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The Practice Management Knowledge Community (PMKC) identifies and develops information on the business of architecture for use by the profession to maintain and improve the quality of the professional and business environment.  The PMKC initiates programs, provides content and serves as a resource to other knowledge communities, and acts as experts on AIA Institute programs and policies that pertain to a wide variety of business practices and trends.

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sole practitioner health insurance

  • 1.  sole practitioner health insurance

    Posted 09-01-2018 12:54
    Any suggestions for getting affordable medical insurance for an individual too young for Medicare?  So I can't be the only one who can't find affordable health insurance for individuals/sole practitioner/business owner.
    So what is "affordable"...up until Jan 2018, I was paying about $325. Searched and even the marketplace indicate for my State of TN there is not an affordable healthcare carrier.  It was over $1200/mth for an individual.  4x my budget with high deductible is not affordable when I never go to the Doctor.

    I have been a sole practitioner since 2008 and had what I called "catastrophic" insurance.  Being a fairly healthy individual I was comfortable self-insuring but wanted to have coverage in case of a healthcare crisis. It seems I got grandfathered in after AHCA/obamacare took effect and was able to keep being covered with the same policy until 2018 when Humana decided or was forced to not carry non-compliant individual coverage.  Since discovering I no longer had a medical health care policy, I have been on a search for the holy grail of affordable insurance for a healthy individual who is too young for Medicare.

    Here are the facts and where I have looked so far without success
    -LIve in TN, just me no family, no spouse to be on their insurance plan, no employees, age 55+, female, non-smoker. Do not take meds and no pre-existing conditions.
    -My other insurance carriers do not carry medical insurance.
    -On the marketplace website....if I could not find affordable health insurance on their website they suggested
    -On the einsurance website I fill out a request for quotes. I will never again fill out a form online to get health insurance quotes.  I was harassed night and day every day of the week from "US health advisor" agents.  Agent claims to be CIgna but it is not.  It is Freedom. Reviews are mixed on US health advisor insurance.
    -I can't seem to find a broker to do a search for me.  They only do group plans.
    -I was surprised aia/aiatrust does not have something available to provide members a group rate.
    -I called Small Business Association and they laughed at me and basically said good luck finding insurance.
    -AARP only has supplement Medicare options
    -suggestions from friends lead me to more US Healthcare agents
    -Found State Farm has something that is AHCA non-compliant for less than $200.  This sounds too good to be true.  It requires a physical for my age to get the preferred rate.  It is not a known carrier.  I have some warning signs so I keep looking.
    -the non-complaint insurance like us healthcare advisors give me warning flags when I research reviews of their customer care and claim denials
    -I even saw a commercial for a health insurance helpline for healthy individuals who are not on Medicare.  When I called I got an "agent" was told the carrier was simple health insurance.  While the "agent", I could tell it was a call center, asked me some questions for a quote, I googled the name and found their BBB rating was a C-.  The complaints were being sold something then getting the policy it was not what they were told.  He gave me a quote and benefits.  I asked to be sent something in writing and he indicated they don't send out packages and brochures that is while the cost is low for their policies. I said I don't do anything without first reviewing something in writing.  He said if I gave him my credit card info he could send something.  I said no thanks and hung up.
    -I came to this forum and the search came up with the last discussion from 2011 where suggestions were things I had already tried with dead ends.  The original poster did not indicate what they finally found for coverage.

    Sorry for long post but wanted to indicate the journey so you knew what I had already tried.

    Elaine Bright, aia LEED AP
    Bright Ventures Architectural Consulting
    Nashville, TN
    Call for nominations for the Best Practices committee. Apply by the deadline of January 31.

  • 2.  RE: sole practitioner health insurance

    Posted 09-03-2018 19:19
    Hi Julia, I would think your local AIA Chapter, or your state AIA component might be able to provide you with options for healthcare insurance.  have you already talked to these entities?

    Steve L. Wintner, AIA Emeritus
    Management Consulting Services
    Georgetown TX 78633-5712

    Call for nominations for the Best Practices committee. Apply by the deadline of January 31.

  • 3.  RE: sole practitioner health insurance

    Posted 09-04-2018 15:23
    This may not be of interest to you, but you may try Samaritan Ministries health sharing or Medi-share as an alternative to health insurance. It is not medical insurance, and not everyone qualifies to participate in Samaritan Ministries, Medi-share or similar sharing programs. Samaritan ministries does not cover pre-existing conditions for one year, you cannot be a tobacco user or abuse alcohol, and must attend church regularly (3 weeks per month). My brother, who is self-employed, pays about $530/month for the three members of his family. His wife had a surgery and the plan covered 100% of the cost. He received checks in the mail from 32 people over a one month period that added up to the total of her bills. Each month he receives the name, address etc. of someone who has had a medical need and he sends a check and a note to let them know his family is praying for their recovery and their needs. It is pretty cool how it works and has done well for him. Samaritan ministries and Medi-share were grandfathered since they were around before Obamacare.

    Richard Semtner AIA
    Rees Associates, Inc.
    Oklahoma City OK

    Call for nominations for the Best Practices committee. Apply by the deadline of January 31.

  • 4.  RE: sole practitioner health insurance

    Posted 09-04-2018 18:52
    Following up on Richard's comments, my husband uses Liberty Healthshare, another faith-based cost sharing option, and pays $199/month.

    Betsy Nickless, FSDA
    SDA-Orange County Chapter
    Mark Scheurer Architect, Inc.
    Newport Beach CA

    Call for nominations for the Best Practices committee. Apply by the deadline of January 31.

