Written By Mindy Waite
With the recent elections and the upcoming development of the Affordable Care Act in 2014, the topic of health insurance has been at the forefront of the national discussion. However, little to no conversation has been initiated about the unique position in which farmers find themselves and their families when it comes to obtaining health insurance.
Most American (and Maryland) farmers work on a “small farm”, defined as 179 acres of less. In Maryland, most farms are also “small businesses” comprised of fewer than 50 employees. Many Maryland farmers run successful businesses; however, it is not unusual for farmers to have less successful years, especially new farmers in their first few years of farming. In lean times, how are Maryland farmers supposed to afford good health insurance for their families?
The answer is too often that they can’t. While there are several current options for getting insurance for your family, none are ideal for most farm families.
Off-Farm Work
Many farm families get insurance by having at least one family member work off the farm. In fact, 2/3 of farm families (and 20% of farm operators) receive insurance in this manner. While this may not work well for single farmers focusing on their farming operation, it is currently the most popular option among farm families.
Individual Insurance Plans
In the United States, 30-60% of farmers (compared to 8% of the population) have individual insurance plans. These plans tend to be more expensive than group plans offered by employers; however, farm operators are self- employed and thus may deduct insurance premiums on their taxes. Individual plans can cover as little or as much medical care as you like, but the premiums will rise or fall to match the benefits.
Catastrophic Insurance: Farmers not eligible for Medicaid (see below) and not requiring medical attention beyond yearly preventative care (such as young, healthy farmers without children) may want catastrophic insurance. Catastrophic insurance protects individuals after life-threatening events by covering emergency medical costs, which can reach hundreds of thousands of dollars. Because this type of insurance does not usually cover expenses outside of emergencies (such as preventative care), the yearly premium is relatively inexpensive. However, these plans tend to have high deductibles and higher out-of-pocket costs for covered services.
State Medical Assistance
State medical assistance may be an option for individuals and families with low incomes. 
Interestingly, studies in other states have shown that farm family enrollment in these programs is quite low; in one state, 17-21% of farm families were eligible for state medical programs, yet only 1% actually enrolled! For the health of themselves and their families, more farmers may want to consider this option.
Medicaid: Farm families making under a certain level of income and owning few non-business assets may be eligible for Medicaid. Medicaid is a free program covers emergency services, physician services, family planning services, vision care, x-rays, prescriptions, and more. If farmers are not eligible for free Medicaid, they may still be eligible for the Premium programs, which have looser income limits, but do require a small insurance premium payment every month. SMADC is currently in contact with the Maryland Department of Health and Mental Hygiene to learn more about farmer eligibility.
Maryland Children’s Health Program: Children of farm families not eligible for Medicaid due to income limits may still qualify for the Maryland Children’s Health Program. This program offers health insurance (doctor, dental, vision, shots, prescriptions, and more) for Maryland children up to age 19 with little to no monthly cost.
County-Specific Healthcare Programs
Some Southern Maryland residents are eligible for count-specific healthcare services for the under-insured, such as Calvert Healthcare Solutions (Calvert), Health Partners, Inc. (Charles) and Health Share (St. Mary’s). These services cover individuals who are not eligible for Medicaid due to income, but cannot afford the rising cost of healthcare. These services generally cover physician appointments, prescriptions, diagnostic services, some hospital care, and advocacy.
Of course, health insurance options for all Americans may change significantly in the next year as the Affordable Care Act solidifies. At SMADC, we are very interested in researching, shaping, and communicating how these changes will affect Maryland farmers, and we plan to hold an educational workshop early in 2013. In the meantime, care to share your thoughts, concerns, or stories regarding health care for farmers?