Health insurance when you're self-employed

When you work for yourself, health insurance is on you — which feels daunting but is very doable. There's no single 'self-employed plan'; instead you choose from several routes, and for most freelancers the ACA marketplace is the best starting point because of subsidies.

Your main options

• ACA marketplace plan — the default for most freelancers; comprehensive coverage with income-based subsidies.
• A spouse's employer plan — often the cheapest route if available to you.
• COBRA — continue a former employer's plan temporarily (usually pricey).
• Medicaid — if your income qualifies.
• Short-term plans — a stopgap only; limited coverage, not a long-term solution.

Why the ACA marketplace usually wins

Marketplace plans cover essential health benefits and can't deny you for pre-existing conditions, and the premium tax credit lowers your monthly cost based on income. Because self-employment income can fluctuate, many freelancers qualify for meaningful subsidies — sometimes paying far less than the sticker price.

Don't forget the tax break

Self-employed people can often deduct their health insurance premiums, which lowers your effective cost further. Talk to a tax professional about the self-employed health insurance deduction.

How to choose

Estimate your annual income (for subsidies), list the doctors and prescriptions you want covered, and compare plans on total cost — premium plus deductible and out-of-pocket max — not just the monthly price. A licensed agent can run your real after-subsidy numbers at no cost.