The 6 Things That Actually Matter
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1Network flexibility — can you see any doctor? PPO plans let you see any doctor or specialist without a referral. HMO plans lock you into a network and require referrals. For freelancers who value their time, PPO wins — no appointments just to get permission for another appointment.
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2Premium vs. deductible balance A lower monthly premium means a higher deductible (what you pay before insurance kicks in). If you're healthy and rarely need care, a lower-premium/higher-deductible plan saves money. If you have regular prescriptions or doctor visits, a higher premium with lower deductible often makes more sense.
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3Tax deductibility — you can write this off Self-employed freelancers can deduct 100% of health insurance premiums from gross income. A $300/month plan at a 22% tax bracket costs you roughly $234/month after the deduction. Always factor this in when comparing costs.
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4Income variability and subsidy risk ACA marketplace plans tie your premium to your income — if you have a good year, your subsidy shrinks and you may owe money back at tax time. Private PPO plans have flat premiums not tied to income at all, making them more predictable for freelancers with variable income.
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5Portability — coverage that travels with you Freelancers often work from different cities or states. HMO plans are built around county-level networks — travel outside your area and you're often not covered for non-emergency care. PPO plans work anywhere in the US.
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6Pre-existing conditions ACA marketplace plans cover all pre-existing conditions at no extra cost. Private PPO plans vary — some cover everything, some have waiting periods or exclusions for specific conditions. If you have an ongoing condition, this is the key question to ask before enrolling.
The freelancer tax advantage: Health insurance is one of the few expenses the IRS lets you deduct above the line — meaning it reduces your taxable income regardless of whether you itemize. Most W-2 employees pay premiums with after-tax dollars. You don't have to.
ACA Marketplace vs. Private PPO — Which Is Right for You?
Choose ACA marketplace if: Your income qualifies for subsidies (under ~$58K for a single person in 2026), or you have pre-existing conditions that need guaranteed coverage.
Choose private PPO if: You're healthy, your income is above the subsidy threshold, you want to see any doctor without referrals, or your work takes you across state lines.
A 10-minute call covers both options with real quotes — so you can compare actual numbers before deciding.
What to Bring to a Quote Call
- Your date of birth
- State where you primarily live
- Any regular medications (generic names if possible)
- Whether you use tobacco
- Rough monthly budget
- Whether you want to cover just yourself or family too
Related Pages
Best health insurance for self-employed people
Health insurance for 1099 workers
PPO vs HMO — full comparison
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