Self-employed health insurance: the 2026 guide
When you work for yourself, nobody hands you a health plan. You're both the employer and the employee, so the whole decision lands on you. That sounds like a lot, but you have real options, and one of them (the self-employed health insurance tax deduction) can lower what you owe at tax time. Here's how the choices stack up in 2026, what they tend to cost, and how to pick.
Your main options in 2026
- ACA Marketplace plans, through healthcare.gov or your state exchange. These are comprehensive, they can't turn you down for a pre-existing condition, and you may qualify for income-based subsidies. One thing to know going in: the enhanced pandemic-era subsidies ended on December 31, 2025, so a lot of people saw their net premiums go up in 2026.
- A spouse's or domestic partner's employer plan, if you can get on one. When it's available, this is often the cheapest route by far.
- A plan built for independent workers, like Molli. Molli is an ACA-compliant major medical plan made specifically for 1099 and self-employed people. It runs on nationwide PPO networks, includes $0 virtual primary care and generic prescriptions through Vitable, and can save up to 30% compared with ACA marketplace plans.¹
- Professional or trade associations, some of which offer group-style coverage to their members.
- COBRA, if you've recently left a W-2 job. It keeps your old plan in place, but you pay the full premium yourself, which usually gets expensive, and it doesn't last forever.
- Short-term or healthshare options. These can look cheaper up front, but they often cover less and may not count as comprehensive coverage, so read the fine print before you commit.
What it costs
Premiums swing a lot depending on your age, where you live, the plan tier, and, for Marketplace plans, your income and subsidy. The only way to know your real number is to pull an actual quote. Get your post-subsidy Marketplace price and a Molli quote, then set them next to each other.
And don't stop at the premium. Add up the out-of-pocket costs (deductible, copays, prescriptions) for the care you actually use during the year. A slightly higher premium with no charge for everyday care can easily beat a cheap premium that bills you for every visit.
The tax break a lot of people miss
If you're self-employed and turn a profit, you can often deduct your health insurance premiums, including coverage for your spouse and dependents, through the self-employed health insurance deduction. It's an above-the-line deduction, so you get it whether or not you itemize. There are rules and limits, so check the specifics with a tax professional. For many people, though, it meaningfully lowers the real cost of whatever plan they land on.
How to choose: a five-point checklist
- Your doctors. Are they in-network? Confirm it before you enroll, not after.
- Total cost. Look at the premium plus the out-of-pocket you'll realistically pay, not the premium by itself.
- Prescriptions. Are your medications covered, and what will they actually cost you?
- How you work. If you bounce between 1099 and W-2 jobs, being able to keep your plan matters, and that portability is something Molli is built around.
- Timing. Marketplace open enrollment for 2027 coverage runs November 1 to December 15, 2026. Outside that window you generally need a qualifying life event to make a change.
FAQ
- What's the best health insurance for self-employed people?
- There isn't one answer. It comes down to your income (which drives subsidy eligibility), the doctors you want to keep, and the care you actually use. Compare an ACA Marketplace plan, a spouse's plan if you have that option, and an independent-worker plan like Molli, using your own numbers rather than averages.
- How do self-employed people get health insurance without an employer?
- You buy it directly, rather than getting it through a job. That usually means the ACA Marketplace, a spouse's plan, an independent-worker plan like Molli, an association, or COBRA if you've just left a W-2 role.
- Can I deduct health insurance if I'm self-employed?
- Usually yes, through the self-employed health insurance deduction, as long as you have self-employment income and meet the rules. A tax professional can confirm what applies to you.
- When can I sign up?
- ACA open enrollment for 2027 coverage runs November 1 to December 15, 2026. Outside that window you'll need a qualifying life event, like losing other coverage. Molli is the exception: you can enroll any time of year, with no window and no qualifying life event required.
¹ Savings vary by location, age, and plan selection. Based on comparison of Molli Pro plan rates to ACA Silver benchmark premiums.