FREELANCE OPEN ENROLLMENT PREP GUIDE ====================================== SoloStack | solostack.madethis.app/resources/freelance-health-insurance Free to use. No signup required. Open enrollment for the ACA Marketplace runs November 1 – January 15. Coverage starting Jan 1: enroll by December 15. Coverage starting Feb 1: enroll by January 15. ============================================== 4-WEEK PREP TIMELINE ============================================== WEEK 1 (Starting November 1): GATHER YOUR INFORMATION ------------------------------------------------------- [ ] Locate your Social Security Number (and numbers for all dependents) [ ] Find your prior year tax return (AGI from Form 1040, Line 11) [ ] List all income sources for next year: - Freelance/self-employment (estimate) - Side jobs or part-time W-2 income - Spouse/partner's income (if filing jointly) - Investment income (dividends, capital gains) - Rental income - Any other sources [ ] List your current doctors, specialists, and hospitals [ ] Get a list of all current prescriptions with dosages [ ] Confirm your current coverage ends: _______________ [ ] Find your state's marketplace URL: healthcare.gov (federal) or your state exchange (see list below) [ ] Create a healthcare.gov account (or log in if returning) [ ] Confirm your current address — marketplace is ZIP-code based STATE EXCHANGES (use your state's site, not healthcare.gov): California: coveredca.com Colorado: connectforhealthco.com Connecticut: accesshealthct.com DC: dchealthlink.com Idaho: yourhealthidaho.org Kentucky: kynect.ky.gov Maine: coverme.gov Maryland: marylandhealthconnection.gov Massachusetts: mahealthconnector.org Minnesota: mnsure.org Nevada: nevadahealthlink.com New Jersey: getcoverednjshop.gov New Mexico: bewellnm.com New York: nystateofhealth.ny.gov Pennsylvania: pennie.com Rhode Island: healthsourceri.com Virginia: marketplace.masymutual.com Vermont: vermonthtealthconnect.gov (note: vermont uses healthcare.gov backend now) Washington: wahealthplanfinder.org All others: healthcare.gov WEEK 2 (November 8-14): COMPARE PLANS ---------------------------------------- [ ] Log into your marketplace and enter your income estimate [ ] Review your subsidy amount [ ] Run comparisons on 3-4 plans that fit your budget [ ] For each plan, check: - Your doctors are in-network (use the plan's find-a-doctor tool) - Your prescriptions are on the formulary (drug coverage list) - The deductible you'd owe if you had a major medical event - Out-of-pocket maximum (your worst-case annual exposure) [ ] Calculate total annual cost at your expected usage level: (Premium × 12) + estimated out-of-pocket costs [ ] Note which plans are HSA-eligible (these will say "HDHP") [ ] Compare HSA + HDHP math vs. lower-deductible options WEEK 3 (November 15-21): VERIFY YOUR NETWORK ---------------------------------------------- [ ] Call your primary care doctor's office and confirm they accept the plan you're considering (don't just rely on the online directory — it's often out of date) [ ] Call any specialists you see regularly with the same question [ ] Call your preferred hospital's billing department to confirm in-network [ ] Check your most expensive prescriptions on the plan's drug formulary: - Tier 1 (generic): lowest copay - Tier 2 (preferred brand): moderate copay - Tier 3/4 (specialty): potentially very expensive [ ] If a key provider is out-of-network, factor in that cost or find a different plan that includes them [ ] Verify whether telehealth is included (increasingly standard but varies) [ ] If considering an HSA: confirm the plan is an IRS-qualified HDHP (minimum deductible $1,650 individual / $3,300 family for 2025) WEEK 4 (November 22-December 15): ENROLL ------------------------------------------ [ ] Select your plan [ ] Complete your application (personal info, income estimate, household size) [ ] Submit enrollment — you'll get a confirmation email [ ] PAY YOUR FIRST PREMIUM — coverage is not active until first payment clears (Many people miss this step and find out mid-January they're not covered) [ ] Set up autopay to avoid future lapses [ ] Note your member ID number and keep your insurance card when it arrives [ ] Add your insurer's customer service number to your phone [ ] Set a calendar reminder for next year's open enrollment (November 1) ============================================== INCOME ESTIMATION WORKSHEET FOR SUBSIDIES (Especially for Freelancers with Variable