Transcript 104 – Daniel Dacquisto on Health Insurance for Self-Employed Music Teachers
Transcript: 104 – Daniel Dacquisto on Health Insurance for Self-Employed Music Teachers
[00:00:00] Andrea: Hey, it’s Andrea with Music Studio Startup, the podcast about the business of teaching music. Learn from the startup stories of music teachers who are doing incredible things with their studios. Be inspired by creating musicians who are branching out and thriving as entrepreneurs. Be empowered by the insights of experts who will help you grow your own studio.
Let’s get started.
Today we’re covering a topic that is a huge question for musicians and often a barrier for people considering self-employment. The topic is health insurance. Whether you have it already, anticipate needing it in the future, or are shopping for it right now during open enrollment, this episode will help you understand what the options are and how you can make an affordable and informed decision.
My guest today was super thorough and helpful in breaking down everything you’ll wanna consider when shopping and budgeting for a plan. Here’s my interview with Daniel.
Hi Daniel, welcome to the podcast. Thank you so much for being here today. Can you introduce yourself and tell us what you do?
[00:01:11] Daniel Dacquisto: Yes. Thank you again for having me, Andrea.
My name is Daniel Dacquisto. I’m a licensed health insurance agent here speaking about the topic of health insurance for the self-employed and startup musicians. I’ve been doing this for about seven years now. You know, I have a few different hats in what I do. I still do work in working with clients and trying to get them the best health plan, but I also do a little bit of recruiting as well as team leadership.
So just progressed a lot in the time that I’ve been here. But I know the focus today is talking about health insurance, how to navigate the markets, and how to find something if you don’t have that employer option.
[00:01:42] Andrea: Mm-hmm. . Yeah. Thank you so much. And longtime listeners will remember an episode I did, I think it was four years ago now, with Heather and she referred me to talk to you this time around.
So I’m excited to be updating this episode. You can let us know what changes to be aware of now that it’s four years later, but let’s just jump right in. So most of my audience are self-employed music teachers. What are the options for insurance for self-employed music?
[00:02:06] Daniel Dacquisto: So for anyone, I mean, who is self-employed, unless you can qualify for Medicaid, you know, that’s based on income and not trying to get into the weeds too much. But typically for an individual that’s below $16,000 annually, or Medicare, now usually you’re thinking Medicare’s for somebody who is 65 and above. But if you are considered disabled, you can tap into those benefits prior to that.
So outside of those two avenues, you really have two options for permanent healthcare. Again, considering the fact you can’t get it through the employer. There’s a lot of stuff out there. So there’s like short term plans, there’s cost sharing plans, so there’s a lot of different options for health insurance that you could come across, especially if you went online and Googled health insurance, you may find a lot of different websites. And also beware, if you put your information out there, there’s a chance that you could be receiving a lot of calls from somebody. You know, once you, you put that info, if anyone’s ever done that, that can happen.
Again, it really comes down to two specific markets to shop for. Again, permanent true health insurance. Number one, that’s the public market, which in a sense is also based on income or another word for the public market could be your state exchange or maybe on the Affordable Care Act, Obamacare. And then you also have the private market, which is more where I specialize in, and those plans are typically based on health. Now again, if you’re a couple, if your spouse, they have an employer plan, that can also course be an option. Now how it’s been working because of the rise of healthcare costs recently, if you are getting added to your spouse’s plan, usually if it’s a pretty large company for the employee themselves, the employer will cover a really large portion or a good portion of the cost. But to add any family members, so a spouse or any kids, sometimes it may be full cost, so it can still be pretty expensive if you have an employer plan again through your spouse.
But again, that could be an option. Sometimes employers may take up a decent portion of responsibility for the rest of the family as well. But again, not all employers will do that. So again, I mentioned, you know, with going back to Medicaid, Medicare, that’s based on certain parameters. So outside of that, again, it’s the public market, like I was saying, the Affordable Care Act, also based on income, but very tricky when it comes to the self-employed because a lot of people don’t always know what they’re going to be making the year ahead.
