The short answer: you have more than one door. The Marketplace can win if your expected income qualifies you for a large subsidy, or if a health condition means a private plan will not accept you. If your subsidy would be small or zero and you can pass a private plan's health questions, a private plan is often the better buy, and it enrolls any month. The honest move is to price both before December 15, the last day on HealthCare.gov to enroll or change for a January 1 start.
Picture it
You run a small design business from your kitchen table. Some months are full, some are quiet, and every November the Marketplace asks you the one question you cannot answer: what will you earn next year? You type in a cautious number, pick a plan, and try not to think about it. A good year would be wonderful, but somewhere in the back of your mind you know that a good year changes the math on the help you got.
Now picture the other version. Before you renew, you sit down for twenty minutes with last year's numbers and this year's trend. You see what the subsidy would really be at a realistic income, and you see a private plan priced for your age and ZIP next to it. One of them is clearly the better fit for the kind of year you expect. You pick it on purpose, and you know what happens if business picks up.
The question only you can answer: next year's income
Marketplace savings are based on your estimated net income for the year you are getting coverage, not last year's income. HealthCare.gov asks self-employed people to do their best to estimate their self-employment income and expenses for the year, based on past experience, realistic expectations, industry standards and other information.
- Start with last year. Your most recent federal tax return is the usual starting point, then adjust for the changes you expect.
- Look at the trend. If your income is hard to predict, HealthCare.gov suggests basing your estimate on your past experience and recent trends.
- Plan to update it. If your yearly net income looks likely to come in higher or lower than you estimated, update your Marketplace application as soon as possible. If you earn more than you reported, you may have to repay some or all of the tax credits you received. If you earn less, you may qualify for more help than you got.
That repayment is the part a lot of business owners do not see coming. How much it would be depends on your own numbers, so it is a question for your tax preparer, ideally before Open Enrollment rather than after. Why the income guess is risky when your income moves.
When the Marketplace is the right call
- Your expected income qualifies for a large subsidy. When the government pays a big share of the premium, the Marketplace can be hard to beat, and we will tell you so.
- A health condition means a private plan will not accept you. Marketplace plans cover pre-existing conditions with no health questions. Have a health condition? Tell us first: depending on the condition, a private plan may still be an option.
When a private plan is worth pricing first
- Your subsidy would be small or zero. Then you are paying close to the full sticker price of a Marketplace plan, and for a healthy applicant a private plan's full price is often lower.
- You would rather not bet on a guess. A private plan has no subsidy, so there is nothing to pay back. The price you sign up for is the price you pay, whatever kind of year you have.
- You work across state lines. Many private plans are nationwide PPOs: see doctors across state lines, no referrals. Many Marketplace plans are HMO or EPO, local to your county.
- Your timing does not fit the window. Private plans are available year-round. For most private plans on our site, applications submitted by the 23rd of the month start on the 1st of the next month, if the carrier approves you.
Private plans ask health questions and approval is the carrier's decision. Some private plans are limited medical, which is not the same as major medical, and we will always tell you which side of that line a plan sits on. How to tell the difference.
If you have an employee
HealthCare.gov notes that if your business has an employee other than yourself, a spouse, a family member or an owner, you may be able to use the SHOP Marketplace for small businesses to cover yourself and your employees. A small group plan is sometimes an option too, and it starts at two people. A group plan or letting employees buy their own.
How to decide before December 15
- Write down a realistic income estimate for 2027, with last year's return and this year's trend beside it.
- See what the subsidy would actually be at that income. HealthSherpa shows it in a few minutes.
- Price a private plan for your age and ZIP, or run the "Am I overpaying?" check, which asks where your plan comes from first.
- Check your doctors and prescriptions against each option by name. The Open Enrollment checklist.
- Mind the dates. On HealthCare.gov, enroll or change by December 15 for a January 1 start; Open Enrollment ends January 15. Private plans enroll any month.
For the full picture of all three paths, see health insurance when you are self-employed.
This is general education, not tax advice and not a guarantee of coverage or savings. Ask your tax preparer how health premiums and any tax credit apply to your own numbers. Plan designs, pricing, enrollment dates, networks and eligibility depend on your state, your location and underwriting. Dates shown are for HealthCare.gov; a few state-run exchanges use their own windows.