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The Ultimate Guide to Self-Employed Health Insurance for Freelancers


As a freelance writer, you don’t have an employer who offers you health insurance. That can be a frightening proposition, but not to worry — there are numerous great self-employed health insurance options for freelancers!

I’ve heard from more than one writer who’s hesitant to pursue their freelance dreams because they’re nervous and unsure of how health insurance for freelancers works. And hearing that makes me sad.

Don’t let this be the issue that stops you from pursuing your freelance writing dream! This. Is. Solvable. Especially now, in the U.S., where I’m thrilled that there are more options for health insurance for self-employed freelancers than ever before. (If you’re outside of the U.S., check out these emerging alternatives that help freelancers limit their risks if they become ill.)

How Much Does Health Insurance Cost for a Freelancer?

The current average cost for self-employed health insurance in the United States is $495 a month — $5,940 annually. The price can be much lower — about $200/month on average — if you qualify for a tax subsidy. Your location also plays a major role in determining your health insurance costs as it can be far more expensive to get insured in some states, like New York & West Virginia for example where month premiums are over $700/month on average, than others, like Colorado and New Hampshire as two examples where average monthly insurance rates are in the $300-$400 range.

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Top Options to Get Self-Employed Insurance for Freelancers

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Ready to start shopping for health insurance for self-employed individuals now? eHealthInsurance.com makes it easy to explore coverage options in your area so you can find the right health insurance plan to fit your individual needs. You can also read on to learn more about some of your different options for getting covered.

Here’s a rundown of the best self-employed health insurance options in 2021:

1. Spouse’s policy

Many a writer has simply added themselves to a spouse or partner’s healthcare policy and kept on rolling. If you’re married, this is the first option you should look into when considering your means of obtaining self-employed health insurance, but don’t sign up just yet.

In some cases, you can get added free, in others you’ll have to pay your part of the premium to be added to their policy.

Get all of the facts about what goes into getting added to your spouse’s coverage, and then make sure you cost-compare to the options below. You may discover that being added to your spouse’s employer’s policy is actually worse for coverage *and* more expensive than self-insuring through another method. But still, this is where you should start if you’re married as it gives you something to compare with when looking at other freelancer health insurance plans.


Passed in 1986, the Consolidated Omnibus Budget Reconciliation Act (COBRA) included a rule that when you leave a company where you had healthcare, they must offer you the right to extend your coverage — usually for up to 18 months — by making your own premium payments. So if you’re planning a departure, this could be an option that buys you some time while you research other self-employed health insurance options for the future.

Often, corporate plans cover more than individual plans, so it can be worth a serious look.

3. Affordable Care Act

If you’re a legal U.S. resident and low income, you’re at high risk for a major disease, or have a pre-existing condition, the ACA has revolutionized healthcare for you, no matter what your employment status. No more super-expensive high-risk pools! No more getting declined for coverage. Legal immigrants can obtain coverage. It’s a viable option for getting freelancer health insurance in many cases.

If you’re not low income, you can still use the healthcare Marketplace at Healthcare.gov to choose from a variety of plan types, and easily compare them. (Visit early — the site tends to bog as we near enrollment deadlines.) More on these types below.

4. Local chamber or business group

For several years, my city Chamber of Commerce offered an affordable group plan for members that had pretty nice coverage! Look into whether a local business or professional organization might have a plan you could join as a member. There are also some national organizations that might be able to help, such as…

5. Freelancer’s Union

The Freelancer’s Union now offers health insurance plans for self-employed individuals in a number of states, including New York, California, Colorado, Connecticut, Florida, Georgia, New Jersey, Pennsylvania, and Texas.

They may not have a freelancer health insurance plan you love available in your locale, but it’s well worth finding out. That’s because if you can’t get into a group of some kind and aren’t low-income, you may face steep premiums.

6. High-deductible private insurance

If you earn a decent income and don’t qualify for subsidized care under the ACA, you may find yourself looking at individual or family insurance plans. After you get over the sticker shock — it can easily run $1,000 or more for a family of four to get a plan with low deductibles — consider getting a bare-bones plan that protects you from complete disaster, but does little else. You’ll pay for most routine medical attention, though being with your plan may entitle you to discount rates.