And what they would do is they would ask you for say right now, what is your estimated income for 2023? If you don’t know that quite you probably want to overshoot it because say you say it’s 40,000 and you do well and you make 60, if you get any tax credits or subsidies, which basically means based on the income you gave them your zip code, your age, or do family members ages, they’re going to say, give you $300 a month subsidy to reduce your premium.
So if the plan is a thousand a month, normally now it’s down to 700 a month. But if you end up making that 60 or 70,000, and whereas you said 40, you’re probably going to have to pay back the entire subsidy you got for that entire year come tax time. So 300 times 12. You’re looking at 3,600.
That happens a lot, especially with the self-employed. So number one, it’s tricky when you’re dealing with that type of situation. But also if that does come up and that’s maybe your best option, you want to make sure you overestimate rather than underestimate.
[00:05:08] Andrea: Good advice. Is that something where you could update it midyear if you’re like, Oh wow, I thought I was tracking at 40, but it really am going to be closer to 60 that you could update it or is it a one and done? You make the declaration in November, whatever.
[00:05:21] Daniel Dacquisto: That’s a great question. Yeah, you can update it. Definitely. Again, if your income fluctuates, you would want to try to stay on top of that just because again, if, if the income is changing, you’d want to make sure you know that, you know, midyear or the first quarter of the year.
So now if your income goes up and you were, you know, paying $300 a month less, now that plan you have to pay a thousand a month or whatever the case may be. So, you know, a little bit tricky there. And then, like I was saying, the last option or the other options, the private market, again, those plans are based on health, but if you can qualify for them, that’s typically where you’re going to find the best rates and best benefits.
And it’s not income based, so they don’t care really how much money you make. It’s just in a sense, you know, what is your health like.
[00:05:58] Andrea: Sure. Okay. So it sounds like both options are ones you should consider and probably someone who’s maybe younger and in better health is probably going to find a better deal in the private marketplace versus the the public. Would you say that’s generally true or not necessarily?
[00:06:13] Daniel Dacquisto: Yeah, I would say that’s correct. I was actually just working with a self-employed individual about an hour ago. She is down in Florida when she, I think was a choreographer and a dance teacher. So similar self-employed. But yeah, she just turned 26, so she was getting booted off her parents’ plan. And again, fairly healthy. The rates were the best definitely in the private avenue, and typically those plants too offer more nationwide coverage and she travels a lot for work, so that was really important to her. But I mean, even people in the thirties, you know, forties, fifties, or you know, even in the early sixties, a lot of people, if they’re fairly healthy, the rates probably will be better on the private market again, unless they’re income is below that specified amount. And if you have a specific or a consistent income, then it’s a lot easier to go that route to where you’re getting subsidies.
[00:06:57] Andrea: And then you just mentioned about that dance teacher. 26. So that’s the magic age in the US, right? As long as you have a parent with health insurance, you’re likely covered on their insurance until you’re 26 and then you get booted, right?
[00:07:09] Daniel Dacquisto: Yes, that is correct. On most plans, some plans could be 24, 25, but on pretty much all employer plans, which is where you would be able to typically have your child on there, your dependent. Yeah. It’s 26.
[00:07:21] Andrea: Okay. So how does one go about choosing a plan?
[00:07:25] Daniel Dacquisto: Awesome. Well, yeah, so again, if you can either get Medicaid or Medicare, I, you, I mean, you should do that.
Medicaid is free insurance. Everything that you go and do is typically going to be free. Now, you know, sometimes the, the doctors and facilities that will accept it might be limited. And you may not be able to always travel with that type of plan. But again, it’s for someone who’s making less income than say, 16,000 a year. If it’s individual, that’s probably going to be your best option.
And then again, same thing with Medicare. Being disabled should probably also do that. And that’s just through the state website medicaid.gov, medicare.gov. And then if we, you know, go based on having maybe a really low income but not quite low enough for Medicaid, then you probably would want to look into the public market.
But again always know that when it comes to getting a subsidy make sure you know about the income and how that works. So it can be a little tricky when the income does fluctuate, but the private plans, when income still a little bit low, can maybe still be a bit expensive.
