part of what is now called the Great resignation. around 4

million workers have quit their jobs each month between July and

November 2021. American workers who are becoming their own

bosses maybe gaining new financial freedom, but they're

losing a big advantage health insurance benefits. Over 54% of

Americans had insurance through their employer in 2020.

One of the reasons that I almost never considered leaving a staff

position until recently was because of health insurance.

The great resignation might be even greater if it weren't for

the way our health insurance system was constituted

one in three insured workers would consider leaving jobs if

health insurance weren't a factor.

This system isn't easy to navigate, it's really difficult

to figure out how much insurance is going to be even as a self

employed person.

Many Americans turn to the Obamacare marketplace to find an

insurance plan. The Biden administration announced that

signups hit an all time high in December 2021. There are

significant limitations in marketplace plan coverage that A

you can't easily see. And B that make the coverage meaningfully

different from what you may have been, you know, used to from

your jobs.

I don't think there is a more important or complicated

decision to make than picking a health insurance plan.

So can Obamacare work for this influx of uninsured Americans

and what's the lasting impact of the great resignation on health

care coverage? The Affordable Care Act frequently referred to

as Obamacare establish the health insurance marketplace

where people can find medical insurance plans from private

providers that are not tied to their jobs. Erica Lehman left

her job in higher education to work on her wedding photography

business full time, she looked for a new insurance plan on the

marketplace.

There were so many options and all of them seem just kind of

like a lot of money for not a lot of support.

Since marketplace plans are offered by private companies,

there's no limit to the number of people who can get their

insurance through the Marketplace. That means people

participating in the great resignation won't be shut out.

increased participation in the marketplace may even encourage

insurers to adjust their offerings. In fact, the number

of insurers participating in the marketplace increased in 2022.

Individual health insurance plans are extraordinarily

expensive, you need to be in a group in order to have really

the benefits of a group insurance. If you're not in a

group, you're gonna have very high copayments and deductibles

and high insurance costs.

71% of uninsured Americans who decided not to get insurance

from either a private insurer or through the Marketplace said

they didn't end up buying a plan because it was too expensive,

according to a 2020 survey by the Commonwealth Fund. Nicole

D'Onofrio left her staff position as a digital marketing

consultant to start her own business. She also turned to the

exchanges to find an insurance plan.

My previous job covered all benefits for an individual. So I

never factored in health insurance into any type of

expenses that I had, I didn't even realize were such great

benefits until I left.

If you're trying to find a plan that is the same or virtually

the same as what you had at work, you might not be able to

do that. Marketplace plans, they have much higher deductibles, on

average, most of them have much narrower provider networks. So

if you have you know a condition you're pregnant, there's a

doctor you're going to see now, there's a decent chance that

that doctor will not be in all or even any of the networks of

the plans that you look at. And you're going to have to go

through and look at each network.

Health insurance is a big perk of working for a company and

workers know it. 26% of Americans would be very or

somewhat likely to start their own business if health insurance

wasn't a factor.

Even if you were a ruthless capitalist who was totally

opposed to socialized medicine, you would have reasons to be

concerned about the way we're doing things if health insurance

is holding people back from the perfect job or from starting

their own business potentially that is an invisible brake on

the productivity of our economy.

Politicians want to be elected and reelected. So they're going

to listen, I hope.

The government does offer subsidies in the form of a tax

credit that help qualified Americans pay for a Marketplace

plan. The vast majority of people who get coverage through

the marketplace qualify for subsidies for premium tax

credits that will reduce the amount you pay each month. So

the premiums are pretty affordable for most people. The

rules of whether someone qualifies can be difficult to

follow. The requirements are based on age as well as income

and vary by location. Additionally, people who have

options to get their insurance through another source such as

an employer or through a spouse usually do not qualify for any

subsidies.

Only 30% of people are aware that you can get financial aid

to buy one of these Obamacare plans.

I've been doing this for years and I still trip over new stuff.

Because the plans change every year.

Since there are many different plans with a range of costs and

benefits on the marketplace. The government bases the subsidies

on the price of what is called a benchmark plan, which is

considered a mid level plan, cost wise. The subsidies are

determined on a sliding scale. People making under a certain

amount only have to pay a percentage of their income. As a

household income rises, the percentage of the required

contribution rises with it.

If you have very low income, the percentage you have to pay is

zero. So the premium tax credit will cover the whole thing.

The pandemic may be partly responsible for altering the

workforce dynamic. Covid has also spurred legislation to make

insurance plans more affordable for most Americans, which means

it may be the perfect time for folks to consider taking the

leap.

The American rescue plan that Congress passed at the beginning

of 2021 enhanced the marketplace subsidies made them better for

everybody and made them available no matter what your

income is.

