If you are self-employed and earn too much to qualify for an ACA premium tax credit under current rules, you still have real options. The main ones are a full-price ACA marketplace plan, joining a spouse's or family member's employer plan, GigCare through PSM's Working Owner model if you are eligible, an HSA-qualified high-deductible plan for the tax savings, and for those with employees, an employer-side arrangement. The right pick depends on your health, your family situation, and whether you have employees.
Last updated: June 2026.
Key takeaways
- Confirm your subsidy eligibility under current-year rules first; many people assume they do not qualify when they would.
- A full-price ACA marketplace plan is still guaranteed issue and still covers pre-existing conditions and essential health benefits.
- A spouse's or family member's employer plan is often the lowest-cost option when available.
- GigCare can fit relatively healthy 1099 workers; the plans here use only Blue Cross and Blue Shield of Nebraska's Network Blue and Aetna.
- An HSA-qualified high-deductible plan plus the self-employed health insurance deduction can lower the effective cost of coverage.
ACA Marketplace enrollment reached a record 24.3 million in 2025, then declined to about 23.1 million for 2026 (CMS and KFF).
The enhanced premium tax credits expired at the end of 2025. For 2026, eligibility for ACA premium tax credits is again capped at 400% of the federal poverty level, which restores the subsidy cliff that the enhanced credits had removed (CMS and KFF).
The share of Marketplace enrollees receiving any premium subsidy fell from 92% in 2025 to 87% in 2026 (CMS and KFF).
For self-employed and 1099 earners specifically, this matters: more households above 400% of the federal poverty level are paying full price for ACA coverage again in 2026, which is exactly the situation where comparing a PSM/GigCare option is worth the time. These rules can change. Congress could act to restore the enhanced subsidies, so check Healthcare.gov for the current-year rules before deciding.
Why Subsidy Rules Matter Here
ACA premium tax credits are income-based, and the specific thresholds, whether an income cliff applies, and how subsidies phase out can change from year to year and depend on current federal law. The honest move is to confirm whether you actually qualify under this year's rules before assuming you do not. See healthcare.gov for the current-year estimate and our how ACA subsidies work guide for the plain-English version.
Option 1: A Full-Price ACA Marketplace Plan
Even without a subsidy, an ACA marketplace plan is still a legitimate choice. It is guaranteed-issue, covers pre-existing conditions, includes essential health benefits, and gives you the strongest consumer protections of any option on this list. You simply pay the unsubsidized premium. For many high-income but high-need shoppers (someone with a chronic condition or a specialty medication), this is the right answer regardless of price.
Option 2: A Spouse's or Family Member's Employer Plan
If a spouse has access to employer-sponsored coverage, adding you (and any children) is often the most cost-effective option, because the employer typically pays a meaningful share of the premium. Compare the cost of adding a spouse against a full-price ACA plan and any other option you are considering.
Option 3: GigCare Through the Working Owner Model
GigCare is Non-ACA, under-65 group health coverage offered through PSM's Working Owner model. The plans available through this agency use Blue Cross and Blue Shield of Nebraska's statewide Network Blue and Aetna. GigCare can fit relatively healthy 1099 workers who do not qualify for an ACA subsidy and who want a broad network. It is not for everyone: there is a short health questionnaire, and the tier-one plans do not cover specialty medications and are not designed for people with significant pre-existing conditions. See our PSM and GigCare explainer and the GigCare vs ACA comparison.
Option 4: An HSA-Qualified High-Deductible Plan
If you are relatively healthy and want tax efficiency, an HSA-qualified high-deductible health plan paired with a Health Savings Account can lower the effective cost of coverage. Self-employed people can generally deduct qualifying health insurance premiums (the self-employed health insurance deduction), and HSA contributions are tax-advantaged as well. The annual HSA contribution and HDHP limits are set by the IRS and change over time, so confirm current limits or ask a tax professional.
Option 5: Employer-Side Arrangements (If You Have Employees)
If you own a small business with employees, your options expand. You can offer (and participate in) an Individual Coverage HRA (ICHRA), a QSEHRA, or a level-funded group plan. See our pillar on group health insurance alternatives for small businesses, and the deeper guides on ICHRA and level-funded plans.
Option 6: Other Non-ACA Products (Use Care)
There are other non-ACA products on the market, including short-term plans, health care sharing arrangements, and limited-medical or fixed-indemnity plans. They can be inexpensive, but coverage, consumer protections, and exclusions vary widely. A licensed agent should review fit before you enroll. See our non-ACA health insurance explainer.
How to Decide
- Confirm whether you actually qualify for an ACA subsidy under this year's rules. Many people assume they do not when they would.
- Check if a spouse's employer plan is an option. It is often the best deal.
- If neither applies, compare a full-price ACA plan, GigCare (if you are eligible and healthy), and an HSA-qualified plan side by side.
- If you own a small business with employees, look at the employer-side options as well.
For a broader view, see our main guide to health insurance for the self-employed.
📚 Related Reading
Need to figure out the best option for your situation? I'm a licensed independent agent in Omaha. I can confirm whether you qualify for a subsidy, quote a full-price ACA plan, check GigCare eligibility, and walk through the trade-offs in plain English. Free consultation, no pressure.
Book a free consultation with Nick Depke or call (402) 680-6171.