In order to do that, again, there’s specific enrollment periods. I know it’s a question on here as well, but for open enrollment, typically it’s November 1st through January 15th for most states, and that’s when you can pick a plan unless you have a special qualifying event. And that means, say if you just lost your job, you moved to a different state, um, you just had a baby.
Things like that, That’s considered a special qualifying event, which would allow you to enroll anytime of the year within 60 days of that event happening, and that you can do for the public plans, you can look on healthcare.gov. Now, if it’s a state specific exchange, say like Maryland, that one you have to go to, like Maryland health connection.gov.
But the majority of the states, basically you can do through healthcare.gov or you can contact a local broker. Now, a broker is typically not going to be able to show you and advise you on the private options. Again, based on health, but they can help you navigate the public market, or you can simply call the number directly to the public market, which I would typically advise doing.
It’s pretty simple. Now, if you have questions about which plan you’d want to pick out, then of course having a broker’s pretty helpful. But otherwise, because of the way it’s done nowadays, you can simply call yourself and then you would be connected directly with them. But yeah, that’s, that’s pretty much how it is.
And then for the public plans, I should say, on the private side. Those plans are open 12 months out of the year. Again, depending upon your situation. Again, it’s not based on income as well. It’s for the most part really based on health. So as long as you can qualify for those plans, you can get them really whenever.
[00:09:48] Andrea: Okay. And then what are the different attributes of the plans that someone would be comparing?
[00:09:53] Daniel Dacquisto: So, you know, premium of course. I mean, I actually always start with that. I say there’s really three main things to focus in on. Premiums, so affordability. You know, what’s the bottom line? Deductibles, how much has to come out of pocket before the insurance kicks in. And then something a lot of times overlooked would be the networks that you would be on. So in most states, you’re going to see epo, hmo, and ppo. Sometimes pos, which stands for point of service, That’s a rare one, and that’s pretty limited as well.
PPOs the best. It’s the one that you can utilize nationwide. It’s the most flexible plan. It’s going to offer you the most, you know, freedom of choice. A lot of states on the public market do not have PPOs in that area. So if your, you know, your job involves a lot of traveling or you just like travel for leisure, that sometimes could be an issue. So you may want to look elsewhere outside of the public market if that’s the case. And if they do offer PPOs in your area, and again, you’re not getting subsidies, those rates are really, really high. Cuz PPO offers the most value, but it’s typically the the highest cost as well.
[00:10:52] Andrea: And then what can you tell us about the EPO and HMO? And the fourth one you said?
[00:10:56] Daniel Dacquisto: Uh, pos point of service. So yeah, you don’t find the POS too much. Those all are in, in a sense, kind of one and the same to where they’re more limited. So with the EPO, you may have some out of network benefits, not always as much though. And then again, it stands for exclusive provider organization, but not always the good kind of exclusive because it’s more limited with the doctors you can see. And HMO stands for health maintenance organization and pretty much the same concept. So again, you’re more restricted within the area. And say with an hmo, let’s say you need to see a specialist, you cannot just go directly to a specialist first. You have to first go to the primary care. Then he or she has to refer you to a specialist that they’re choosing.
So, you know, again, a little bit limited in those in regards, but it’s typically going to be more affordable than say a PPO at least. So you know, there’s some value.
[00:11:43] Andrea: So having a sense of your own health needs and what kinds of doctors you’re going to need to visit, how often the travel thing that’s like it really influences how someone might prioritize these options.
[00:11:54] Daniel Dacquisto: Yes, exactly.
[00:11:56] Andrea: You mentioned the open enrollment period and some of the things that influence when you could enroll. Are there any other deadlines we should be aware of?
[00:12:04] Daniel Dacquisto: Well, I guess employer plans. So I know we’re talking more for the self-employed, but you know, I’m sure some people do have a spouse and maybe their husband or wife has an employer option.
There’s also enrollment periods for most employer plans. The difference with them, a lot of them you are locked in for the year usually. Sometimes you’re not, but sometimes you are. So especially with a large company, unless you leave the company, if you sign up for a plan, you have to continue to pay those premiums until the next year’s enrollment period.
