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Self Employed Health Insurance

Finding health insurance for self employed individuals can be a big hurdle, it gives entrepreneurs pause before jumping headlong into self-employment.

You may have a couple of options for buying coverage, such as purchasing health insurance as a group or individual or family plan.

Self Employed Health Insurance

Group Health Insurance

You need more than 1 employee to be eligible for a Group Health Insurance. Group health insurance plans are designed to be more cost-effective for businesses. Employee premiums are typically less expensive than those for an individual health plan. Premiums are paid with pretax dollars, which help employees pay less in annual taxes. 

The Affordable Care Act (ACA) requires business owners and employees to carry health care coverage that meets certain requirements. Employer mandate might not even apply to you if have fewer than 50 employees.

Assess your needs as a Group

Determine what you and your employees health needs, consider the following:

  • Who will be covered? Consider the needs of your employees and their dependents to find a plan that will suit the diverse medical and financial needs of the group.
  • How much cost sharing can you afford? Premiums for small business health insurance are paid by the employees and the employer. Make sure consider how much cost sharing makes sense for your business.
  • What kinds of benefits are important for you and your employees? It’s important to ask your employees which types of benefits are important to them.

Individual or Family Health Insurance

If you are running your own show means you wear lots of different hats. Before choosing a health insurance plan for you or family, you should know some key features of a quality health insurance plan.

► Doctor/Medical Services Network – each health insurance company has a list of Doctors, Hospitals, and other medical services that accepts their plan.

► Co-pays – the amount you have to pay out of your pocket for an appointment or medical service. Usually for Doctor appointments and medication prescriptions.

► Deductible – the amount you have to pay before the health insurance company starts paying. Usually you pay a deductible for hospital stays, emergency, MRI, out patient surgery, and other medical services.

► Coinsurance – It’s the percentage of the cost of a covered medical service you pay after meeting your deductible. A 80/20 coinsurance means the health insurance company pays 80% and you 20% coinsurance from hospitalizations, emergencies, MRI, ambulatory services, and even doctor visits.

► Out of Pocket Maximum – is the maximum you will pay in one year. Your maximum limit for paying deductible, coinsurance, and other cost. The Max Out of Pocket for a Marketplace plan is $8,550. 

What are my self-employed health insurance options?

Your best option is a Marketplace Health Insurance.

As a Self Employed or Schedule C or Form 1099 filer, you use your Adjusted Gross Income to determine if you qualify for a subsidy. A subsidy reduces the regular price of health insurance plans in order to be more affordable.

What do Marketplace Health Insurance plans cover?

All Marketplace health plans must cover 10 Essential Benefits.

  1. Preventive and wellness visits, including chronic disease management
  2. Maternity and newborn care
  3. Mental and behavioral health treatment
  4. Services and devices to help people with injuries, disabilities, or chronic conditions
  5. Diagnostic lab tests
  6. Pediatric dental and vision care
  7. Prescription drugs
  8. Outpatient care
  9. Emergency room services
  10. Hospitalization

A Marketplace Health plan can not deny you coverage if you have a medical condition, such as heart problem, cancer, diabetes, high price medications, and other. A health insurance outside the Marketplace can deny your application.

Marketplace Quoting System

The quoting system for the marketplace looks at three things to get the highest potential incentive (discount) to help lower the regular price of a health insurance.

3 things 

► Age – the younger you are the lower your policy payment.

► Family Size – the system considers your family size to help you get a higher incentive.

► Income – yearly income is a big factor to determine your incentive.


Your age determines how much your health plan will cost you.

Federal rules allow insurers to charge older adults (60’s) up to three times the premium they would charge younger adults (20’s).

Family Size

The system Marketplace savings are based on expected income for all household members, not just the ones who need insurance.

  • Include your spouse if you’re legally married.
  • If you plan to claim someone as a tax dependent for the year you want coverage, do include them on your application.
  • If you won’t claim them as a tax dependent, don’t include them.
  • Include your spouse and tax dependents even if they don’t need health coverage.

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