Most self-employed people go to Pennie or Healthcare.gov, see the price, and assume that’s the price. The marketplace is one of three options, and for a healthy person paying full price it’s often the most expensive one.
Bring a rough number for this year’s net income and last year’s return if you have it. We’ll figure out which side of the subsidy line you’re on first, because that decides which door we walk through.
I’m Nathan Baughman, owner of BIG Benefits for Small Business here in Bucks County. Self-insured, self-employed, 1099: that’s the person I built this business for. The self-employed are overcharged and underserved when it comes to health insurance, and most of it comes down to nobody explaining the options.
Marketplace (Pennie). Guaranteed issue, no health questions, and if your household is under about 400% of the poverty level (roughly $64,000 single / $132,000 family of four for 2027) you may qualify for a tax credit. Best if you have ongoing conditions or your income is under that line. Enroll Nov 1 – Jan 15 or with a life event.
Private, underwritten plan. Priced on your health, not your income. Answer some health questions; if you’re reasonably healthy you land in a lower-risk group with a lower premium. Major PPO network, max out-of-pocket, unlimited contract, guaranteed renewable to 65, enroll any month. Best if you’re over the subsidy line or paying full price and healthy.
Short-term. A bridge of up to four months in Pennsylvania while you wait for open enrollment or a start date. Not a place to live.
Add-ons. Standalone dental and vision, term life while you’re healthy, accident coverage if you pick a high deductible.
Three doors, not one. Get the income estimate right. Take the deduction. Make sure it’s actual insurance: max out-of-pocket, unlimited contract, guaranteed renewable.
“Nathan is so helpful! A great resource for small business owners!” — Rich H., WI
You guessed your income. Subsidies are based on the income you estimate for the year. Guess low and you pay it back at tax time. Guess high and you overpay all year. Commission and project income makes this hard, and nobody at the 800 number is going to help you think it through.
You forgot the deduction. If you’re self-employed and not eligible for a spouse’s employer plan, 100% of your health, dental and vision premiums are deductible above the line. That changes the real cost of every plan you’re comparing.
You bought something that isn’t insurance. Health shares, indemnity plans, “benefits packages” marketed to the self-employed. Some have a place. None of them are health insurance, and a lot of people find that out at the hospital.
1. Is there a maximum out-of-pocket? 2. Is it an unlimited contract? 3. Is it guaranteed renewable? If a plan uses words like “deductible” and “PPO network,” that doesn’t automatically make it actual health insurance. These three questions do.
A one-minute explainer on your health plan options when you work for yourself.
Send me an age and a zip code and I’ll send back a general idea of what’s available in your area. Twenty minutes, no charge, no pressure. Happy to answer any and all questions so you can make the most informed decision for you, your family, or your business.