And if you find a better plan, a lot of times you cannot get out of those unless it’s the enrollment period as well. And for most cases, it’s usually right around the same time. So, you know, October, November, December. Like in public market is November 1st to January 15th. And how that works is you can pick a plan on November 1st or November 5th, but they don’t start until January 1st.
And if you want to have a plan start January 1st, you have to pick a plan by December 15th. If not anything from December 16th to January 15th would be starting February 1st. So, little bit different there. Again, unless it’s a special qualifying event, then they typically can start the first of the month preceding that event.
[00:13:11] Andrea: Okay. I know there can be a huge range on what someone should expect to budget. Can you give us maybe percentages or anything that would be helpful guidance if someone’s turning 26, getting health insurance for the first time, they want to prepare their budget for that expense. Is there a range that you can give us for that person?
[00:13:29] Daniel Dacquisto: Yeah, so somebody turning 26, I mean, it does vary because there’s things like, okay, I want to have a PPO or an HMO. Or I want to have maybe a really low deductible, or I don’t care, I rarely ever go, but in case something crazy happens, I’ll take a high deductible for the emergencies or maybe, um, I want to have dental and vision on there, or something like that. You know, those additives can add a little bit more to the cost. But for someone turning 26 on the private side for like a base medical plan, and again, those are PPOs, if they can qualify. Maybe in the low one hundreds per month is where it’d be starting at. And then let’s say maybe they couldn’t qualify for the private plan due to health, maybe conditions, and they’re making pretty good money so there’s no subsidy plans in the public market. Even for just a 26 year old could sometimes be as high as three, 400 a month. So that might be the range there for them. And then of course, if you’re adding family members, the rates will always change with that. But yeah, typically it comes down to someone’s income, the zip code, again, the size of the family for the tax credits. And like I said, you know, either an agent or broker can a lot of times help you navigate that.
[00:14:32] Andrea: How about some other benchmarks? Maybe 35, 45, 55. Can you give us some benchmarks to those prices?
[00:14:38] Daniel Dacquisto: Definitely. Now are we talking to individual or family or just a couple?
[00:14:42] Andrea: Let’s go individual and then we’ll talk family too.
[00:14:45] Daniel Dacquisto: Yep. So I would say 35, and again, when I’m, when I’m giving you kind of ranges, the private is always going to be the lowest costing when you’re not factoring income because it’s based on health. So I would say for 35 you’re starting at about 200 a month. And again, on the high end for the public market, it, it could get as high as like 450-500.
45, probably starting at about 300 a month. And then, again, same concept of really high end. Maybe they need some really good benefits because they have certain conditions on the public market with no subsidy. Could be seven, 800s. And then 55, another example, I actually was working with a lady who was on her COBRA option, which is an employer plan continued after you leave the employer, but the full price of it for just herself is 1400 a month. I think she was 61. Now. I know that that’s, that’s outrageous. It was a good plan. Of course, it better be, paying that much per month. But we got her down to, I think, in the 500s, for the private option because she was healthy enough to qualify.
[00:15:39] Andrea: All right. Yeah, and I guess if you’re looking at $1,400 a month, there’s a lot you could be putting towards a deductible if you were just saving some of that as cash. Right? And then I guess at 65, then you’re eligible for Medicare, so then that becomes a non-issue. Okay. Well thanks for those kind of benchmarks. Let’s look at the family options. So let’s say you’re a couple with two kids.
[00:15:58] Daniel Dacquisto: Okay what age roughly?
[00:16:00] Andrea: Couple in their 30s?
[00:16:01] Daniel Dacquisto: Um, private side. I would say five to 600 a month. Again, starting at the base plan, if again, you want to factor dental, vision, other things like that. And, and that’s one thing I, I forgot to mention too. The plans on the private side are pretty customizable, whereas in the public market, you’re picking just one plan from maybe an option of 30 or 40 from various carriers. Private, you can change a little bit. Yeah, I would say five, 600 a month up to maybe 900 a month on the private side. And then public maybe eight or 900 a month to again, family of four for maybe a good plan if they need it that way. It could be around 2000 a month with no subsidy.
[00:16:35] Andrea: Talk about how dental and vision work. So in the public market, it sounds like they would be wrapped into a plan, but on the private side you could like have one or the other or neither.
