Health insurance for the self-employed: your three main paths

Who counts as self-employed

For health insurance, you're self-employed if you earn income from your own work rather than a paycheck with benefits.

That covers more people than you might think:

• Sole proprietors and single-member LLC owners
• Freelancers and consultants paid on a 1099
• Partners and S-corp owners who run their own business
• Gig workers who drive, deliver or rent out their skills

Why it's different from having a job

You pay the whole premium yourself. Nobody shares the cost, and nobody picks the plan for you.

Your income also moves around. That matters, because ACA subsidies are based on what you expect to earn this year — not last year.

Path 1: An ACA marketplace plan

Exchange plans accept everyone and must cover essential health benefits, including pre-existing conditions and maternity.

If your net profit keeps you under 400% of the poverty level, a subsidy can make this the lowest-cost choice.

• Best for: moderate incomes and anyone with health conditions
• Watch for: high deductibles and local-only networks

Path 2: A private underwritten PPO

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

Healthy applicants who get little or no subsidy may pay less than a full-price exchange plan.

Path 3: A level-funded PPO

Level-funded plans are built for business owners, including one-person businesses. You pay a fixed monthly amount, and the plan funds claims behind the scenes.

Health questions and eligibility rules apply, and availability varies by state.

How to choose between them

• Estimate your 2027 net profit, then run the ACA vs private calculator.
• If a subsidy covers more than half the benchmark premium, start with the exchange.
• If you're healthy and over the subsidy line, compare private and level-funded plans.
• If you have a condition or expect a baby, stay with the ACA.

Go deeper

Our full guide covers the 2027 subsidy cliff, the premium deduction, HSAs and what to look for in a plan.

If you have a specific trade, the Who we help hub has a guide for it.

Mistakes self-employed people make

The most common mistake is guessing income. A rough number can leave you with too little subsidy all year, or a big repayment at tax time.

The second is buying on premium alone. A low monthly price with a very high deductible can cost more in a year you actually need care.

The third is assuming you'll be accepted anywhere. Private underwritten plans may decline you or exclude a condition, so keep your current coverage until a new plan is approved.