You Have Two Completely Different Paths to Coverage
Most self-employed people think health insurance means going to HealthCare.gov and picking a marketplace plan. That works for some people, but it's not the only option, and for many self-employed individuals who earn above a certain income threshold, it's actually not the best one.
With licensed agents in 31 states, Health Advisory compares both paths for every client: ACA marketplace plans and private off-exchange plans. Here's how they differ.
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ACA Marketplace vs. Private Off-Exchange Plans
| ACA Marketplace Plan | Private Off-Exchange Plan | |
|---|---|---|
| Best for | Anyone with a health history, or income under the tax-credit line | Healthy households above the tax-credit line ($63,840 for one person for 2027) |
| Subsidies available | Yes, income-based tax credits | No federal subsidies |
| Plan types | HMO, EPO, PPO (varies by state) | Varies by plan and state; a licensed agent explains each option on a call |
| Network flexibility | Restricted to in-network (most plans) | Depends on the plan’s network; check your doctors before you buy |
| Referrals needed | Yes, for HMO/EPO plans | Depends on the plan |
| Tax deductible | Yes, 100% deductible if self-employed | Yes, for the medical coverage in the plan |
| Income reporting required | Yes, reconciled at tax time | No income reporting |
The Income Threshold That Changes Everything
For 2027 coverage, the premium tax credit stops above $63,840 for a single adult (400% of the federal poverty line; $132,000 for a family of four). Once your household income goes above that line, the credit disappears entirely, and you pay full price: the median lowest-cost Silver plan for a 40-year-old runs $529 to $860 a month across the 17 states with federal marketplace data, and about 2.6 times that at 60.
At that income level, a healthy applicant can often pay about half the marketplace’s full price on a private plan with a national PPO network (UnitedHealthcare or PHCS). These plans are built for people who don’t need maternity, substance-use or ongoing mental-health coverage: they are medically underwritten, are not ACA coverage, and pay set amounts for covered care, so a licensed agent walks through exactly what a plan pays before you buy. This is the conversation most self-employed individuals never get to have, because most brokers only show marketplace options.
One condition on that. Off-exchange plans are medically underwritten: they ask health questions and what you are offered depends on the answers. A healthy household frequently does better there. Someone with a significant health history may be rated up or declined, and those plans do not treat pre-existing conditions the way an ACA plan does. If that is your situation the marketplace is the right answer and its guaranteed issue is why.
How the $63,840 cliff works → · Options above the line → · Why premiums jumped in 2026 →
A licensed agent compares both sides for every client. If the marketplace is better for your situation, that is the recommendation. If a private plan makes more sense, you will see both options side by side.
Dental and vision too: dental and vision insurance for the self-employed.
The Self-Employed Health Insurance Deduction
Whether you choose a marketplace plan or a private plan, if you are self-employed and not eligible for coverage through a spouse's employer, you can deduct 100% of your health insurance premiums from your taxable income on Schedule 1 of Form 1040. This deduction reduces your adjusted gross income dollar-for-dollar, which in turn affects your ACA subsidy calculation and other income-based deductions.
Worked out for your state, with a calculator and 2027 prices: Alabama · Arkansas · Florida · Indiana · Kansas · Michigan · Mississippi · Nebraska · Nevada · North Carolina · Ohio · Oklahoma · South Carolina · South Dakota · Tennessee · Texas · Utah · Wisconsin. S corporation owners follow different rules: see health insurance for S corp owners.
A Note on Texas
If you are self-employed in Texas and want a PPO, the ACA marketplace cannot help you, for 2027 every Texas marketplace plan is an HMO, EPO or POS, with no PPO in any of the 254 counties. A PPO in Texas requires going off-exchange. See the dedicated Texas self-employed guide for details.
Covering Your Team
If you're a small business owner with employees, you may have options for group coverage depending on your business size. Whether you're shopping for yourself or trying to offer a benefit to your team, checking your options costs nothing and doesn't commit you to anything.
What Coverage Actually Costs — Real 2027 Numbers
Most pages about self-employed health insurance tell you to “compare your options.” Here are the actual filed rates. Every figure below comes from the CMS Plan Year 2027 Qualified Health Plan Landscape file — the federal government’s published record of what insurers are actually selling.
Across the 17 states covered here where the federal marketplace operates, the median lowest-cost Silver plan for a 40-year-old ranges from $529/month in Indiana to $860/month in Utah — before any premium tax credit.
| State | Median @40 | Range @40 | Low @27 | Low @60 | Insurers | Plan types |
|---|---|---|---|---|---|---|
| Indiana | $529 | $474–$625 | $388 | $1,006 | 4 | EPO, HMO, POS |
| Ohio | $610 | $528–$822 | $433 | $1,122 | 9 | HMO |
| Michigan | $646 | $469–$924 | $384 | $995 | 7 | EPO, HMO, PPO |
| Alabama | $672 | $656–$759 | $538 | $1,393 | 4 | EPO, PPO |
| South Carolina | $675 | $587–$771 | $481 | $1,246 | 6 | EPO, HMO |
| North Carolina | $688 | $545–$988 | $447 | $1,158 | 5 | EPO, HMO, POS, PPO |
| Oklahoma | $689 | $618–$898 | $507 | $1,313 | 5 | HMO, PPO |
| Florida | $701 | $597–$1,516 | $489 | $1,267 | 11 | EPO, HMO, POS, PPO |
| Arkansas | $718 | $718–$718 | $589 | $1,525 | 4 | POS, PPO |
| Wisconsin | $735 | $615–$874 | $504 | $1,305 | 12 | EPO, HMO, POS, PPO |
| Tennessee | $737 | $696–$869 | $571 | $1,478 | 5 | EPO |
| South Dakota | $767 | $561–$799 | $460 | $1,192 | 3 | EPO, HMO, PPO |
| Kansas | $775 | $632–$1,053 | $518 | $1,341 | 5 | EPO |
| Mississippi | $775 | $758–$860 | $622 | $1,610 | 3 | HMO |
| Texas | $792 | $598–$1,036 | $491 | $1,270 | 13 | EPO, HMO, POS |
| Nebraska | $849 | $699–$890 | $573 | $1,485 | 5 | EPO |
| Utah | $860 | $601–$954 | $564 | $1,218 | 5 | EPO, HMO |
Full-price PY2027 filed rates before premium tax credits: the lowest-cost Silver plan in each county, then the median, lowest and highest across the state; Low @27 and @60 price the state’s cheapest Silver plan at those ages. Most self-employed buyers under the subsidy line pay substantially less. Not a quote or an offer of coverage.