[00:16:44] Daniel Dacquisto: Yes, exactly. Well, on the public market, typically you have to get dental and vision separately, unless it’s for, um, your child, basic dental care, basic vision care will come with that. But to get that for an adult, you need to get that separately. So a lot of times you have to find somewhere else to go and do that. Nowadays, on healthcare.gov, they give you some websites and links to do that, so it makes it a bit easier, but that’s usually not factored in the premium. And then on the private side, yep, you can add it subtracted, but it’s right there on it. So you click yes, you can click no, you have that option for it. And then cost, um, I mean, honestly with dental vision are usually pretty straight across the. For an individual dental policy on the low end, $30 a month, maybe on the higher end, 50 and visions usually right around $10 a month.
[00:17:23] Andrea: And some people would opt not to have that because they don’t need glasses or they don’t expect any oral surgeries in the next year and can pay out of pocket for the dental service they do need. Right.
[00:17:33] Daniel Dacquisto: Yeah, no, that’s spot on. And that’s what I tell people too. If you only are going to use it for cleanings, you’re going to pay more in the dental insurance than what you pay out of pocket for that. But if you foresee maybe a crown or root canal, something like that, or even a chip tooth or cavity, then dental insurance could work for you.
Um, vision, like the one on the private sites really actually cost effective. So it’s about $10 a month typically. So you’re looking at what, 120 a year. An eye exam, if you get that done once a year, if you didn’t have insurance, could be 2 to $300 just for that one visit. So you’re already saving money there. And then for frames and lenses, for example, on the one plan I’m thinking about, typically it’s a $10 copay for the frames, and same thing with the lenses. So you’re looking at a lot of savings, you know, in that sense. So again, just depends on someone’s needs.
[00:18:12] Andrea: I remember that was surprising to me when I was first shopping for self-employed insurance because, you know, I’d always grown up with dental insurance. I was fortunate in that way and so I was just like, Of course you get that. And then realized that, oh, I had really strong teeth and didn’t need to worry about that. I wasn’t planning on playing hockey or anything . So yeah, always good to just know where you can, afford to take risks .
[00:18:31] Daniel Dacquisto: Right, exactly.
[00:18:32] Andrea: How about maternity coverage? I’ve had this come up with a lot of clients where they are hoping to have a baby and wanting to budget for that. What can you tell us about insurance in anticipation of a baby?
[00:18:43] Daniel Dacquisto: Definitely and not yet. That’s a great question. That’s a question I get asked a lot as well. The best plan if you’re going to have a child or you’re currently pregnant, would be the public market because they cover any condition regardless.
Well, I should say for the most part as compared to the private option. But that’s a lot of times why the plans could be much, much more expensive. And what I would typically suggest if you can afford it or they, for getting us subsidies, getting a goal plan. Actually, my wife and I are looking to conceived for our first here in the next year or so.
So she’s works with me as well. Same industry. So she’s planning on getting on a goal plan herself to kind of have that, you know, set up. Again. A lot of the out pocket doesn’t come in the first couple trimesters. It’s typically the third one. But again, a goal plan will be more expensive than the premiums, but typically you’re going to have less out of pocket. So you’ll get a lot of benefit that way and you can save some money when the delivery happens and things of that nature. Hopefully there’s no complications but if there, you know, there are, that’s also too where a lot of the expenses can come. Otherwise, I believe like an average delivery shouldn’t be too much, more than like 10-15,000.
But if other things come up, then of course it can cost some more. And then also, let’s say you’re looking to, you know, it’s an important question to get pregnant in a few years. But you’re super healthy, you and the spouse are healthy, maybe the kids as well. Again, I would suggest a private plan because you’re going have better benefits for anything else and also save money on the premiums. And I would always tell ’em, Look, when it’s time you guys are, you know, planning to conceive or even sometimes even after the fact, you can then just switch maybe the wife onto the plan there, to the public plan. The cost signal will go for just her part because you know she’s not going to use those benefits.
And then once the baby is born, then we could try and have everybody come back onto the private. So some intricacies there to kind of maneuver that properly. But that’s again, what we do and work with you on that and make sure you have the most cost savings and such.
