• Ashley Poynter

The 5 top health insurance questions for self-employed individuals



Understanding health coverage if you’re self-employed

The first step in understanding health coverage for the self employed is to make sure you’re actually self employed! It probably sounds funny, but some people may appear to be self employed but are actually defined as a small employer.


An individual is considered self employed when they have a business that generates income but do not have any employees. Is that you? Great! Read on.


Self employed individuals have several options when it comes to health insurance. Most people are aware of the Health Insurance Marketplace, which offers a variety of health coverage options for people who work for themselves as a freelancer, consultant, 1099, or who run their own small business with no other employees.


Sidenote: If you do run a business that has other employees—even just one—you may be able to access the Small Business Health Options Program (SHOP) Marketplace, which caters to small businesses.



Top 5 self-employed health insurance questions (and answers!



1. Is the Marketplace my best, most cost-effective option for health insurance?

Great question! Many people are looking for inexpensive yet comprehensive health insurance plans for self employed individuals. Who doesn’t want more for less? The Marketplace offers an Income Level & Savings tool to help you figure out which savings you may be eligible for on the Marketplace. It will ask you three questions:


1. How many people are in your household?

2. What state do you live in?

3. What is your estimated income for 2019?


Once you plug in your information, it will generate “next steps” for you to follow through. Those with higher income levels may not be eligible for additional savings, depending on the state.


In other cases, you may qualify for a Marketplace plan that has lower premiums. The tool provides the option to preview plans along with their estimated pricing based on your income level. You are able to find out the exact savings and premium prices upon filling out a Marketplace application.


Finally, you may be eligible for free or lower-cost Medicaid coverage. To see if you qualify, you will need to fill out a Marketplace application to apply for Medicaid. Those that qualify can enroll in Medicaid year-round.


2. How much does it cost to get self employed health insurance?

This one is tricky. There are a variety of factors that can influence the cost of health insurance for self employed people. When applying for health insurance, premiums are typically tied to factors such as your age, the state you live in, level of coverage and deductible amount. Many times, you can preview the plans you are considering on the website of the organization offering them (via the Marketplace or directly from the insurer).


There are some things to consider when choosing a self employed health insurance plan, as they will factor into the overall cost of healthcare coverage:


  • Premium: this is the monthly cost the insured (you) pay to maintain active coverage.

  • Deductible: this is the amount you are responsible for paying—even for covered services—before insurance kicks in and begins covering costs.

  • Coinsurance: this is the portion of costs that the insured is responsible for covering for a health care service, which is typically represented as a percentage (e.g. patient covers 30%, insurance covers 70%)

  • Copayments: this is a fixed amount the insured pays for a covered health care service (e.g. $20 for a doctor visit)


3. Where do I look for self employed health insurance?

The Health Insurance Marketplace is usually the first place people go to look for self employed health care options. That said, there are other avenues to find coverage. Let’s look at a few below:


  • Insurance companies: you can purchase health insurance directly through insurance companies if you don’t qualify for savings through the Marketplace. Most allow you to view plan options as well as prices so you can compare which plans may work for you.

  • Short-term health insurance providers: you may be eligible for short-term health insurance plans that cover a specific amount of time. These plans usually run up to 12 months, though some states allow you to renew plans up to 36 months. There is no enrollment period for these plans.

  • The National Association for Self-Employed (NASE): this association offers special health insurance options to its members. Through monthly or annual membership fees, you can get access to insurance plans that are usually only available for large corporations.

  • The Freelancers Union: this is a free online resource for the self-employed that enables you to purchase health care coverage and support advocacy for freelancers.

  • Decent.com: That’s us! We offer self employed health insurance plans that are designed specifically for freelancers in Austin, TX (soon to be expanding). Specifically, we offer:

  • Pathfinder Bronze Plan: It’s our most affordable option and a perfect fit for freelancers and other self-employed individuals shopping at the bronze plan level. The best part? It comes with FREE primary care. See your doctor whenever you want—for $0. Oh, and you can enroll any day of the year.

  • Trailblazer Silver Plan: This plan is the perfect alternative silver option for self employed people making at least $55,000/year and/or who have families. It runs at 20% below market price and also offers FREE primary care. This plan also includes low or no copays for care before you’ve hit your deductible.


4. Are my self employed health insurance premiums tax deductible?

Before we start, know that we are not legal, benefits, tax, or HR experts. However, there are some circumstances under which your health insurance premiums may be tax deductible:


  • If you don’t have other health insurance coverage: If you aren’t eligible for an employer-sponsored health insurance plan from your employer or your spouse’s, you may be able to take advantage of the self-employed health insurance deduction.

  • If you report business income: If you report business income from your self-employed venture, you should be able to claim this deduction. Note: you can’t deduct more than you earn from your business, so if your business is not generating income or incurs a loss, you cannot claim the deduction.

You can read a more detailed write-up on this topic here.


5. I’m young and healthy. Do I really need health insurance?

Yes! Everyone should have affordable, comprehensive health insurance—even the young and healthy. Here’s the thing: life happens. You sprain an ankle snowboarding. You catch a bug you just can’t shake. Over time, these things can add up to huge and unexpected medical bills that put a dent in your wallet if you don’t have coverage.


We get it. No one wants to go to the doctor, especially with the way the current system works. No one wants to feel like a number in a giant database controlled by people who are constantly raising health care rates. It’s a drag to sit in a waiting room for 30 minutes just to speak to your doctor for 5-10.


Decent created plans centered on free primary care, so you can focus on what matters: living life. We believe that the doctor-patient relationship should sit at the center of healthcare and that neither should have to jump through hoops to give or receive care. Decent’s Pathfinder and Trailblazer plans are built around this belief. You get personalized care with your primary care doctor as often as you like with $0 co-pay or out-of-pocket costs. Get in to see your doctor with a same or next-day appointment or through our telemedicine (video calls) service. Have a question? Our plans offer 24/7 phone, texting, and email support for your health questions.



Worried? We got you.

If you’re self employed and starting to panic about health insurance options for 2020, take a deep breath. As you can see, there are plenty of options available for you to secure health care coverage for the upcoming year. We’re obviously biased towards our plans because we built them with you in mind.


Regardless of the option you choose, be sure to find the best plan for your needs. Consider the overall costs of choosing one health insurance plan over another (including hidden costs that may apply). Also consider you (and your family’s) health needs. While you can’t predict everything with 100% certainty, look for a plan that will cover the essentials at low or no cost (doctor’s visits, prescriptions, etc.)


Opting out of health insurance coverage is not only risky but can result in unforeseen (and overwhelming) costs if something should happen. Research your options and make an educated decision that fits your lifestyle and your pocketbook. Get a free quote from Decent today. We’ve got your back.

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