Health Insurance When You’re Self-Employed: Your Options and What It Really Costs
Updated October 19, 2026 · Written and reviewed by Thyrza Oliveira, licensed health insurance agent (NPN 21702538)
No employer plan? Here are your options, what a full year really costs, and how to choose, from a licensed agent in 31 states.
If you’re self-employed, you buy your own health insurance. Nobody else pays part of it. You have three main options: a Marketplace plan (HealthCare.gov or your state’s exchange), a private plan sold outside the Marketplace, or your spouse’s job-based plan. If you just lost coverage from a job, COBRA may be a fourth.
Which one makes sense comes down to four things, and here’s the order I’d check them in: your enrollment deadline, your doctors, this year’s income, and your health. Marketplace premiums depend on your age, where you live and tobacco use, and your income decides whether you get a subsidy. Private plans are medically underwritten, so your health history decides whether you’re approved and what you pay.
I offer private PPO plans. I don’t enroll people in Marketplace plans. If the Marketplace is the better fit for you, I’ll tell you, and I’ll point you to someone who enrolls Marketplace plans.
Why does health insurance feel harder when you’re self-employed?
Because every part of it lands on you.
- You pay the whole premium. No employer covers part of it.
- Your income moves around, and a Marketplace subsidy is based on your guess of this year’s income. Guess low and you may have to pay some of it back at tax time.
- If you earn too much to qualify for a Marketplace subsidy, you pay the full price and the full yearly increase. For 2027, insurers proposed a median increase of about 15% (KFF, August 2026, proposed rates). Here’s what the 2027 increase means and what to do.
- Nobody from HR explains the plans to you. That’s what the rest of this page is for.
What are my health insurance options if I’m self-employed?
You have three main options, plus COBRA if you just left a job with a group plan. Here’s how they compare.
| Option | May make sense for | How the price is set | When you can sign up | Keep in mind |
|---|---|---|---|---|
| Marketplace plan | People who qualify for a subsidy, or who have health conditions | Age, where you live, tobacco use. Your income sets your subsidy | Open Enrollment, or a special enrollment period after a qualifying life event | The only place to use a subsidy. Can’t turn you down for your health history |
| Private plan outside the Marketplace | Healthy people who earn too much to qualify for a Marketplace subsidy | Medically underwritten: your health history affects approval and price | Some take applications outside Open Enrollment. Ask me what’s open in your state | Not everyone qualifies. Check the network for your doctors |
| Spouse’s job-based plan | Married, and your spouse has coverage at work | Set by the employer | The plan’s enrollment window, or at least 30 days after you lose other coverage | Compare the cost of adding you with the cost of your own plan |
| COBRA | You just left a job that had a group plan | The full cost of the old plan, plus up to a 2% fee | Generally 60 days to elect it | Federal COBRA needs 20 or more employees. Smaller employer: state mini-COBRA rules |
| Health sharing ministry | Healthy people who accept the limits | Monthly share amount | Varies | Not insurance. Limits apply |
| Temporary or limited plans | Short gaps | Varies | Often any time | Some have no max out of pocket. Check before you buy |
What is a private PPO plan, and who is it for?
A private PPO is a health plan you buy outside HealthCare.gov, through a licensed agent. It’s the kind of plan I offer. Three things to know:
- It’s medically underwritten. The insurance company looks at your health history before it says yes, and that also sets your price. Not everyone qualifies.
- The price isn’t tied to your income. There’s no subsidy, so there’s also nothing to pay back at tax time when your income changes.
- PPO plans generally let you see specialists without a referral. Networks differ from plan to plan, so check your doctors before you decide. Here’s how to check if a doctor is in network.
Because these plans are medically underwritten, healthy applicants can pay less than the full price of a Marketplace plan. The only way to know is to compare your own quotes.
Prefer to talk it through? Text me. I’m a licensed agent and I reply fast.
Rather not talk yet? Get a quote online →
I’m paid on a 1099. Who covers my health insurance?
You do. A company that pays you on a 1099 doesn’t offer you a health plan and doesn’t pay any part of your premium. You’re not their employee, so there’s no benefits packet. You buy your own plan.
A travel nurse reached out to me recently because she needed a PPO plan. That’s the spot every contractor ends up in sooner or later: the coverage has to come from you now, not from the job.
Your options are the ones in the table above: a Marketplace plan, a private plan outside the Marketplace, or a spouse’s plan. There’s no COBRA unless you had group coverage at a job before, because COBRA only continues a plan you already had.
If you work in more than one state, look hard at the network. A plan that works well near home can be a problem on the road. Travel nurses, start with health insurance for travel nurses. Realtors and other commission earners, see health insurance for realtors. Losing more than health coverage when you leave a job? Read you quit the job, don’t quit the benefits.
How much does health insurance cost if you’re self-employed?