[00:20:25] Andrea: Okay, so is that something where you would need to be enrolled in a plan that has maternity coverage before you get pregnant or, or could it be after?
[00:20:33] Daniel Dacquisto: A lot of times it could be after, because there’s special qualifying events for that to get on the public market. Now, again, if you know it’s going to happen within a few months or something like that, or you’re at least trying to have it happen, then it wouldn’t really make any sense to switch plans that quickly. But say, thinking in a few years, well then, yeah, you’re going to get a lot of savings up front and if something else happened outside of the pregnancy, you’ll have better benefits that way. And then also too, we would just need to switch again, the spouse onto that plan and keep the rest of the family over here to still minimize the savings.
[00:21:02] Andrea: Okay, So some strategy around , around that.
[00:21:05] Daniel Dacquisto: Yes. Yeah.
[00:21:07] Andrea: All right, so that’s one way of saving money if you’re looking at this particular scenario of having a child. Can you give us any advice on other ways to save money on health insurance and healthcare?
[00:21:17] Daniel Dacquisto: Yeah. Well, I mean, I would say the best way to save money on health insurance is of course to be healthy. If you can I know some people are always fortunate and maybe they have things that they’re born with, but proper treatment with theproper diet.. I build, I should say, I build great relationships with my clients as well as my wife.
So we become more trustworthy and me being used to being a trainer too, sometimes I will talk about those things as well, as long as they allow me to. It’s not really my business to get into that, but again, I usually become close with them. So, And again, we’re working with mostly preferred risk people on the private side.
So healthy upfront, you know, the less you go to the doctor, the more you’ll save. Of course, I also do work with a few doctors as well that are in my networking group so just kind of connecting on an avenue. But outside of that, in terms of the insurance specifically, like I was saying, if you can do it based on income, you can save money that way, but now you’re limiting yourself on the amount of money you can make, you know, per you for yourself or for your family.
So that’s maybe not always the best way to go about some savings in a sense. Otherwise, you know, there’s a private avenue, you know, plans where you can qualify based on health and if you can do that you’re going to get much lower rates and just things like getting your annual checkups done on a somewhat consistent basis. Catching certain conditions before they may actually happen or develop can reduce the amount of attention you may need at a future date with a doctor or professional in that aspect. But yeah going back to the insurance itself, the private avenue, because it’s based on health, it’s typically going to give you the most savings.
[00:22:35] Andrea: How about HSA for self employ?
[00:22:38] Daniel Dacquisto: Yeah, I mean, that’s always a good option. It’s a great way. There’s a lot of tax benefits there and a great way to kind of put off money until needed at a later time. Now, of course, that’s going to come with a high deductible plan, so you might have a bit more out of pocket in that sense. And then it can be harder to find an HSA these days. The private option typically doesn’t offer it that way. They do FSAs or flexible savings account. Spending account, excuse me, and the HSAs, you can only get them typically through the public markets and not in all zip codes. So it just depends. But yeah, that can, you know, be a good option as well.
[00:23:09] Andrea: Okay. And for those who aren’t familiar, can you give some more background on the difference between hsa, fsa and how they work.
[00:23:15] Daniel Dacquisto: Yeah, so hsa, you’re basically, like I said, putting money away that’s tax deferred for a later date. And you can also use it for health insurance costs. You can use it to pay premiums. You can use it for medical bills if those come up. And what you can also do too, I have this happen a lot. Let’s say you currently have an HSA with a lot of funds in there, if you were to get onto a private plan, You cannot fund that HSA anymore, but you could still take those funds and then at least utilize what you currently have in there towards medical bills for that private option.
You couldn’t use it to pay the premiums, so some people they might have had an HSA for a long time and, and they want to keep those funds or keep adding to that, but they’re also paying a lot in premiums and maybe not having the best benefits. So they’re looking to maybe jump ship and get a different plan. That might be based on health, but like I said, you don’t have HSAs that way, but they can at least still keep anything they’ve already funded to utilize for a later date. So it still works out for the most part.
[00:24:09] Andrea: Okay. Can you talk to us about the tax deductible portions of the healthcare expenses?
