptions): → Prioritize: lower monthly premium, higher deductible → HSA-eligible HDHP is often best Medium usage (1-2 specialist visits/year, ongoing prescriptions): → Prioritize: moderate premium, mid-range deductible, solid prescription coverage → Silver plan on ACA Marketplace often best High usage (chronic conditions, regular specialist visits, planned procedures): → Prioritize: lower deductible, lower out-of-pocket max, PPO network access → Gold or Platinum plan usually wins despite higher premium My usage level: [ ] Low [ ] Medium [ ] High Step 3: Calculate What You Can Afford -------------------------------------- Monthly premium budget: $_______ /month Annual deductible you could pay in one year if needed: $_______ Out-of-pocket maximum you could handle (worst-case scenario): $_______ IMPORTANT: Total annual cost = (Monthly Premium × 12) + any care costs up to OOP max A plan with $300/mo premium + $6,000 OOP max costs up to $9,600/year A plan with $500/mo premium + $2,000 OOP max costs up to $8,000/year → The "expensive" plan is sometimes actually cheaper if you use it Step 4: Check Your State Marketplace Situation ------------------------------------------------ [ ] Does my state run its own marketplace (vs. Healthcare.gov)? State exchanges: CA (Covered California), NY, CO, CT, DC, ID, KY, ME, MD, MA, MN, NV, NJ, NM, PA, RI, VA, VT, WA All others: Healthcare.gov [ ] What is my estimated annual income for this year? $_______ (This determines subsidy eligibility — see PART 3 below) [ ] Am I currently covered by another plan that ends on: _______________ (This determines your Special Enrollment Period window) ============================================== PART 2: COVERAGE COMPARISON WORKSHEET ============================================== Use this to compare up to 4 plans side by side. PLAN 1 PLAN 2 PLAN 3 PLAN 4 Plan Name: _________ _________ _________ _________ Insurer: _________ _________ _________ _________ Metal Tier: _________ _________ _________ _________ Monthly Premium: $_______ $_______ $_______ $_______ After subsidy: $_______ $_______ $_______ $_______ Annual Deductible: $_______ $_______ $_______ $_______ Out-of-Pocket Max: $_______ $_______ $_______ $_______ Network Type: HMO/PPO/EPO HMO/PPO/EPO HMO/PPO/EPO HMO/PPO/EPO HSA Eligible? Y / N Y / N Y / N Y / N My PCP in network? Y / N Y / N Y / N Y / N Specialists in net? Y / N Y / N Y / N Y / N Preferred hospital? Y / N Y / N Y / N Y / N Key prescriptions? Y / N Y / N Y / N Y / N Rx monthly cost: $_______ $_______ $_______ $_______ Telehealth included? Y / N Y / N Y / N Y / N Mental health covered? Y / N Y / N Y / N Y / N Annual cost (premium × 12, no claims): $_______ $_______ $_______ $_______ Annual cost (worst case, max OOP): $_______ $_______ $_______ $_______ SCORE (1-10): _______ _______ _______ _______ HOW TO SCORE: Weight by your priorities - Doctors in network: 0-3 points (most important) - Total annual cost at your expected usage: 0-3 points - Prescription coverage: 0-2 points - Network flexibility (PPO > EPO > HMO): 0-1 point - HSA eligibility: 0-1 point Winner: _______________ ============================================== PART 3: TAX DEDUCTION CHECKLIST ============================================== Self-Employed Health Insurance Deduction (Form 1040, Schedule 1, Line 17) --------------------------------------------------------------------------- [ ] I am self-employed (sole proprietor, single-member LLC, S-corp shareholder with >2% ownership, partnership) [ ] I was NOT eligible to participate in an employer-sponsored health plan (your own employer, OR a spouse's employer) at any point during the year [ ] Amount of premiums paid this year: $_________ (can deduct 100%) [ ] Covers: [ ] Medical [ ] Dental [ ] Vision [ ] Long-term care [ ] Long-term care deduction limit (age-based, 2025): Age 40 or under: up to $480 Age 41-50: up to $900 Age 51-60: up to $1,800 Age 61-70: up to $4,800 Age 71+: up to $6,000 [ ] Limitation: cannot deduct more than your net self-employment income My net SE income: $_________ | My premium total: $_________ Deductible amount: $_________ (lesser of the two) HSA Contribution