These plans may have a $10,000-$20,000 deductible. (I know!) That is money you’d be smart to set aside in a savings account, so it’s there if you end up needing it. You may save so much in premiums that you could sock that money away — and if you’re lucky, end up keeping it if you stay healthy that year. I know writers who’re paying $300 and less for these self-employed health insurance plans.

Click here to shop and compare plans online.

7. Health Savings Accounts

Here’s something that can take some of the sting out of getting a high-deductible plan — many plans will allow you to sock some of that money away in a tax-sheltered HSA. I highly recommend choosing a plan with an HSA feature, if you can. You can then pay medical expenses that aren’t covered by your plan from the HSA account.

How’s that help? If your family is allowed to put $6,000 a year in an HSA and your tax bracket is 20 percent, that’s deposit is subtracted from your gross income — and you save $1,200 on your tax bill. I’ve been using HSAs for years…just wish they would let me put in even more.

8. Get healthcare as a business

You may be able to obtain freelancer health insurance at lower rates for your family, and any employees you may have, by applying for it through your business. (Yes, you’ll need to be a legit, registered business.) Check out the federal Small Business Health Options Program, for one. Your state may have other alternatives.

In my state, you need at least two people working in the business to qualify for these plans, but rules vary, as insurance is a state-regulated industry. When I cost-compared last year, the rates were worse on the business plans for me than they were for an individual/family plan, but it’s worth checking, as rates change each year.

9. Faith-based healthcare-sharing

Some religious denominations are trying to step into the breach and offer low-cost healthcare on a pool-your-money basis. Everyone pays a modest monthly premium based on ability to pay, and then those who need get their bills paid out of the pool. The Alliance of Healthcare Sharing Ministries might be a place to start looking into this — the Alliance says a half-million people are now enrolled in this model.

The catch: There’s no absolute guarantee here your bills will get paid — you appeal to the group for assistance. It’s not insurance, but a cost-sharing scheme that could well be a low-cost alternative, if you’re okay with a degree of uncertainty in the mix.

10. Medicaid

You might think you make too much to qualify for Medicaid, but that might not be the case. Many states offer expanded Medicaid options with less stringent income requirements. Check with your state to see if this is available.

11. Pay cash and get a discount

If you’re rolling in dough — or have few assets and aren’t worried about losing them all — you can consider being a cash customer. Paying cash in full when you receive medical services can often earn you a discount off the retail price of up to 30 percent if you’re savvy enough to ask for it.

12. Get a flat-fee doctor

Visit the doctor a lot? This is an emerging physician model that’s might be worth checking out. For a low monthly rate — think $79 a month or so — you get all-you-can-eat visits. This angle doesn’t take care of hospital, pharmacy, or other medical costs, but it could be a money-saver on the doctor side.

Can You Write Off Health Insurance if Self Employed?

As a self-employed individual, you may be able to deduce your premiums paid for medical, dental, and long-term care coverage for yourself, your spouse, and your dependents. The policy can also cover your kids who are under the age of 27, even if they aren’t your dependent. You cannot take the self-employed health insurance deduction if you’re eligible for coverage under a plan from your employer (e.g. you’re a part-time freelancer still working a regular job) or your spouse’s employer.

Learn more about the self-employed health insurance deduction on the IRS site.

Putting it all together

Yes, self-employed health insurance options are a bit complicated for freelancers to navigate. You might want to combine several of the ideas above to help keep your healthcare costs down. There are many options. That’s why you should start learning about your alternatives so you can make an informed decision.

One note: The open enrollment period in November/early December isn’t the only time of year you can get health insurance! If you have a life event such as getting married, adopting, or losing your job-related coverage, you may be able to enroll in the off-season. So if you move into freelancing months from now, you may still be able to get into a plan at that time.

I’m not going to lie here: Freelancers can get coverage — but self-employed health insurance costs. Depending on your family size and situation, maybe a lot. It can be a bit of a shock, if you’ve been at a company that picked up all or most of the premiums. This is one reason freelancers need to earn high hourly rates — you have costs you didn’t have as an employee.

My personal advice, as the child of an insurance salesman? Don’t go uninsured. You’ll be at risk of losing everything if you have a medical crisis.

How have you gotten self-employed health insurance for freelancers? Leave a comment and share.

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