There’s no single price. It depends on your age, where you live and, outside the Marketplace, your health. Anyone who gives you a number without asking those things is guessing.
Here’s how each side sets the price:
- Marketplace: premiums are based on your age, where you live and whether you use tobacco. Your health history doesn’t count. Your income doesn’t change the premium itself. It decides whether you get a subsidy, and the subsidy lowers what you pay.
- Private plan outside the Marketplace: medically underwritten. Your health history affects whether you’re approved and what you pay. Your income isn’t part of it.
2027 update (as of October 19, 2026): insurers proposed a median increase of about 15% for 2027 (KFF, August 3, 2026; proposed rates, and final rates vary by state). If you earn too much to qualify for a Marketplace subsidy, you pay all of it. For example, on a $600 a month plan, a 15% increase is about $90 more a month, or about $1,080 a year. That’s an example, not a quote. More on the 2027 premium increase.
The four numbers that decide what you really pay
Premium times twelve isn’t your cost. It’s your floor. Four numbers decide what a year really costs, and here’s the order I’d look at them in:
- Premium. What you pay every month, whether you use the plan or not.
- Deductible. What you pay yourself before the plan starts sharing the bill. A cheap premium with a big deductible just moves the money to the day you get sick.
- Max out of pocket. The most you pay in a year for covered, in-network care, not counting premium. This is your worst case. For 2027, Marketplace plans can’t set it above $12,000 for one person or $24,000 for a family (federal limits, as of October 19, 2026). Many plans sit lower. Some cheap plans sold outside the Marketplace have no max out of pocket at all, so there’s no ceiling on a bad year.
- Network. Whether your doctors and your hospital are in it. It can throw out the other three, because out-of-network care doesn’t count toward your max out of pocket.
Plain-English guide: deductibles, coinsurance and out-of-pocket maximums.
What does a full year cost? Three examples
A full year costs your premium plus what you pay for care, up to the max out of pocket. So run the year three ways: a healthy year, a year with one ER visit, and a bad year.
These are made-up examples with round numbers. They’re not quotes and not any real plan. One self-employed person, no subsidy, comparing two example plans:
| Example only | Example Plan A | Example Plan B |
|---|---|---|
| Monthly premium | $600 | $450 |
| Deductible | $6,000 | $7,500 |
| Max out of pocket | $9,000 | $12,000 |
| Premium for the year | $7,200 | $5,400 |
| Healthy year (about $300 of care) | about $7,500 | about $5,700 |
| One ER visit (about $4,000, in network) | about $11,200 | about $9,400 |
| Bad year (reaches the max out of pocket) | about $16,200 | about $17,400 |
Plan B saves about $1,800 in the healthy year and in the ER year. In the bad year it costs about $1,200 more. Neither plan is wrong. The question is whether you’d rather pay more every month or risk paying more once. Make that call with the numbers in front of you, not from a hospital bed. And if that ER visit was out of network, none of this math holds, which is why the network check matters.
Can I deduct health insurance if I’m self-employed?
Generally, yes, if your business has a net profit and you weren’t eligible for an employer-subsidized plan through your own job or your spouse’s. I’m not a CPA, so this is the general rule only. Ask your CPA before you count on it.
- It’s an adjustment to income, so you don’t have to itemize. You figure it on IRS Form 7206, and it goes on Schedule 1 of your Form 1040.
- It can cover premiums for you, your spouse and your dependents, including dental and qualifying long-term care premiums.
- It can’t be more than your net profit from the business.
- You can’t take it for any month you were eligible for an employer-subsidized plan, even through your spouse, and even if you didn’t sign up.
- For sole proprietors, the plan can be in your own name or the business’s name.
- If you had a Marketplace plan with a subsidy, the math gets more complicated. The IRS covers that in Publication 974, and it’s a good one to hand to your CPA.
The deduction doesn’t lower your premium. It lowers what the plan costs you after taxes. Source: IRS Instructions for Form 7206.
When can I sign up if I’m self-employed?
For a Marketplace plan, during Open Enrollment or during a special enrollment period after a qualifying life event. For 2027 plans on HealthCare.gov, Open Enrollment runs November 1, 2026 to January 15, 2027. Pick a plan by December 15 if you want it to start January 1. Some states that run their own Marketplace have different dates (HealthCare.gov dates and deadlines).
Common qualifying life events:
- Losing health coverage (a job ending, COBRA running out, aging off a parent’s plan)
- Getting married
- Having a baby or adopting a child
- Moving to a new ZIP code or county
Two things don’t open a window by themselves: signing a new 1099 contract, and a change in your income.
For a private plan: some plans sold outside the Marketplace take applications outside Open Enrollment. They’re medically underwritten, so not everyone qualifies. Ask me what’s available in your state.
Just lost job coverage? You have 60 days.