Income) ============================================== The Challenge: ACA subsidies are based on your Modified Adjusted Gross Income (MAGI) for the UPCOMING year — but as a freelancer, you don't know exactly what you'll earn. Here's how to handle it. STEP 1: ESTIMATE YOUR INCOME SOURCES -------------------------------------- Freelance/self-employment income (gross revenue): $_______ MINUS: Business expenses (software, equipment, home office): -$_______ MINUS: Self-employed health insurance premium (this becomes a deduction): -$_______ MINUS: HSA contribution (if applicable): -$_______ MINUS: Half of self-employment tax (IRS allows this deduction): -$_______ = Estimated net self-employment income: $_______ Other income sources: Spouse/partner W-2 income: $_______ Investment income: $_______ Rental income: $_______ Any other income: $_______ TOTAL HOUSEHOLD MAGI ESTIMATE: $_______ STEP 2: APPLY THE SAFE HARBOR APPROACH ---------------------------------------- For freelancers with variable income, the IRS safe harbor approach is: IF you overestimated income and got less subsidy than you deserved: → You receive the difference as a tax credit when filing (Form 8962) → This is a good outcome IF you underestimated income and got more subsidy than you deserved: → You repay the excess on your tax return → Repayment is CAPPED (2025 caps: $350-$1,400 for income up to 400% FPL) → Above 400% FPL: full repayment required RECOMMENDATION: If your income is variable, estimate at the higher end of your expected range. You may get slightly less subsidy during the year, but you'll either reconcile evenly or get a refund — rather than owing money. Safety buffer: Add 5-10% to your income estimate as a buffer. STEP 3: INCOME CHANGES MID-YEAR --------------------------------- If your income changes significantly during the year: [ ] Report the change to your marketplace as soon as possible [ ] Your subsidy amount will be recalculated prospectively [ ] This prevents a large reconciliation at tax time [ ] Log into your marketplace account → "Report a life change" Changes that affect subsidy eligibility: - Significant income increase or decrease - New employer coverage offered - Marriage, divorce, or new household member - Moving to a different state ============================================== HOW TO AVOID THE FAMILY GLITCH ============================================== THE PROBLEM: Before 2023, if your spouse's employer offered "affordable" coverage for the employee, that disqualified your entire family from ACA subsidies — even if adding family coverage was expensive. THE FIX (effective January 2023): The IRS changed the affordability test to apply separately for family coverage. If the employer's family plan costs more than 9.02% of household income, family members can seek subsidies on the marketplace even if the employee can't. HOW TO CALCULATE: Employer's family plan annual cost to employee: $_______ Divide by household MAGI: ÷ $_______ = _______% of income If result > 9.02%: → Family members can seek ACA marketplace coverage with subsidies → The employee stays on the employer plan → This is now legal and intended under the "family glitch fix" PRACTICAL STEPS: [ ] Get the exact per-paycheck cost for family coverage from your spouse's HR [ ] Annualize it: monthly cost × 12 = $_______ [ ] Calculate as % of your household income [ ] If > 9.02%, you may qualify for ACA marketplace subsidies separately [ ] Each family member can potentially be on different plans ============================================== SPECIAL ENROLLMENT PERIOD (SEP) TRIGGERS ============================================== These qualifying life events give you a 60-day enrollment window outside of open enrollment. Document the event — you will need to submit proof. LOSS OF COVERAGE: [ ] Lost job-based insurance (fired, quit, laid off, hours reduced) Required proof: letter from employer or benefits admin with coverage end date [ ] COBRA coverage ended or became unaffordable Required proof: COBRA termination notice [ ] Student health insurance ended (graduated, enrolled less than half-time) [ ] Coverage ended because you aged off a parent's plan (turned 26) Required proof: letter from parent's insurer [ ] Plan or insurer ending coverage (insurer exits market) HOUSEHOLD CHANGES: [ ] Got married or entered a legally recognized domestic partnership Required proof: marriage certificate [ ] Got divorced or legally separated — lost coverage from ex's plan Required proof: divorce decree [ ] Had a