[00:24:14] Daniel Dacquisto: Yeah, I can get into that. Now I always tell this before I say any tax advice. I’m not a cpa, you know, so if you have a cpa, talk to him or her about that. But if you’re self-employed, and especially if it’s private insurance, at least the monthly premiums should be deductible. Okay? So if you’re paying 500 a month, you should be able to deduct $6,000, you know, annually. As long as you have that plan for the entire year. If you have, say like an HRA 1 0 5, health reimbursement arrangement, maybe it’s just you, I’m in the spouse working, you know, for your company, you can have that as well. And what that allows you to do is also write off any healthcare cost.
So not just the premiums, but now I go in and I have a prescription that I take or I, I went and saw the doctor, I had a surgery. Then those typically would be tax deductible as well.
[00:24:56] Andrea: So that’s in contrast to, typically it’s you have to meet a certain percentage of your income has to be going to health expenses to be able to write off the general expenses, the non premium expenses. Is that correct?
[00:25:08] Daniel Dacquisto: Yeah. Yep.
[00:25:09] Andrea: Let’s switch gears here for a minute. Can you talk about multi teacher studio owner, So this is a teacher who’s maybe doing some teaching, also administrator of a school, maybe they’re full-time administrator and they are looking to hire employees. What options are there for them to consider to provide either some kind of health benefit, maybe they’re not doing full insurance, but some kind of health benefits for their employees.
[00:25:32] Daniel Dacquisto: Another great question. If it’s a health benefit there’s different things like association packages that will have like supplemental coverage, maybe some prescription things here and there some discounts. So you could do that and that’s usually pretty inexpensive. If you’re looking to provide full health benefits you can either get a group plan. Now, when you get a group plan, there really aren’t going to be any subsidies or breaks on the premium. So those plans are basically the public market, just via group. So they can be pretty expensive. Now, again, you know, if you’re having employees and you probably want to offer them decent benefits.
The more you can offer towards their insurance, probably the better. I’ve seen, again, depending upon how well the company’s doing, typically like I’ve talked about in the beginning, the employee themselves, they may pay the full thing or half, but to add any family members, it could be the full price for them. So when it comes to what you will sponsor, a lot of questions go into that. There’s no one right answer, so to say. But I mean, of course the more you would pay for your employees, I’m sure the better they’d be appreciative of that. And again, you can just get a group plan. You know, common carriers are United, Anthem, there’s Aetna as well. But those can be pretty expensive. You could do the private avenue. Problem with that is, it’s a little bit convoluted sometimes and when I, I say that meaning again, we talked about having to qualify for that. So I say if you have five employees or less, that could be a good option cuz maybe you can put, you know, three or four employees and maybe even their family members on the private plan. Save a lot of money that way. And then maybe only one or two don’t qualify and you can find them another option. But if it’s, you know, 10, 15, 20. You really don’t want to have all 10 over here, 10 over there. I mean, you could do that as well. It just gets a bit trickier that way. But yes, anytime you go to the private avenue, you’re going to be able to save some money that way, especially on group plans, because let’s say for a family, they’re making it a thousand dollars per family.
If you have five families, that’s 5,000. If it’s 500 a month, you know, on the private side you’re saving $500 a month per person or per family, I should say. That’s a lot, you know, throughout the year. And then however you do it, with the way you want to actually offer the benefits, you could just say, I’m offering it, but you’re guys are paying for all of it so you pick which plan you want. I’m going to pay for all of it, which you know, would be very neat, or I’ll give you a stipend. A lot of people do this nowadays because they don’t want to get into the insurance themselves, but they’ll say, Okay, you pick whatever plan you want, show me it, that you have it, and I will pay 200 a month, you know, a family, 500 a month, you know, towards that, whatever the case might be. So.
[00:27:51] Andrea: Yeah, that’s a great option that keeps it like you’re putting forth effort still, like trying to make that work for your employees. And even if you can’t provide the whole thing. Again, thinking of the teacher who’s budgeting for this or wanting to build this studio that has 10 employees and they want to provide health insurance, are there any cutoffs that they should be aware of? Like if they start a group plan, do they immediately have to offer it to all the employees or is there a way to gradually add on, you know, full-time people get it, or people teaching so many hours a week, get it and then tiering it like that?