If your job-based coverage ended, you can pick a Marketplace plan within 60 days after losing it, and you can apply up to 60 days before if you know it’s ending. Miss that and you wait for Open Enrollment (HealthCare.gov special enrollment).
COBRA lets you keep your old job’s plan, usually for up to 18 months. You pay the full cost plus up to a 2% fee, and you generally have 60 days to elect it. Federal COBRA only applies if the employer had 20 or more employees (U.S. Department of Labor). Smaller employer? Your state’s rules decide. Here are the mini-COBRA rules by state.
One warning. If you start COBRA and then stop paying it on your own outside Open Enrollment, that doesn’t open a new Marketplace window. Decide before you elect. For the first weeks after a job ends, see health insurance after a layoff.
Who might a private plan suit, and who should stay on the Marketplace?
A private plan may make more sense when you’re healthy, you earn too much to qualify for a Marketplace subsidy, and you want a PPO network.
Private plans are health-based, so I’ll ask a few health questions first. That way you know quickly whether a private plan is even an option.
Stay on the Marketplace if:
- You qualify for a subsidy. In 2026, 87% of Marketplace enrollees got one (KFF, May 2026). If you’re one of them, the price after help is often hard to beat. How 2026 subsidies work.
- You have a health condition being treated now. Marketplace plans can’t turn you down or charge you more for your health history. Private plans can decline you.
- You’re pregnant or planning to be. Talk to me first, and I’ll tell you what fits your situation.
- Your income might drop. If a slow year could put you back in subsidy range, the Marketplace leaves room for that.
If the Marketplace is the better fit, I’ll say so, and I’ll point you to someone who enrolls Marketplace plans.
Marketplace or private plan: which costs less for you?
It depends on whether you qualify for a subsidy and on your health. There’s no answer that fits everyone.
- The Marketplace may make more sense when your income is low enough for a real subsidy, or when a health condition would make underwriting hard.
- A private plan may make more sense when you earn too much to qualify for a Marketplace subsidy, you’re healthy, and you want a broad PPO network.
The only way to know is to put both numbers side by side for your household. Bring me your Marketplace price and I’ll put a private quote next to it. If the Marketplace is the better fit, I’ll tell you.
Read the full comparison: private vs Marketplace health insurance in 2027 →
Three mistakes to avoid
1. Buying a plan with no max out of pocket because it’s cheap
Some cheap plans limit what the plan pays, not what you pay. Before you buy, find the max out of pocket in the plan documents. If there isn’t one, there’s no ceiling on a bad year. Here’s how to spot a limited-benefit plan.
2. Guessing your income low on the Marketplace
Your subsidy is based on what you expect to earn this year. Earn more than you estimated and you may have to pay some or all of the extra back at tax time. Update your income on the Marketplace when it changes.
3. Dropping COBRA before the next plan is lined up
Stopping COBRA on your own doesn’t open a new Marketplace window outside Open Enrollment. Line up the next plan first.
Self-Employed Health Insurance by State
Plans, networks, and premiums vary by state. Find guidance for yours:
Thyrza
Licensed Health Advisor
NPN: 21702538
Work with one licensed agent, not a call center
I’m Thyrza Oliveira, a licensed health insurance agent (NPN 21702538) in South Florida, licensed in 31 states. I offer private PPO plans, and I’ll tell you when the Marketplace is the better fit. You deal with me directly, not a call center.
About the author. Thyrza Oliveira is a licensed health insurance agent (NPN 21702538) based in South Florida and licensed in 31 states. She offers private PPO plans and refers Marketplace enrollment to a Marketplace-enrolling agent when that’s the better fit. About Thyrza · Contact
Updated: October 19, 2026 · Reviewed: October 19, 2026 (subsidy status, 2027 rates and Open Enrollment dates rechecked)
Sources: HealthCare.gov, dates and deadlines; special enrollment periods; COBRA coverage; health coverage if you’re self-employed · U.S. Department of Labor, COBRA · IRS, Instructions for Form 7206 · IRS Rev. Proc. 2026-24 (2027 HSA limits) · KFF, proposed 2027 premium changes (August 2026) · KFF, 2026 Marketplace enrollment (May 2026) · healthinsurance.org, 2027 Open Enrollment changes (September 2026, 2027 out-of-pocket limit).
Self-employed health insurance: FAQ
Want your own numbers?
Send me your ZIP code, your age and your doctors, and I’ll run a private quote you can set next to your Marketplace price. Text or WhatsApp is fastest: 954-501-5554. You can also call the same number.
Comparing options as a 1099 or self-employed worker? See how a private PPO alternative to the Marketplace compares.
Working in a specific field? See my guides for health insurance for contractors, health insurance for freelancers and health insurance for landscapers. Have employees? Start with health insurance for small business owners.