The Self-Employed Guide to Health Insurance

Leaving a W-2 job — or never having one — means losing the default path most Americans use to get health coverage. Self-employed professionals have to actively choose a path, and the three realistic options are an ACA Marketplace plan, a private PPO plan, or a health-sharing ministry.

ACA Marketplace plans are guaranteed-issue (no health questions) and can include a premium tax credit based on your estimated household income. The catch for self-employed people is that estimate: if your income ends up higher than projected, you may owe back part of the subsidy at tax time. If it's lower, you may get more credit than you initially claimed.

Private PPO plans are individually underwritten — the carrier asks health questions and prices your premium accordingly — but the premium doesn't change based on your income. For self-employed people with unpredictable income but generally good health, this trade-off is often worth it: you know your monthly cost regardless of how the year goes.

Health-sharing ministries are not insurance. They're a cost-sharing arrangement among members, often cheaper than either option above, but with no guaranteed payment, exclusions for pre-existing conditions, and no regulatory protection if a claim is denied. We generally recommend treating these as a last resort, not a first choice.

The self-employed health insurance deduction is worth understanding regardless of which path you choose: if you're self-employed and not eligible for an employer plan (including through a spouse), you can generally deduct 100% of your premiums for yourself, your spouse, and dependents as an above-the-line deduction. This applies whether you choose a Marketplace or private plan. Confirm the specifics with your CPA, since eligibility has a few edge cases (like if your business had a net loss for the year).

How to actually decide: run the math both ways. Estimate your Marketplace subsidy based on your realistic income for the year, get a private PPO quote for comparison, and weigh the premium difference against the network and flexibility difference. This is exactly the comparison we walk through on a free consultation call — bring your rough income estimate and we'll have real numbers for both paths within the same call.