Best Health Insurance for the Self-Employed in 2027

Being your own boss means buying your own health insurance. For 2027, that decision got harder: the enhanced ACA tax credits expired, and many renewal notices jumped.

Here's how the main options compare now, and how to pick the right one for your income and health.

What changed for 2027

• Above 400% of the federal poverty level, there is no ACA subsidy at all.
• Below that line, you pay a larger share of income than in 2021–2025.
• For self-employed people, subsidies are based on net profit, which can swing from year to year.

Option 1: ACA marketplace plans

Exchange plans must accept everyone and cover essential health benefits. If your net profit keeps you under the cliff, a subsidy can make them the cheapest choice.

Best for: moderate incomes, and anyone with a pre-existing condition.

Watch for: high deductibles and local-only networks on many plans.

Option 2: Private underwritten PPOs

Sold directly by carriers outside HealthCare.gov, these plans often use national PPO networks and can start in any month. Health questions apply.

Best for: healthy freelancers and contractors above the subsidy cliff.

Watch for: some private plans are not ACA major medical, and pre-existing conditions may be limited. Read our private PPO guide.

Option 3: Level-funded PPOs for business owners

Level-funded plans give self-employed people and small businesses a fixed monthly cost, often on a large carrier network. The Ameristead Diamond plan, for example, uses the Cigna PPO network and has a $0 deductible.

See options for high earners.

Option 4: A spouse's employer plan

If your spouse has work coverage, joining it is often the simplest and cheapest route — even at a higher family rate.

Use the tax rules in your favor

Self-employed people with a net profit can generally deduct health insurance premiums above the line, lowering adjusted gross income.

• Retirement contributions (SEP-IRA, solo 401(k)) lower the income used for ACA subsidies.
• An HSA-eligible plan lets you save for medical costs before tax.

General information, not tax advice. Ask your tax professional how these apply to you.

What to look for in a 2027 plan

• A network that fits how you work, especially if you travel.
• Copays you can budget for visits and urgent care.
• An out-of-pocket maximum your savings could handle.
• Prescription coverage for anything you take regularly.
• Flexible start dates if your work changes mid-year.

How to decide

Run your household through the ACA vs private calculator. If a subsidy covers more than half the benchmark premium, the exchange is likely your better deal. If not, see the private plans available in your state — no phone number needed to look.

Related: health insurance for freelancers · health insurance for contractors · lost your ACA subsidy?