Deduction (Form 1040, Schedule 1, Line 13) ------------------------------------------------------------- [ ] I have a High Deductible Health Plan (HDHP) — required for HSA 2025 HDHP minimums: $1,650 deductible (individual), $3,300 (family) [ ] 2024 HSA contribution limits: Individual: $4,150 | Family: $8,300 | Age 55+ catch-up: +$1,000 [ ] 2025 HSA contribution limits: Individual: $4,300 | Family: $8,550 | Age 55+ catch-up: +$1,000 [ ] Amount contributed this year: $_________ [ ] This is deducted separately from the premium deduction (both apply) What Counts as a Deductible HSA/Medical Expense ------------------------------------------------- [ ] Doctor visits (copays, coinsurance, deductible payments) [ ] Prescriptions [ ] Dental (cleanings, fillings, crowns, braces) [ ] Vision (glasses, contacts, LASIK) [ ] Mental health therapy [ ] Chiropractic care [ ] Physical therapy [ ] Medical equipment (glasses, hearing aids, crutches, blood pressure monitors) [ ] Ambulance / emergency care [ ] Lab tests and diagnostic imaging [ ] Fertility treatments [ ] Some over-the-counter medications and menstrual products (post-CARES Act) NOT eligible: cosmetic procedures, gym memberships (usually), teeth whitening Quarterly Estimated Tax Adjustment ------------------------------------ When you add health insurance premiums, your taxable income drops. This means your quarterly estimated tax payments should decrease. Calculation: Annual premium: $_________ × 0.153 (SE tax rate) = $_________ SE tax savings Annual premium: $_________ × your income tax rate = $_________ income tax savings Total annual tax savings: $_________ Per-quarter adjustment: divide by 4 = $_________ less per quarter Update your quarterly payments when you start or change coverage. ============================================== PART 4: OPEN ENROLLMENT CALENDAR ============================================== ACA Marketplace Open Enrollment --------------------------------- Start of enrollment: November 1 (each year) Coverage starts Jan 1: Enroll by December 15 Deadline: January 15 (coverage starts Feb 1) Note: Some state exchanges have slightly different dates. Check your state marketplace for exact deadlines if you're not on Healthcare.gov. Special Enrollment Period (SEP) Triggers ----------------------------------------- You have 60 days from the qualifying event to enroll mid-year. [ ] Lost job-based coverage (fired, laid off, quit — even voluntarily) [ ] COBRA ending or becoming unaffordable [ ] Got married or entered domestic partnership [ ] Had a baby, adopted, or placed a foster child [ ] Divorced or legally separated [ ] Moved to a new ZIP code or county [ ] Gained citizenship or lawful presence [ ] Returned from incarceration [ ] Income change that affects subsidy eligibility [ ] Aged off a parent's plan (turning 26) [ ] Marketplace plan ends mid-year (insurer exits market) Important: Document your qualifying event. You'll need proof when enrolling (job separation letter, birth certificate, marriage certificate, etc.) How to Avoid the Coverage Gap ------------------------------- 1. Don't cancel old coverage before new coverage starts 2. If leaving a job: your employer coverage typically ends the last day of the month you leave (sometimes last day of employment — check your HR) 3. ACA coverage starts the 1st of the month following enrollment (unless you enroll Dec 1-15, which starts Jan 1) 4. Use COBRA as a bridge if needed — expensive but avoids gap 5. Enroll in ACA before your old coverage ends if possible If you MISS open enrollment: - Check if you qualify for a Special Enrollment Period first - Consider a short-term health plan (3-12 months) as a bridge - Consider a health sharing ministry as a lower-cost bridge - Medicaid may be available if income qualifies (check eligibility) - Next open enrollment starts November 1 ============================================== Downloaded from: solostack.madethis.app/resources/freelance-health-insurance SoloStack — business templates for freelancers and solopreneurs Not financial or legal advice. Consult a licensed insurance broker or CPA. ==============================================