[00:28:22] Daniel Dacquisto: Yeah. Great question again. So, Private plans all those companies really care about is if you can qualify for an out, so they don’t really care who’s part-time or full-time. It’s up to you if you want to, um, offer any benefits or not, or offer any stipend to those individuals. Typically, with a traditional group plan, it’s usually full-time only. That’s what I almost always see, which is usually anywhere from 36 to 40 hours. And then, If somebody’s just coming on board, a lot of companies will make you wait 90 days before you can roll into the plan.
Maybe that’s because they might think you’re going to leave right away, or just the way they have it set up. But yeah, it typically takes 90 days. So some people, a lot of people, I should say, are shopping too, not for long term plans, and that’s when a short term plan could be beneficial because that’s what it’s meant for say, three months because I’m switching jobs. But the new one does not offer any benefits until the 90th day, and I’m not paying COBRA because that’s 1400 a month. So you could do that.
[00:29:13] Andrea: Sure. Okay. That’s really helpful. Thank you. Is there anything I haven’t asked on this broad topic, uh, that I should have?
[00:29:21] Daniel Dacquisto: No, I mean, I was, I was looking at the questions earlier, um, that you had sent me. You know, kind of going back to navigating it, health insurance can seem complicated. It’s not crazy. Like I said, there’s, there’s, there are a few nuances to it, but there’s really three main things you want to look into: the premium, the network, your deductibles, and then of course the doctors and facilities that would accept it as well. And again, if you have questions, there are the public market websites, and I think there’s question later on healthcare.gov for most states. If you’re in a specific state that has your own exchange, like Maryland or Pennsylvania, Colorado, come to mind more Nevada and you go to the state website and they have what’s called navigators.
So. You could typically call those numbers that are listed there and they can help you , navigate the plans. They’re, I don’t think they’re actually, they’re not licensed agents, so they might not know the specifics, but they can typically tell you the basics they know as well. So I think that’s always something to look into. So if you have questions try and maybe reach out to like a local broker or licensed agent can always be helpful.
[00:30:20] Andrea: And what states are you licensed to work in?
[00:30:22] Daniel Dacquisto: Uh, 33. So I would not know all of them on top of my head.
[00:30:26] Andrea: But there’s a greater than 50% chance you can help someone it sounds like.
[00:30:29] Daniel Dacquisto: Yes, and even if I’m not licensed in the state, I can definitely help direct and guide you to at least a public marketer trying to find a broker who is so or agent.
[00:30:37] Andrea: Fantastic. Daniel, thank you so much. This was tremendously helpful. I really appreciate you taking the time today. Where can listeners get in touch with you and follow up if they have more question?
[00:30:45] Daniel Dacquisto: Yeah, well, I have an agent website, which I think I, I sent over to you. I have Facebook, Instagram, also a LinkedIn as well. I think I sent, um, all over to you as well. Those would be the, the places to find me.
[00:30:56] Andrea: Awesome. We’ll link up to all those in the show notes so people can reach out. Thank you so much.
[00:31:00] Daniel Dacquisto: Yes, thank you for having me.
[00:31:07] Andrea: Daniel’s the expert on health insurance options, so I’m not going to add too much to what he shared. But I did want to add one piece of general business budgeting advice that I share with all my clients. That advice is to build your business financial plan to include the cost of health insurance, even if you don’t need it.
Obviously if you’re able to be on a parent’s plan or a partner’s plan for free or cheaper than individual options, you’d take advantage of that. But if or when circumstances change and you do have to take on this additional expense, you’ll be so grateful that your pricing already took this into consideration and you don’t have to do a sudden rate increase just to stay profitable.
And hey, for as long as you do have access to that insurance through your parent or partner, you’ll just enjoy a more profitable business. There are worse things. You can find the contact info for Daniel, along with the links mentioned in this episode and many more resources to help music teachers run sustainable businesses at musicstudiostartup.com/episode104 .
That’s all for today. Thanks for listening. I’ll be back next week.