Prior to the American Rescue Plan act, an individual could

only qualify for a tax credit if they made less than 400% of the

federal poverty level, which comes out to about $51,500 for

an unmarried person with no dependents. But if that same

person made $52,000, they would pay the full price premium. The

sharp line for qualifying is frequently called the subsidy

cliff. The subsidy Cliff impacts older Americans the most

especially in the middle income bracket. The American Rescue

Plan Act removed that cap making it so people who make more than

four times the poverty level qualify for the sliding scale

subsidy, basically making the subsidy Cliff disappear. The

legislation also changed the max a person would have to pay from

about 10% of their income to 8.5%. It's rare for people who

make above 600% of the poverty level which is around $77,000.

For an individual to qualify for a subsidy. KFF estimates that

the American rescue plan act increased the number of people

eligible for subsidized coverage from 18.1 million to 21.8

million people. But the subsidy enhancements are set to expire

at the end of 2022. The Build Back Better Act includes

provisions aimed to expand those subsidies. The Congressional

Budget Office estimates that 3.4 million Americans would get

coverage through the marketplace over the next decade if the

enhanced subsidies are kept in place. The Build Back Better act

has yet to pass the Senate as of January 2022, which means these

deals may not last.

If you find the perfect plan this year, you're going to have

to do this whole thing again at open enrollment and see if your

same plan is offered next year or if it's been changed. That's

allowed, insurers can make changes to their networks and to

their formularies into their premiums and their deductibles

every year so you are going to have to kind of stay on top of

this.

The Obamacare exchanges seem to be most people's simplest option

when it comes to finding a comprehensive plan. But there

are other options for entrepreneurs to explore. A

temporary solution for many workers is a program called

Cobra which gives anyone who worked at a company with at

least 20 employees the right to continue to pay for their

insurance plan after they leave. Workers are usually eligible to

stay on Cobra for up to 18 months. This option, however, is

expensive because the previous employer is no longer

subsidizing the insurance costs.

Cobra was definitely something I wish I could have just stayed

with. Because I love my previous insurance. I was used to all my

providers, I knew it was a network, it was just very

expensive. It was over three times the amount that I would

pay if I were just paying my portion of my husband's

insurance. Also it would have been really awkward to ask my

employer how much is Cobra: "I'm thinking of leaving my job, but

I'm not leaving yet. I need to see how much Cobra would be"

that would be an awkward conversation to have.

Neither Nicole nor Erica were eligible to receive a premium

tax credit for a plan from the marketplace. Nicole decided that

going on her husband's plan was the best financial option for

them. But it was still expensive, and it was difficult

to estimate how much she would end up paying in the end.

I think I guessed at my husband's potential insurance

would be from past forms he might have gotten. Because we

didn't know for sure how much anything costs until we paid it,

basically.

Erica also considered the option of going on her husband's plan.

It was so expensive for a family plan and it's just the two of us

that it was more economical for him to go on the insurance and

for me to figure out another option. When I first was looking

at health insurance I didn't even consider or didn't even

think of the option of having separate health coverage.

Erica considered plans with direct primary care providers.

These are essentially membership plans where patients pay a flat

fee directly to a healthcare provider and have no out of

pocket cost at time of service. These plans are not health

insurance. Instead it's paying upfront for a membership to

access primary care services throughout the year. The

downside of this option is that it doesn't typically cover

emergency services. Many direct primary care providers recommend

people who go this route also get a high deductible insurance

policy to cover emergencies.

That made me nervous because I just don't know, the only things

that I could find that actually covered emergency rooms were in

the health cost sharing option and the marketplace.

Erica ultimately decided to go with a cost sharing plan cost

sharing organizations, which are also called Health Care sharing

ministries are not insurance companies. This means they don't

have to follow the minimum coverage requirements that the

Affordable Care Act outlines sharing ministries are typically

a group of people who may share religion who pool funds and

agree to pay for one another's health care costs under certain

conditions.

They can exclude your pre existing condition. They can

charge you more just because they don't like the looks of

you. Or based on your age or based on your health or based on

whatever. There are no rules. Often if they're cheaper, it's

because you're not getting the same protection.

I am fairly healthy. So I feel like this is an okay thing for

me to take a chance on.

There are a lot of considerations to make when

choosing a health insurance plan. When you think about

affordability, think not just about the premium, but about the

additional costs you're going to pay out of pocket when you need

care. You almost never get 100% coverage. So if you are healthy

and you don't use a lot of care, you may find the marketplace is

way more affordable than what you're used to at work because

right it's on a sliding scale. If you're older, if you have a

significant health condition, you need to count more than just

the premium.

I feel like in America, we're in such like a rushing urgent

society. And I feel like with anything, any decision that

you're making any big change that you're making, allow

yourself the time and the grace and the space to really sit with