Health insurance if you work for yourself (self-employed or 1099): your options for 2027

Option 1: the Obamacare Marketplace and help based on your 2027 income

If you are self-employed, a 1099 contractor or have your own business with no employees, you can buy your plan at HealthCare.gov or on your state’s marketplace. Marketplace plans cover pre-existing conditions and the essential health benefits.

The help with your premium (the premium tax credit) is based on what you expect to earn in the year of coverage, not on what you earned last year. For 2027, keep in mind what changed when the expanded help ended at the end of 2025:

• The income limit is back: according to the IRS, starting in 2026 the help is generally for households with income between 100% and 400% of the federal poverty level. For 2027 coverage, that is $15,960 to $63,840 a year for 1 person, or $33,000 to $132,000 for a family of 4.
• If you get more help than you should have, you pay it all back when you file your taxes: starting with tax year 2026 there is no longer a repayment cap. For anyone whose income goes up and down, this is the most important thing about 2027.
• Enrollment at HealthCare.gov: November 1, 2026 to January 15, 2027. To have coverage starting January 1, enroll by December 15. Some states with their own marketplace have different dates.

How to estimate your income when it changes month to month

On the Marketplace application you don’t enter what you bill, but your net business income: what is left after subtracting business expenses, which is what you report on Schedule C of your tax return. HealthCare.gov asks you to estimate it based on past experience, realistic expectations and what is normal in your line of work.

• Start with your most recent tax return and adjust for what you already know about 2027: new or lost clients, slow seasons, big expenses.
• Keep track of your income and expenses during the year, even in a simple spreadsheet.
• If halfway through the year you see you will earn more or less than you estimated, update your Marketplace application as soon as possible. If you earn more, you get less help each month and avoid paying back a large amount; if you earn less, you may get more help.

A tax preparer can help you figure out the net income you will report. A benefits consultant helps you see how that number changes your insurance options.

Option 2: private plans outside the Marketplace

Outside the Marketplace there are also health plans you can get through an insurance company or an agency. None of them come with government help, and they are not all the same:

• Major medical plans that follow Obamacare rules and are offered outside the Marketplace: they cover pre-existing conditions, but they follow the same open enrollment.
• Limited benefit plans (for example, plans that pay a fixed amount per day in the hospital or per doctor visit): they can help with certain costs, but they are not major medical insurance. They generally don’t count as minimum essential coverage and don’t protect you from the penalty in states that have their own, like New Jersey and Rhode Island.
• Some private plans can be started in any month, which helps if you missed the deadline or lost the financial help. They may have different rules on pre-existing conditions, benefits or how long they last.

Before you sign, ask: is this major medical or a limited benefit plan? Does it cover my current health conditions? What does it exclude and what is the most it pays? Are my doctors and my medications included? Ask for the answers in writing.

Option 3: Medicaid and CHIP

If your net income is low, look into Medicaid. Income limits, what it covers and what it costs vary from state to state, and not every state expanded Medicaid for adults. Even if you don’t qualify, your children may qualify for CHIP. You can apply for Medicaid and CHIP any time of year.

The premium deduction for people who work for themselves

The IRS lets many self-employed people deduct what they pay for medical, dental, vision and qualified long-term care insurance for themselves, their spouse, their dependents and their children under age 27 at the end of the year. It is figured on Form 7206 and goes on Schedule 1 of Form 1040. The main conditions:

• Your business had a net profit for the year (Schedule C or F), or you are a partner with net earnings from self-employment. The deduction has a limit tied to that profit.
• You can’t deduct the months when you were eligible for a plan subsidized by an employer, yours or your spouse’s, even if you didn’t enroll.
• It lowers your income tax, but not the self-employment tax from that business.
• If your plan is from the Marketplace and you get the premium tax credit, the calculation changes: the IRS points you to Publication 974.

This is general information, not tax advice. Confirm your situation with a tax preparer or at IRS.gov.

Health savings account (HSA)

If your plan is a qualifying high-deductible health plan (HDHP) and you meet the IRS’s other requirements, you can open an HSA: what you put in is tax-deductible, and you can use it tax-free for qualified medical expenses.

• 2027 limits (IRS, Rev. Proc. 2026-24): up to $4,500 for self-only coverage and up to $9,000 for family coverage.
• To count as an HDHP in 2027, the deductible must be at least $1,750 (self-only) or $3,500 (family), and the out-of-pocket maximum can’t be more than $8,700 or $17,400.
• Starting in 2026, according to IRS Notice 2026-5, bronze and catastrophic plans available on the Marketplace count as HDHPs even if they don’t meet those amounts.

Frequently asked questions