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8 Questions Owners and Independents Should Ask During Open Enrollment

If you’re a practice owner or independent physician, you’ve most likely seen your health insurance premiums rise steadily. So you may be surprised to learn there could be options to help you control costs and get a better plan for 2023.

But it’s true. At TMA Insurance Trust we’re always looking for ways to help Texas physicians find health insurance that works best for their needs and their budget. And our research has revealed there are little-known health insurance options that could potentially help small practice owners and independents get better coverage for themselves, their families and their employees. 

To help understand how these options could work for you, here’s a quick Q&A.

How Can I Get Better Health Insurance During Open Enrollment?

During Open Enrollment it may be possible to get a better health plan than what you have now. That’s because there are special health insurance options and waivers that allow owners and independents to bypass certain criteria relating to group health insurance. This can impact how practice owners offer health insurance to their employees and may provide independent physicians with options for group PPO and HMO coverage they never knew they had. 

How Do the Waivers Work for Practice Owners?

The waivers can give practice owners the option to contribute what your practice can afford for your employees’ premium payments – or to not pay anything at all. In addition, you would no longer be required to cover any of your staff in order to be eligible for group PPO health insurance coverage.

The waivers could then help you get PPO coverage for yourself while offering more affordable options to your staff. So for example, you might choose to get group PPO coverage for just yourself and your family – while offering a mix of PPO and HMO plans to your employees. 

It’s good to note that as it’s becoming more challenging in today’s marketplace for employers to hold onto valued employees, the waivers may help make it more affordable for practice owners to offer health benefits so they can retain as well as compete for the best employees.

How Do the Special Options Work for Independent Physicians?

The special options may help independent physicians qualify for group health insurance as well as the corresponding group rates. So you could potentially get a group HMO plan that costs less than an individual HMO plan – with comparable benefits. Likewise, independents who  thought they were only eligible for an individual HMO plan may now qualify for a group PPO plan – even if they have no employees. Here’s what you need to know:

    • For partners with no W-2 employees, you may be eligible for group coverage only for yourself. You’ll need to provide partnership documentation and the company’s SS4 or recent K-1 (Form 1065).
    • For physicians who own a business with their spouse, or their spouse is a W-2 wage employee, you may qualify for group coverage even without partnership documentation.
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Why Didn’t I Know About These Options Before?

Most physicians don’t have time to pore over health insurance regulations and guidelines. But at TMA Insurance Trust, this is what we do. We’ve made it our business to know where to look and what questions to ask in order to find these types of “hidden” benefits for the physicians we serve.

I’m as Busy as Ever – Do I Have to Sort Through Different Plans and Carriers? 

We can help save you time and reduce the hassles of shopping for a new plan. We’ll compare plans from different carriers and provide quotes so you don’t have to study plan details and do time-consuming research. TMA Insurance Trust is a full service insurance agency and we offer group and individual plans from leading national carriers. 

What if I’m Planning to Open My Own Practice?

If you’re preparing to open your own practice, we can help you start your own group plan. Simply call our advisors to get started.

Is There a Time Limit to Get Coverage for Next Year?

To get the best plan for 2023 you need to act now. Your paperwork must be complete and submitted to the insurance carrier by December 12, 2022 for a January 1, 2023 effective date. 

What’s My Next Step?

Call our advisors for a consultation. We’ll discuss your needs and budget and provide you with what we think are your best options. And you should know this: Our advisors are different from ordinary brokers or agents. They do not work for sales-based commissions so their recommendations will not be biased and there will be no pressure whatsoever. Their experience and expertise are available at no cost to you.

Now is the time to get your best plan for 2023. Call us at 800-880-8181, Monday to Friday, 8:00 to 5:00 CST.

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For over 60 years, TMA Insurance Trust advisors have been serving Texas physicians, their families and staff. TMA Insurance Trust prides itself on offering unbiased information and strategies to members, along with exclusive group rates on a range of the highest-rated plans in the industry.

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