100%Share of premiums that can be deductible
$4,5002027 HSA limit, self-only
Nov 1Open enrollment starts for 2027
400%Poverty-level cap for subsidies
Key takeaway: Most self-employed people buy a Marketplace plan, where subsidies depend on your estimated net self-employment income. If you have a profit and aren’t eligible for an employer plan (including a spouse’s), you can usually deduct your premiums above the line. Pairing a Bronze or high-deductible plan with an HSA adds more tax savings.
How we put this guide together: We used healthinsurance.org, HealthCare.gov, IRS Publication 969, GoodRx’s summary of the self-employed health insurance deduction and BenefitChamps on 2027 changes. This is general information, not tax advice. Rules and figures were checked in October 2026. Health insurance rules change often, so confirm details at HealthCare.gov or your state marketplace. See our advertiser disclosure.

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Your main options

OptionProsCons
Marketplace planACA protections; subsidies based on incomePrices rising; networks can be narrow
Spouse’s employer planEmployer pays much of the premiumFamily cover can be expensive; blocks the SE deduction
COBRA from a former jobKeep the same plan and doctorsUp to 102% of full premium; usually 18 months
MedicaidLittle or no costIncome limits; work requirements in many states from 2027
Short-term planCheap and quickCan exclude pre-existing conditions; not ACA-compliant

See our guides to COBRA, Medicaid vs. Marketplace and short-term plans.

Estimating income for subsidies

Marketplace subsidies use your household’s modified adjusted gross income, which for the self-employed is based on net profit (revenue minus business expenses), not gross receipts. Freelance income can swing a lot, so:

  • Use last year’s tax return as a starting point and adjust for known changes.
  • Update your estimate on the Marketplace whenever income changes significantly.
  • Remember there’s no cap on repaying excess subsidies from tax year 2026, and no subsidy above 400% of the poverty level.
  • Retirement contributions (such as a SEP-IRA or solo 401(k)) and HSA contributions lower your income for subsidy purposes.

See our subsidies guide for income bands and examples.

The self-employed health insurance deduction

  • Who qualifies: self-employed people with a net profit from the business that sponsors the plan. You can’t take it for any month you were eligible for an employer-subsidized plan, including through a spouse.
  • What qualifies: medical and dental premiums for you, your spouse and dependents, qualifying long-term care premiums (within limits) and Medicare premiums.
  • How it’s claimed: as an adjustment to income on Schedule 1 of Form 1040, so you don’t need to itemize. Some people use Form 7206.
  • With subsidies: you can deduct only the premiums you paid yourself, not the part covered by the tax credit.

Health savings accounts

If you choose an HSA-eligible plan (including Bronze and catastrophic Marketplace plans), you can contribute up to $4,500 for self-only cover or $9,000 for family cover in 2027, plus $1,000 if you’re 55 or older. Contributions are deductible, growth is tax-free, and withdrawals for medical expenses are tax-free. Unused money rolls over and can be invested.

Practical tips

  1. Enroll during open enrollment (November 1, 2026 to January 15, 2027) or within 60 days of losing other cover.
  2. Check that your doctors are in network; Marketplace plans often use narrower networks; see HMO vs. PPO.
  3. Keep an emergency fund at least equal to your deductible.
  4. Consider disability and life cover too, since there’s no employer safety net; see our self-employed business insurance guide.

Frequently asked questions

What is the best health insurance for self-employed people?

For most, a Marketplace plan, especially if your income qualifies for subsidies. A spouse’s employer plan can be cheaper if available.

Can I deduct health insurance if I’m self-employed?

Usually yes, as an above-the-line deduction, if you have a net profit and aren’t eligible for an employer-subsidized plan, including a spouse’s.

How do freelancers estimate income for subsidies?

Use expected net profit after business expenses, update the Marketplace when it changes and keep records for tax time.

Can self-employed people have an HSA?

Yes, if they have an HSA-eligible high-deductible plan. Bronze and catastrophic Marketplace plans now qualify.

Are short-term plans a good option for freelancers?

Only as a stopgap. They can exclude pre-existing conditions and don’t have to cover essential benefits.

Sources

Insurance prices, discounts and rules change often and vary by state. Figures were checked in October 2026; confirm details with the insurer or your state insurance department.