baby, adopted a child, or placed a child for adoption Required proof: birth certificate, adoption order, placement agreement Note: newborns and newly adopted children can be added at any time [ ] Dependent child no longer qualifies (turned 26, married) RESIDENCE CHANGES: [ ] Moved to a new ZIP code, county, or state that offers different plans Required proof: utility bill, lease agreement, or official mail at new address [ ] Returned from incarceration [ ] Moved to/from a U.S. territory OTHER: [ ] Gained U.S. citizenship or lawful immigration status [ ] Released from incarceration [ ] Changed status to/from eligibility for Medicaid or CHIP [ ] Marketplace made an error on your enrollment [ ] Experienced a declared natural disaster that prevented timely enrollment HOW TO ENROLL DURING SEP: 1. Go to healthcare.gov or your state exchange 2. Create or log into your account 3. Select "Special Enrollment" 4. Select the qualifying event from the drop-down 5. Enter the date the event occurred 6. Upload documentation when prompted (scan or photo accepted) 7. Choose your plan 8. Pay first premium ============================================== WHAT TO DO IF YOU MISS OPEN ENROLLMENT ============================================== FIRST: Check if you have a SEP qualifying event → Any of the events listed above opens a 60-day window → Even income changes or moves can qualify → When in doubt, call the marketplace helpline: 1-800-318-2596 IF NO SEP QUALIFYING EVENT: Option 1: Short-term health plan (bridge coverage) - Available year-round - Not ACA-compliant (pre-existing conditions may not be covered) - Deductibles typically $1,000-$5,000 - Costs $100-$300/month for healthy individuals - Duration: 1-12 months (check state rules; some states limit to 3 months) - Good for: emergencies only, as a bridge - NOT good for: ongoing conditions, prescriptions, maternity Option 2: Health Sharing Ministry (bridge coverage) - Available year-round - Not insurance — see full explanation above - Lower cost but significant limitations - Wait 30-60 days before coverage begins for new conditions Option 3: Medicaid (if income qualifies) - No enrollment period — can apply year-round - Income limit: 138% of FPL in Medicaid expansion states (~$20,120 single) - 40 states + DC have expanded Medicaid; check kff.org/medicaid for your state - Covers: comprehensive benefits including prescriptions and mental health - Cost: free or very low cost Option 4: CHIP (if you have children) - For children under 19 in households under ~$56,000 (family of 4) - No enrollment period — apply year-round through your state Option 5: Wait it out and use cash-pay or direct primary care - Direct Primary Care (DPC) clinics charge $50-$150/month for unlimited primary care, no insurance needed - Supplement with catastrophic short-term plan for emergencies - This is a calculated risk — acceptable only if very healthy and have emergency savings to cover a catastrophic event REMINDER: Next open enrollment starts November 1. Mark your calendar now. ============================================== 6 QUESTIONS TO ASK BEFORE CHOOSING A PLAN ============================================== 1. Are my current doctors in-network? Don't trust the online directory alone. Call the office directly. 2. What will my prescriptions cost? Look up each drug on the plan's formulary and check its tier copay. Some plans have $0 generic tiers; others can cost $100+/month for Tier 3. 3. What is my realistic total annual cost? (Premium × 12) + expected out-of-pocket = real cost Run the math at your expected usage level, not just the lowest-cost scenario. 4. Does the plan cover the care I'll actually need? Mental health, maternity, specialist referrals, out-of-state care? 5. What's my HSA opportunity? If the plan is HDHP-eligible, can I contribute enough to offset the higher deductible risk? Run the HDHP + HSA math (see coverage comparison template). 6. What happens if I have a really bad year? Know your out-of-pocket maximum. That's your worst-case annual exposure. Can you cover it? If not, lean toward a lower OOP max plan. ============================================== Downloaded from: solostack.madethis.app/resources/freelance-health-insurance SoloStack — business templates for freelancers and solopreneurs Not insurance advice. For personalized guidance, consult a licensed insurance broker or navigator. Navigators provide free enrollment help at localhelp.healthcare.gov ==============================================