You spend your working days dealing with dental coverage, but arranging medical insurance for your own household is another matter. Once you're the practice owner, that responsibility falls on you. Here's how other dentists are choosing coverage and managing the expense this year.
Hi, I'm Sam Jaber. I'm a licensed health insurance broker helping people arrange their own medical coverage. I work from Tampa and serve clients over the phone throughout the 36 states where I'm licensed.
First, I want to make an important distinction because dentists searching for insurance often run into confusion here. We're discussing medical insurance, meaning coverage for physician appointments, hospital treatment, and prescriptions for you and your family. We're not talking about the dental benefits your patients use, or a dental insurance policy you might purchase for your own teeth. Those are entirely separate types of coverage.
As an associate at a group practice or corporate dental office, you may have received medical benefits as part of your employment. Purchasing your own practice, or becoming a partner in one, changes that arrangement. The dentists who contact me generally have a few common choices to work through, and I'll explain the process so you can identify the right direction for your household.
The first thing we need to establish is this: does your household income fall below the marketplace's premium assistance threshold?
That income threshold is approximately four times the federal poverty level. For a single-person household, it's just above $60,000 annually. A household with four members has a substantially higher income limit before crossing it.
For a self-employed practice owner, the relevant figure is net income after paying business expenses, not simply the practice's gross production or collections. Your schedule might be full and revenue might look impressive, while your personal earnings remain much lower, particularly when you're repaying a practice loan, purchasing equipment, or financing the buyout of a partner. Don't assume you exceed the threshold just because the practice generates substantial revenue. Start with your actual personal income, then see which situation below applies to you.
This describes many of the dental practice owners who call me. Your practice has an established patient base, household earnings are above the marketplace subsidy threshold, and you're looking at expensive full-price premiums even though your family doesn't typically use much medical care.
That's when private medical insurance with underwriting becomes worth considering. During the application, you'll provide health information for everyone who needs coverage. The carrier uses that information to determine eligibility and the premium. For households in good health, the resulting price can often be lower than the marketplace's unsubsidized premium.
These policies use PPO networks with nationwide coverage, allowing your family to visit physicians at home, near your children's college, or while you're attending a dental conference in another state. I'll also check the network to see whether the doctors your family already knows and trusts participate.
There are specific limitations to understand with medically underwritten coverage. Your answers to the health questionnaire affect approval and coverage, which makes providing accurate information especially important. Benefits also vary by policy. Before you enroll, we'll review the plan you're considering and go through the services and expenses it actually covers.
Next step: Call me and I'll put together a nationwide PPO quote for your household, then compare it directly against the marketplace's full premium so you can clearly evaluate the difference.
When your associate position ends, the employer-sponsored medical plan will probably end too. Losing those benefits typically opens a special marketplace enrollment period lasting 60 days, allowing you to apply outside regular open enrollment. There are already plenty of deadlines involved in buying or joining a dental practice, so make sure this particular one doesn't slip by.
Should a private medically underwritten policy turn out to be a better fit, remember that the insurance company must review your application before coverage can begin. I'd get that process underway before your associate position ends, rather than starting afterward.
During your first year of practice ownership, your personal income might be lower than it will be later. Loan payments and startup expenses can leave your earnings below the marketplace subsidy threshold, making subsidized marketplace coverage the most affordable choice for that year. If that's your situation, use a reasonable estimate of annual income when enrolling. As the practice grows, update your earnings with the marketplace because excess premium assistance may need to be repaid when you file taxes.
Next step: Get in touch several weeks before your final day as an associate. We'll plan the changeover carefully so your household doesn't experience a gap in medical insurance.
Practice owners often ask whether their own coverage should come through a health plan for the office staff. If you don't employ anyone, you'll purchase individual insurance just as other self-employed professionals do. Paying a hygienist or another contractor on a 1099 doesn't make that person an employee for this purpose. Once your practice employs at least one person who isn't an owner or a family member, small-business health coverage may become available. That comes with different requirements and deserves its own discussion. We can begin by getting your family's coverage figured out.
Your county can make a big difference in marketplace choices. Some counties offer only HMO or EPO coverage, while others have PPO policies with premiums that many families find too expensive. You may have another route. If your household is healthy, I can quote nationwide PPO insurance in each of the 36 states where I hold licenses. Give me 15 minutes on the phone and we'll see what the premium looks like.
You're welcome to call without preparing anything, but these details will help us compare coverage more efficiently:
Working with me doesn't cost you a separate fee. Once you sign up for insurance, the carrier pays my compensation. Your premium remains unchanged whether you purchase the policy through me or enroll without my assistance.
Straight answers, no sales pitch.
Possibly, depending on how your practice is staffed. With no employees, you purchase your own individual insurance as another self-employed person would. Employing someone who isn't an owner or family member may make a small-business health plan available, subject to its separate requirements.
In most situations, yes, although restrictions apply. Your self-employed health insurance deduction is limited by the business's profit. You also can't claim it for months when you were eligible for employer-sponsored coverage, including through your spouse's employer. Your tax preparer can help determine what applies to you.
No. Someone working for your practice as a contractor doesn't qualify as an employee for purposes of establishing eligibility for a small-business health insurance plan.
That's one of the benefits of having a nationwide provider network. For healthy households earning above the subsidy threshold, I can compare private insurance options using nationwide PPO networks throughout all 36 states where I'm licensed.
Tell me approximately how much income you're taking from your dental practice, which members of your household need coverage, and which physicians you'd prefer to continue seeing. I'll compare the available routes and their prices, and if your existing insurance is already suitable, I'll recommend keeping it.
Dentists in private practice in your state
Other lines of work I help