Self-Employed Professionals
ACA Marketplace Plans For Self-Employed
Health coverage if you're self-employed
If you're self-employed, you can use the individual Health Insurance Marketplace to enroll in flexible, high-quality health coverage that works well for people who run their own businesses.You’re considered self-employed if you have a business that takes in income but doesn’t have any employees. You can enroll through the Marketplace if you’re a freelancer, consultant, independent contractor, or other self-employed worker who doesn’t have any employees.
Self-employment income and Marketplace savings
When you fill out a Health Insurance Marketplace application, you’ll have to estimate your net self-employment income. Marketplace savings are based on your estimated net income for the year you’re getting coverage, not last year’s income. When you’re self-employed, it can be hard to estimate your income for the coming months or year. Learn how to estimate your income if you’re self-employed.
If your spouse’s plan offers coverage to spouses and dependents, in most cases you won’t qualify for premium tax credits and other savings on a Marketplace plan.
If your spouse’s job-based insurance doesn’t cover spouses and dependents, then you can buy a Marketplace plan for you and your dependents. Depending on your household income, you may qualify for a premium tax credit and other savings.
In most cases, a married couple has to file a joint federal tax return to be eligible for premium tax credits and other savings on Marketplace plans. Learn about the limited exceptions to the joint-filing rule.
What prescriptions are covered by my plan?
- Your plan will help pay the cost of certain prescriptions.
- Your plan’s list of covered drugs is called a "formulary."
- Visit your plan’s website, call their Member Services, or review your Summary of Benefits and Coverage for a list of covered drugs.
How can I find a doctor in my plan?
- Most plans give you the best price on services when you go to an "in-network" health care provider who has a contract with the plan.
- You may be able to visit doctors who aren’t in your plan’s network, but you may pay more.
- Learn how to find a doctor in your plan's network.
How do I use my coverage?
- Learn how to stay healthy and get the care you need (PDF, 698 KB). You’ll find tips on where to go for care, how to find a provider, and more.
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Find Affordable Health Coverage
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Among those who qualify for subsidies, the average cost of health insurance in North Carolina is $68.00 per month. However, rates vary based on income, and the cost can be as low as $0 per month!
What is an Affordable Care Act (ACA) subsidy?
The Affordable Care Act (ACA) subsidies are tax credits that allow you to pay less for a health insurance plan purchased on an ACA marketplace.
- How it works: When you use the subsidies, the cost of private health insurance is reduced based on the size of your family and your household income. Subsidies can be applied throughout the year to lower your monthly bill, or the lump sum can be taken as a deduction when you file income taxes.
- Who can sign up: Health insurance subsidies are available for those whose income falls in a certain range, depending on family size, and who buy insurance on HealthCare.gov or a state-run health insurance marketplace.
- Which insurance plans qualify: ACA subsidies can be used to lower the cost of insurance from any company, and the discount can be applied to four levels of coverage: Bronze, Silver, Gold and Platinum. They can't be used for the cheapest options: Catastrophic plans, Medicaid, the Children's Health Insurance Program (CHIP) or coverage offered by your employer.
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Health Insurance Plan Levels
Bronze 60/40 plan
- Most affordable monthly cost
- Highest costs when you use the insurance
- Preventive Care doctor visits are free and do not require coinsurance or copays in many cases.
Silver 70/30 plan
- If you qualify for cost-sharing reductions in addition to your advanced premium tax credit subsidy, you must pick a Silver plan to get the extra savings. You can save hundreds or even thousands of dollars per year if you go to the doctor.
- Moderate monthly premium
- Moderate decuctible costs
Gold 80/20 plan
Gold 80/20 plan
- High monthly premium
- Low costs when you need care
- Deductibles — the amount of medical costs you pay yourself before your plan pays are usually low.
Advanced Premium Tax Credit & Cost-Sharing Reductions
If you don’t have health coverage through an employer and you’re not eligible for Medicare or Medicaid, you may qualify for a health care subsidy. Established by the Affordable Care Act (ACA), this federal assistance covers some of the premium and out-of-pocket costs of health coverage. There are two types of subsidies offered:
Advanced Premium Tax Credit (APTC): This subsidy helps lower your monthly insurance premiums. It’s based on the cost of health coverage in your state, your estimated income and your household size, which includes you, your spouse and any tax dependents.
Cost-Sharing Reductions (CSRs): This subsidy offers extra savings that reduce out-of-pocket costs by decreasing deductibles, coinsurance, copays and out-of-pocket max. If you qualify for CSRs based on your income, you must enroll in a plan that falls in the Silver ACA level to enjoy these extra health insurance savings.
The best part is you may be eligible for both types of subsidies, which can dramatically lower your annual health insurance costs.
ACA Health Insurance, Dental Insurance, Vision
