For many years, self-employed professionals, gig workers, and small business owners have faced a significant challenge in the health insurance market. If you aren't part of a large corporation with thousands of employees, finding a high-quality, comprehensive health plan that doesn't break the bank can feel like an impossible task. You often find yourself stuck between expensive individual plans on the ACA (Affordable Care Act) Marketplace or "short-term" plans that might not offer the long-term protection you actually need.
At Total Benefit Solutions Inc, we have always committed ourselves to finding better ways for our clients to navigate these complexities. We are thrilled to announce a new partnership that addresses this exact gap. We have entered into an agreement to offer Ameristead Health Plans, a robust, self-funded group solution specifically designed for the "builders of America," including sole proprietors, entrepreneurs, and small employer groups.
These plans are not your typical individual policies. They are built on the backbone of a major national network and offer a level of flexibility and coverage usually reserved for much larger organizations. If you’ve felt overlooked by the traditional insurance system, Ameristead might be the solution you’ve been searching for.
What Makes Ameristead Different?
Ameristead operates on a "self-funded group" model. In the past, self-funding was a strategy primarily used by Fortune 500 companies to lower costs and customize benefits. Ameristead has effectively "democratized" this model, making it accessible to the individual entrepreneur or the small business with just a few employees.
Because these are group-style plans, they offer different structures than the standard individual plans you might find on a state exchange. They are administered by Marpai Health, a technology-driven third-party administrator (an organization that processes insurance claims and manages the day-to-day operations of a health plan), ensuring that your member experience is streamlined and modern.
One of the most significant advantages of Ameristead is the network. These plans utilize the Cigna PPO and EPO networks. This means you gain access to a massive, nationwide database of doctors, specialists, and hospitals without the geographic restrictions often found in local HMO plans.
Understanding the Six Plan Tiers
Ameristead provides six distinct tiers of coverage, allowing you to choose the level of financial protection and monthly premium (the amount you pay every month to keep your insurance active) that fits your specific situation.
1. Bronze Plan
The Bronze plan is the most affordable option in terms of monthly premiums. It is designed for individuals who are generally healthy and primarily want protection against "catastrophic" medical events. While you will pay more out-of-pocket for routine care, your fixed monthly costs remain low.
2. HSA (Health Savings Account) Plan
This is a High-Deductible Health Plan (HDHP) that is specifically designed to be paired with an HSA. This allows you to put aside pre-tax dollars to pay for qualified medical expenses. It’s an excellent choice for entrepreneurs looking for tax-advantaged savings combined with low monthly premiums.
3. Silver Plan
The Silver plan strikes a balance between cost and coverage. It features moderate deductibles (the amount you pay for covered health care services before your insurance plan starts to pay) and includes predictable copays (fixed amounts you pay for a covered health care service, usually when you receive the service) for doctor visits and prescriptions.
4. Gold Plan
If you want more predictable costs and lower coinsurance (your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service), the Gold plan is a strong contender. It uses the same copay structure as the Silver plan but offers reduced deductibles, making it easier to access benefits sooner.
5. Platinum Plan
The Platinum plan offers very high levels of financial protection. It features the second-lowest deductibles and coinsurance rates available in the Ameristead lineup. This is ideal for those who anticipate more frequent medical needs or simply want the peace of mind that comes with minimal cost-sharing.
6. Diamond Plan
The Diamond plan is the most comprehensive option offered. It features the lowest deductibles and the most minimal out-of-pocket costs. While the monthly premium is the highest of the six, it provides the most robust coverage for those who want the absolute best protection available.
The Power of the Cigna PPO Network
One of the biggest frustrations for gig workers and entrepreneurs is travel. If you are a digital nomad or your business takes you across state lines, you need insurance that follows you. Ameristead plans utilize the Cigna PPO (Preferred Provider Organization) network.
A PPO network is generally more flexible than an HMO (Health Maintenance Organization). With a PPO, you don’t typically need a referral from a primary care physician to see a specialist. Most importantly, because it is a national network, you can find in-network providers in almost every corner of the United States. This nationwide access ensures that whether you are working from home or traveling for a client meeting, you are covered by one of the most respected names in healthcare.
The Role of Medical Underwriting
It is important to note that Ameristead plans require a health screen, also known as medical underwriting. This is a process where the insurance company reviews your health history to determine eligibility and pricing.
Unlike ACA Marketplace plans, which are "guaranteed issue" (meaning they must cover you regardless of pre-existing conditions), Ameristead uses underwriting to help maintain lower premiums for the group. This makes these plans an exceptionally high-value option for individuals and small groups who are generally healthy and looking for a way to escape the rising costs of the traditional Marketplace.
As your advocate, we at Total Benefit Solutions can help you understand if your health profile makes you a good candidate for this type of plan. We never want you to feel overwhelmed by the application process; we are here to walk you through every step.
Is Ameristead Right for You?
Ameristead is specifically built for those who "build America." This includes:
- Sole Proprietors: If you are a "business of one," you can finally access group-style benefits.
- Gig Workers: Freelancers and independent contractors who need reliable coverage that isn't tied to a traditional 9-to-5 job.
- Entrepreneurs: Startup founders who need to protect themselves and their families while they grow their businesses.
- Small Groups: Employers with just a few employees who want to offer high-quality Cigna PPO coverage without the administrative headaches of traditional large-group plans.
Because these plans are administered by Marpai Health, you also get access to modern tools for managing your health, including easy-to-use digital portals for tracking claims and finding providers.
Why Work with Total Benefit Solutions?
Navigating health insurance rules and regulations is complicated. You shouldn't have to do it alone. As independent brokers and advocates, we don't work for the insurance companies, we work for you.
We specialize in health insurance advocacy. Our commitment is to never accept "no" as an answer when fighting for our clients' rights and benefits. When you explore Ameristead through us, you aren't just getting a plan; you're getting a partner who will help you compare options, handle the paperwork, and stand by you if you ever have a dispute with a provider or an insurance company.
We shop around and compare options across the entire market to ensure that Ameristead: or any other plan we recommend: is truly the best fit for your budget and your health needs.
Get Your Personalized Quote Today
The landscape of health insurance for the self-employed is changing, and for the first time in a long while, those changes are in your favor. Ameristead offers a rare combination of national network access, flexible plan tiers, and group-style benefits for the individual entrepreneur.
If you are ready to see how Ameristead compares to your current coverage, or if you are looking for your first plan as a new business owner, reach out to us. We can provide exact dollar amounts for premiums and deductibles based on your specific needs and health screen results.
Visit our website at www.totalbenefits.net to learn more about our advocacy services, or call us directly to speak with a consultant who can guide you through the Ameristead enrollment process.
Total Benefit Solutions Inc
(215) 355-2121
www.totalbenefits.net
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