Self-employed and suddenly paying full price for health insurance?
The enhanced premium tax credit ended December 31, 2025, and many self-employed people got a renewal they did not expect. I am an independent, licensed advisor who runs your numbers both ways and tells you which door fits.
Free. Never a fee. 7 days a week, 8 a.m.–10 p.m. ET.
The enhanced credit expired, and the income cap is back
Through 2025, the enhanced premium tax credits removed the income cap on Marketplace help. They expired December 31, 2025, and Congress did not extend them for 2026.
That brings back the original rule: an income cap at 400% of the federal poverty level. Under the line, you may qualify for help with your premium. Over it, a Marketplace plan is full price.
| Household size | 2026 income line (400% of poverty level) |
|---|---|
| 1 person | $62,600 |
| 2 people | $84,600 |
| Family of four | $128,600 |
Source: 2025 HHS poverty guidelines, which set 2026 Marketplace eligibility. Alaska and Hawaii use different figures. Credit expiry per KFF.
The number that matters is net profit, not gross receipts. Eligibility uses modified adjusted gross income, which for a sole proprietor starts with net profit after business expenses, plus any other household income such as a spouse’s wages. Plenty of people rule themselves out by looking at the wrong number.
Marketplace with a credit, or private if you are healthy
I place both kinds, so you see both side by side.
When the Marketplace wins
Your net profit is under the line and a credit brings the premium down. Or you have real medical history: a chronic condition, ongoing prescriptions, a past surgery, a pregnancy.
Marketplace plans cannot decline you or price you on your health. For anyone with real medical history, this is the right door, credit or no credit.
When a private plan wins
You are over the income line, so there is no credit to lose, and you are in good health. Private underwritten plans are priced on your health as well as age and ZIP code, so a healthy person can come out ahead. You can apply any month of the year.
The honest part. A private plan is not guaranteed issue and not ACA coverage. The carrier reviews your medical history and can decline you, charge more, or exclude a condition. If I do not think you will pass underwriting, I will say so on the first call and we go to the Marketplace.
What I ask you, and why
INCOME
What your net profit looks like
Not your gross. Your Schedule C profit, or salary and K-1 if you run an S-corp. A rough number is fine. It tells me whether a credit is on the table.
HEALTH
Your health, honestly
Prescriptions, conditions, anything from the last few years. Not to judge you. It decides which door you can walk through and saves you a declined application.
DOCTORS
Who you need to keep
Your doctor, your specialist, the hospital you would drive to. I check networks before I quote, not after you enroll.
HOUSEHOLD
Who goes on the plan
Just you, or a spouse and kids. Household size moves the income line, and sometimes two plans beat one.
How working with me goes
A real conversation. About 15 minutes by phone about your business, your income, your health and your doctors. I listen before I quote.
I run the numbers both ways. The Marketplace with any credit you qualify for on your net profit, and if you are healthy, a private quote next to it. You see both side by side.
You decide, I enroll you, and I stay your contact. When something changes, a strong year, a new hire, a baby, you call me, not a hotline.
When you can enroll, and the tax note
Open enrollment for 2027 coverage on HealthCare.gov runs November 1, 2026 to January 15, 2027; enroll by December 15 for a January 1 start (CMS). Outside that window you need a qualifying life event, like losing other coverage, marriage, a move, or a baby, which opens a special enrollment period.
Private underwritten plans take applications year-round. If it is March and the credit is gone, you do not have to wait until November to look at your options.
The self-employed health insurance deduction
If you pay your own premium, the self-employed health insurance deduction on IRS Schedule 1 may apply to you. I do not give tax advice, so ask your tax professional whether it applies to you. I am glad to send them a summary of what you paid.
Self-employed questions, answered plainly
My income changes every month. What number do I use?
The Marketplace asks for your best estimate of this year’s modified adjusted gross income, which for a sole proprietor starts with expected net profit after expenses plus any other household income. We estimate carefully and update it if your business shifts mid-year.
I earn well over $62,600. Is the Marketplace pointless for me?
No. If you have medical history, the Marketplace is still the right door, because it cannot decline you or price you on your health. If you are healthy, a private quote earns a look. I show you both.
Does it cost me anything to work with you?
No. There is never a fee to you. The carrier pays my commission whether you choose a Marketplace plan or a private one.
I have an LLC or an S-corp. Does that change anything?
It changes which income number we use, not whether you can get coverage. Have your last return handy and I will walk through it with you. The guides below cover the LLC and S-corp details.
Guides for your kind of business
These live on Browse Health Plans, the free price tool I built, and go further into the math than one page can.
Let’s run your numbers both ways
One call. Know your rough net profit and your doctors’ names.
7 days a week, 8 a.m.–10 p.m. ET. Licensed in 17 states. Never a fee.
Outside my 17 states? Browse Health Plans, the free price tool I built, shows your county's prices and a licensed advisor follows up.