Most guidance for self-employed people is about qualifying for a subsidy. If you own a cosmetic dental practice, that guidance is not written for you: your income is almost certainly above the point where any credit exists, and the useful questions are different ones.
You Are Almost Certainly Above the Cliff
Where the credit ends in 2026
| Household size | 400% of poverty | Credit above this |
|---|---|---|
| One person | $62,600 | None |
| Couple | $84,600 | None |
| Family of four | $128,600 | None |
Those figures are 400% of the federal poverty level for the 2026 plan year. Cross them by a single dollar and the premium tax credit does not taper — it ends. The enhanced schedule that removed that edge between 2021 and 2025 expired on 31 December 2025, so it is fully in force again for 2026.
For a practice owner this usually settles the question before it is asked. You are paying full price, and the decision is about which plan and which tax treatment, not about eligibility.
The Deduction Is Your Real Lever, and It Scales With Your Bracket
The self-employed health insurance deduction lets you take 100% of premiums off gross income on Schedule 1, Line 17, above the line, capped at your net self-employment income. Its value rises with your marginal rate, which is precisely why it matters more to you than to the people the subsidy articles are aimed at.
At $150,000 of net income with a $1,100 monthly premium, the full $13,200 is deductible — about $4,224 at a 32% marginal rate. It reduces income tax only, not self-employment tax.
The mechanics change with your entity. An S-corporation shareholder owning more than 2% needs the corporation to pay or reimburse the premium, and it must appear in Box 1 of the W-2 to be deductible. Partners take it against partnership income. Getting this wrong is the most common way practice owners lose a deduction they were entitled to.
If You Employ Staff, the Question Changes Shape
A practice with hygienists, assistants and front desk staff is a different problem from a solo operator. Once you are offering coverage to employees you are in group insurance, with its own rules, and your own coverage usually rides on that decision rather than being bought separately.
Which of the two routes is cheaper depends on headcount, the ages in your practice and what you intend to contribute. It is worth pricing both rather than assuming the group plan wins because it is the conventional answer.
Where an HSA Fits at Your Income
An HSA-qualified high-deductible plan is worth more at a 32% or 35% marginal rate than at 12%, because the deduction it carries is worth more. For a high earner with no premium tax credit to lose, the trade of a higher deductible for a triple-tax-advantaged account is a genuine consideration rather than a consolation prize.
The One Case Where the Cliff Is Still Live
If your income varies enough that a slow year could land you under $62,600 — a sabbatical, a practice sale, a year of heavy equipment depreciation — then the cliff cuts the other way and a credit becomes available. It is worth checking in any year your net income drops materially, because nothing about it is automatic; you have to claim it.
If you want the group and individual routes priced against each other for your practice, call (713) 575-9904.