  • 5.  RE: sole practitioner health insurance

    Posted 09-06-2018 16:56

    Working with the AIA Trustees (who are AIA members), I know that they share your frustration with the challenges that individuals and small firms have with obtaining quality and affordable health insurance.

    As of today, there is not yet an association group plan nor customized health plans that the AIA Trust can offer to AIA members-but the AIA Trust is continuing to monitor the situation in the event that changes. The continuing Affordable Care Act (ACA) still defines only two ways in which someone can purchase private insurance: through their employer or as an individual. Currently membership associations cannot band together and purchase health insurance on behalf of their members, and until that changes, there are no immediate plans with association group pricing that the AIA Trust (or anyone) can offer to individual members. However, the Department of Labor (DOL) announced regulations on June 19, 2018, which expand the definition of Association Health Plans (AHPs). This expansion applies to firms and the self-employed (working owners).

    The Trustees are committed to finding a healthcare solution as soon as possible. We are working in conjunction with our independent consultant, the AIA Small Firm Exchange, and an insurance agency to explore the potential new options that are permissible for association plans under the new DOL guidance.

    However, a fully insured AHP option is dependent on the insurance companies obtaining approvals from the various states and offering such products in the marketplace. The DOL guidance clearly reaffirms the regulatory oversight authority of each state and the approval timelines vary greatly among the states. There is also a question of how many insurance companies will offer these products. To date, United HealthCare has expressed an interest and our team has ongoing discussions with their representatives.

    As we have updates on this topic, we will share them on our AIA Trust website: We also regularly update our page of healthcare resources found here:  In addition, you can sign up for the quarterly AIA Trust newsletter, Managing Your Risks, here: which will continue to publish healthcare coverage updates.

    Ann Casso Hon. AIA
    Executive Director, AIA Trust
    The American Institute of Architects
    Washington DC

    Call for nominations for the Best Practices committee. Apply by the deadline of January 31.

  • 6.  RE: sole practitioner health insurance

    Posted 09-10-2018 16:38
    thanks so much for your suggestions.  I am not much for big government.  I was ambivalent about the ACA/obamacare when it came out but thought it would be nice for those who could not get health coverage due to illness or work situation.  Now, it seems discrimination for a healthy entrepreneur.  After my struggle to find health insurance, I will be a watchdog on the healthcare insurance issue.  I also wanted to document for future so those in the same situation can be aware of of the journey.
    1.  Chamber of Commerce and other business/trade organizations:  Seems, I am just speculating from my present experience, that since the ACA has gotten long in the tooth and grandfathered plans with major medical insurance companies are being dropped that the Business/trade organizations can no longer find affordable plans to offer their members.  My chamber no longer offers and other design and construction industry organizations that I have looked at are not offering group rates/plans to members as of this writing.  If you find any currently doing so let me know.
    2.   aiatrust is no longer offering health insurance as of this writing.  Ann thanks for your response to explain what is going on with that situation and I will keep a lookout for future changes.
    3.  US Health Advisors is offering a plan put it is not health insurance.  It may be an alternative but do your research.  I can't put my finger on it but I just don't get a good feeling about their business practice.  Something about where multiple agents across the country are forced to have to call and email you just as soon as you have filled out an online form.  The online forms do not disclose that it is US Health Advisors so you can avoid if you have already researched them.  Ask me how I know.  Again, this week, I filled out a form that offered to compare insurance and immediately got my phone ringing off the hook and canned emails.  There are many reviews that raised a flag.
    4.  Someone suggested going back to work long enough to get Cobra.  So this is where the government is squashing the small business/entrepreneur.  I like what I am doing and just to get health insurance I have to go back to work for someone else.  It was office politics that drove me out on my own and right now just don't have the stomach to go back to working for someone else unless it was an offer I could not refuse.  The businesses are being forced to make employees contribute and select high deductibles to get the insurance affordable for employees.  Watch out for Cobra, the insurance premiums can be high when you leave and elect to go on COBRA.  If you have a health event when on COBRA and period expires, you are stuck with little options.
    5.  BCBS of TN was suggested when you put in for a quote and indicate income that will not get a healthcare market subsidy you will be redirected to an off-market company that it seems similar to USHealthAdisors.  In my case, it was GoHealth who in the review seems to have a huge amount of limitations and may be similar to US health advisors. It seems all major medical carriers are redirecting to off-market if you can't get subsidies from Oh, also phone rang off the hook and my hiya phone ap identifying them as a telemarketer and they don't leave a message.

    6.  The solution I am researching now is the Health Share ministries mentioned in a couple of previous replies. It seems to work most like major medical insurance with affordable premiums.  (I have eliminated Liberty due to some red flags but mainly due to BBB NR rating because of a pattern of complaints and numerous complaints.  I eliminated Samaritan because they want you to send a check directly to someone who has a claim and I prefer a platform that all you do is send your premium in and then they send it out to who has a claim.) I am checking out Medi-share, Altrua, and Solidarity.   I will let you know which I chose after I compare apples to apples.

    7.  One thing I did learn from a US Health Advisor that there is a Healthcare Blue Book similar to Kelly Blue Book for cars.  Check it out at
    Since my deductible will be so high, I will be using this to find fair prices on labwork and testing.  Maybe even procedures.

    Fill free to contact me if you come across this thread looking for options and want to discuss.

    Elaine Bright, aia LEED AP
    Bright Ventures Architectural Consulting
    Nashville, TN

    Call for nominations for the Best Practices committee. Apply by the deadline of January 31.