No HR department, no employer contribution, and an income you have to predict before the year happens. That last part is the one that costs people money.
When you left employment, you didn't just lose a subsidy — you lost the person who handled this for you. Nobody explains open enrollment. Nobody tells you your plan changed at renewal. And the application asks you to state next year's income as if you already know it.
That's the actual problem with self-employed health insurance, and it's not the one most websites address.
Almost everything written about self-employed health insurance assumes you want a subsidy. Most of it is aimed at someone earning $40,000 who needs to find out they qualify for help.
If you're clearing six figures, none of that is your situation. Your premium tax credit is zero, healthcare.gov is quoting you full retail, and the advice to "check the Marketplace first" gets you a number that makes you close the tab.
Since January 1, 2026, this describes far more people than it used to. The enhanced premium tax credits expired and a hard cutoff returned at 400% of the federal poverty level — $62,600 for one person, $128,600 for a household of four. Above that line the credit doesn't shrink, it disappears. Plenty of successful sole proprietors who paid a manageable premium in 2025 opened a renewal notice this year that had roughly doubled.
For a healthy household in that position, a non-Marketplace PPO frequently costs meaningfully less than the unsubsidized Marketplace equivalent, with access to a wider network than the narrow HMOs that increasingly dominate on-exchange plan menus. That's the comparison worth running, and healthcare.gov cannot run it for you.
A word on what these plans are, because vague descriptions are how people get surprised. They're medically underwritten — the application asks about your health history, and coverage can be declined, limited, or priced based on it. They're also not ACA-compliant, which means pre-existing conditions may be excluded and the essential health benefits guaranteed on every Marketplace plan aren't automatic here.
What you get for that is a lower premium, a real maximum out-of-pocket, and frequently a wider network. Whether that trade favors you depends almost entirely on your health, which is why it's the first thing I ask about — before I quote anything. Term length and renewal rules vary by plan and by state, and I'll tell you exactly what applies to yours.
If you have an ongoing condition, an ACA plan's guaranteed coverage is often worth more than the premium difference, and I'll say so. That's a real conversation, not a formality.
Marketplace subsidies are calculated from your projected modified adjusted gross income for the coming year. A salaried employee knows that number. You're estimating it, and the estimate determines how much help you get.
Since January 1, 2026, getting that estimate wrong carries a much bigger penalty. The enhanced premium tax credits expired, which brought back a hard cutoff at 400% of the federal poverty level — $62,600 for one person, $128,600 for a household of four. Cross it by a dollar and the credit doesn't shrink, it disappears. I've written a full breakdown of the cliff, because it's the single most important number for someone in your position to know.
Eligibility runs on modified adjusted gross income, not on what you invoiced. For someone sitting a few thousand dollars above their threshold, that distinction is worth real money — and it's a conversation for your CPA, not for me. What I can do is tell you precisely where your line falls and what your premium looks like on each side of it. That's a far more useful thing to bring to your accountant than a vague question.
Healthcare.gov shows you Marketplace plans. A carrier's website shows you that carrier's plans. Below the subsidy threshold, the Marketplace is usually the best deal available and I'll tell you to stay there. Above it, you're paying full retail and comparing everything becomes worth the time. Seeing both sides requires access to both, which is most of what an independent broker is for.
Nothing. Not a fee, not a markup, not a "consultation charge." Brokers are paid a commission by the insurance carrier, and that commission is built into the premium whether you use a broker or not. Enroll directly and the carrier keeps it. Enroll through me and it pays for someone who works on your behalf and picks up the phone in March when something goes wrong.
The plan costs the same either way. I'd rather you know exactly how I'm paid than wonder. There's a fuller explanation on the licensing page, along with my NPN so you can verify I am who I say I am.
Self-employed people may be able to deduct premiums for themselves and their family, subject to IRS rules and limits on net self-employment income. This is a tax question for a CPA. What a broker can do is tell you your exact premium and subsidy threshold so the tax conversation is grounded in real numbers.
No. Below 400% of the federal poverty level, subsidies usually make the Marketplace the best available deal. Above that line the subsidy is zero, you pay the full premium, and comparing non-Marketplace options becomes worthwhile — with clear eyes about what those products do and don't cover.
You can update your projected income with the Marketplace during the year, which adjusts your credit going forward instead of creating a surprise at tax time. If your income is genuinely unpredictable, this is worth revisiting quarterly rather than annually.
Licensed in 29 states as Rohr Health Advisors LLC — Cavin Rohr, NPN 21388659. You can verify that before you call me, and I'd encourage it.
No fee, no pressure, no obligation to enroll in anything.
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