Florida Self-Employed: Where the Cheapest Coverage Is
Florida has 67 counties and 11 insurers on the 2027 marketplace, and the widest price spread of the 17 states covered here: the lowest-cost Silver plan for a 40-year-old runs from $597 to $1,516 per month depending on the county. That is a 2.5× difference inside one state, for the same metal tier.
The single lowest-priced Silver plan in Florida for 2027 is Clarity Silver from Ambetter Health in Calhoun County — $597/month at age 40, with a $8,000 deductible.
| Florida county | Lowest Silver @40 | Insurers |
|---|---|---|
| Calhoun County | $597 | 4 |
| Brevard County | $623 | 7 |
| Holmes County | $624 | 2 |
| Madison County | $628 | 4 |
| Wakulla County | $635 | 4 |
The Network Trap Nobody Warns Self-Employed People About
If your work takes you across county or state lines — contractors, truck drivers, consultants, photographers, anyone with clients in more than one metro — plan type matters more than premium.
9 of the 17 states covered here have no PPO plans at all on the 2027 marketplace: Indiana, Kansas, Mississippi, Nebraska, Ohio, South Carolina, Tennessee, Texas and Utah. Every plan there is an HMO, EPO or POS, which generally means out-of-network care isn’t covered except in emergencies. Kansas, Nebraska and Tennessee are EPO only statewide, and Mississippi and Ohio are HMO only.
Florida is one of the better states for this: PPO, HMO, EPO and POS plans are all available, with a PPO in every county, so multi-county coverage is achievable if you know which plans to look at.
How Much Premiums Rise With Age
ACA premiums are age-rated, and the curve is steep. Under the federal default age curve a 60-year-old pays about 2.6× what a 27-year-old pays for the same plan; Utah uses its own curve, about 2.2×. In Florida, the lowest-cost Silver plan runs $489/month at 27, $597 at 40, $834 at 50, and $1,267 at 60.
This is why the self-employed health insurance deduction and careful income planning matter more the older you get — a small change in net income can move you across a subsidy threshold worth thousands of dollars a year.
Want county-level data? Last year’s figures are in The Self-Employed Health Insurance Index 2026 — 15 states, 1,314 counties, published free under an open licence with a downloadable CSV.
Check Your Eligibility
Ready to see your own numbers? Start with your ZIP code ↑ · Prefer to talk? Call (713) 575-9904
Built for How You Work
- No employer required, coverage available to freelancers, contractors, and business owners
- Subsidies based on your projected income, with flexibility as your business changes
- Free, no-obligation eligibility check, takes about a minute
- See the Coverage Guide or FAQ for more details
- Find state-specific information on the Licensed States page
- Further reading: COBRA vs. Marketplace Missed Open Enrollment Estimating Income for Subsidies
- Browse coverage guides by profession: Health Insurance by Profession
- Guides by line of work: 1099 physicians and CRNAs · Travel nurses · Truck drivers and owner-operators · Gig workers (DoorDash, Instacart) · Uber and Lyft drivers · Freelancers · Real estate agents · LLC owners · S corp owners · Small business owners
- Not sure the marketplace is right for you? When the ACA Isn't the Right Fit
Paid on a 1099? Health insurance for 1099 employees, 1099 vs W-2 coverage and whether a client can pay your premiums.
Self-Employed Guides by State
Self-Employed Health Insurance FAQ
How much does health insurance cost for the self-employed in 2027?
It depends on age, ZIP code, and income. For 2027 the lowest-cost Silver plan for a single 40-year-old has a median of about $529–$860 a month depending on the state, before any tax credit, but ACA subsidies are based on your net self-employment income after expenses, so many 1099 earners pay far less than sticker once the credit applies. A quick income estimate is the only way to know your real number.
Do self-employed people qualify for ACA subsidies?
Yes, the marketplace is built for variable, self-employed income. Subsidies run on your estimated MAGI (net earnings after business deductions), not gross revenue. Estimate the year honestly, then update the estimate on the marketplace whenever your income changes; the credit adjusts the following month.
Can I deduct my health insurance premiums if I'm self-employed?
Usually yes. The self-employed health insurance deduction lets you write off 100% of your premiums "above the line" (no need to itemize), as long as you have net self-employment profit and aren't eligible for a spouse's employer plan. It lowers both your taxable income and your MAGI for subsidy purposes.
Marketplace or private plan, which is better if I'm self-employed?
Two different doors. If your income qualifies you for subsidies, the ACA marketplace is usually the best value and can't deny you for health history. If you earn too much for a meaningful subsidy and you're healthy, a medically underwritten private plan often prices lower. The right call is a side-by-side comparison for your income and health profile.
Can I get coverage if my income changes month to month?
Yes, variable income is normal for the self-employed, and the marketplace handles it. Estimate your full-year net income, enroll, and update the estimate when reality shifts. Reconciliation at tax time squares any difference, so an honest estimate keeps surprises small.