A medical spa is a clinic wearing a spa's branding: injectables, lasers and skin treatments delivered under medical supervision, usually with nurses or physician assistants on staff and a medical director attached. That structure puts the owner in a different position from anyone running a salon.
You Are Almost Certainly Above the Cliff
At $165,000 of net profit with a spouse and two children, the 2026 poverty guideline is $32,150 and 400% of it is $128,600. You are around 513%, so there is no premium tax credit at all — and the credit ends abruptly rather than tapering.
The enhanced schedule that removed that edge between 2021 and 2025 expired on 31 December 2025, so it is fully in force for 2026. For an established med spa this usually settles eligibility before the conversation starts.
Clinical Staff Change the Question Entirely
Once you employ injectors, nurses or aestheticians, health insurance stops being a personal purchase. Clinical staff are in demand and are exactly the employees a competitor can poach, and coverage is one of the few benefits a small clinic can offer that a larger group also offers.
Below fifty full-time-equivalent employees there is no requirement to offer anything, so this is a business decision rather than a compliance one. If you do offer a small group plan, your own coverage generally comes through it rather than being bought individually — which is often the cheaper route at your income, precisely because no credit is available on the individual side.
The Deduction Is the Lever You Do Have
100% of premiums come off gross income on Schedule 1, Line 17, above the line, capped at net self-employment income. Its value rises with your marginal rate, which is why it matters more here than to a lower earner.
Self-employment tax at $165,000 is $165,000 × 0.9235 × 0.153, roughly $23,314, of which about $11,657 is deductible.
If the spa is an S-corporation, the corporation must pay or reimburse the premium and it must appear in Box 1 of your W-2 for a shareholder owning more than 2%. Getting that wrong loses the deduction entirely, and it is a common error in professional practices.
Your Malpractice Cover Is Not Health Insurance
A med spa carries professional liability for the treatments it delivers and a medical director arrangement for clinical oversight. Neither provides health coverage for the owner or anyone else. They are unrelated products solving unrelated problems.
A Slow Year Reopens the Question
If income drops materially — an expansion year with heavy equipment depreciation, a device purchase, a period out of the business — a credit can become available. Nothing about it is automatic; you have to check and claim it.
If you want a small group plan priced against individual coverage for your clinic, call (713) 575-9904.