We still don’t know what’s happening with healthcare subsidies in the United States, but entrepreneurs are on edge about what 2026 means for healthcare costs. Many of us have relied on public healthcare exchanges and Affordable Care Act subsidies (which lower plan costs) ever since the Obama administration. If the ACA subsidies expire at the end of this year, public marketplace premiums will likely become unaffordable for some self-employed folks.
While we’ve heard about panic-inducing price hikes, we’ve also noticed entrepreneurs and freelancers trading recommendations on social media that go beyond typical health insurance. Maybe you don’t have to take out a second mortgage just yet. You could consider an alternative plan, which might involve paying doctors directly or getting insurance through an association you belong to.
Jill James, who runs a strategy and operations consultancy, put together a comprehensive guide to your health insurance options that covers a lot of the nuances of insurance, but we wanted to highlight a variety of specific solutions we heard entrepreneurs recommending.
This was not written by medical professionals and is not medical advice. We did our best to vet these options for you but you should talk to your own care providers and do your own research in addition to what we present here.
Private health insurance
If you’ve been on the public exchange for a while, it might be time to work with a healthcare broker and find a private plan that better suits your needs.
Dr. Noor Ali, a doctor turned healthcare expert who advises small business owners, says private plans can be more affordable than public plans, especially if you do something called individual underwriting.
“Depending on your lifestyle, if you're generally healthy, do an individual underwritten plan assessed on your individual risk, and that can save 30 to 50% on premiums,” Dr. Noor said.
The application process involves 15-20 questions about your health so insurance carriers can figure out how much you’re going to utilize your plan. Dr. Noor gave the example of the difference in cost for a person with asthma who has a flare up every once in a while versus someone with asthma who smokes and is in the ER every month. She also emphasized how it’s important to revisit what’s available in the market every year taking into account your changing needs, like having a baby or getting diagnosed with a chronic illness.
You can buy private health insurance on your own by googling “health insurance” + your state, but working with a broker can give you faster direction on the right plan for you and your family.
Talk to your marketplace
State marketplaces like Covered California employ brokers to help you sign up and get coverage. Jill James, who has been helping entrepreneurs with health insurance, recommended on Threads, “Pick up the phone to ask [brokers] for help…If they can qualify you for any state programs or subsidies, they will.”
Healthcare plans on public marketplaces meet certain legal requirements for standards of care which other alternatives may be missing. The first step to seeing if you qualify for federal- or state-subsidized health insurance is to check on Healthcare.gov or your state’s marketplace.
Check your specific state health plan to find out if and when coverage will change. For example, in Massachusetts changes to MassHealth (Medicaid) will take effect starting in Fall 2026 or 2027 (not this January, giving a few more months to figure things out). Massachusetts ConnectorCare subsidized plans will go up in price next year. Be sure to look for official info about your particular plan, as changes vary widely.
HSA + Catastrophic plan
We put an ask out about health insurance alternatives through Source of Sources, a platform for journalists to connect with sources, and every single entrepreneur who responded said they were doing a health savings account (HSA) combined with a catastrophic health insurance plan. Having an HSA requires you to also enroll in an eligible health insurance plan so these entrepreneurs were choosing the lowest premium, high deductible plans. In most cases, they were also including a concierge medical plan for preventative care (which we get into below).
All of these entrepreneurs had employees and mentioned that this route saved them 25-30% on their healthcare benefits overhead, even if they contributed to their employees’ HSAs too.
Dr. Noor does not recommend this route for solopreneurs or teams smaller than five people. She told us, “High deductible plans aren’t giving you any benefits until you're coming out of pocket $10,000 or whatever your high deductible is. You can only get an HSA if you have a high deductible—a.k.a. shitty plan. You’ve just ensured three separate times that your insurance company’s not paying your medical bills, you are, because you’re paying premiums, you have a high deductible and you’re contributing to your HSA.”
Instead, she said you’re better off getting an individual plan, private or public, tailored to your needs.
Association Health Plans and group insurance
Solopreneurs or small teams may find Association Health Plans and group insurance plans to be more affordable with better benefits than public and private health insurance. An increasing number of organizations are providing alternatives for entrepreneurs including coverage for family and employees.
Solo Health Collective offers a PPO insurance plan to solo business owners who are self-employed with no employees. In-network services are covered 100% after the deductible, including a wide variety of healthcare including mental health coverage, but with exceptions including autism and gender transition. Freelancers Union, a non-profit organization supporting independent workers, partners with Solo Health Collective to provide health insurance in all 50 states.
For small business owners with employees, newer Association Health Plans may help meet the need for coverage. Hollie Miller, Founder and CEO of Guilds with Benefits, currently setting up a new Association Health Plan for solo and small business owners in Oregon, wrote to us in an email, “We are building this plan in such a way that it would be able to cover a small business owner, their family, and their employees and their families.” However, Guilds with Benefits is waiting for the State to “determine whether they will allow that or not,” Miller said. Their Association Health Plan will operate similar to group insurance plans, including in-network and out-of-network coverage.
Chambers of Commerce sometimes offer health plans for entrepreneurs, so it’s worth checking your options locally. The Chamber of Commerce of Eastern Connecticut offers their members a Cigna plan. The Minnesota Chamber of Commerce offers ChamberHealth, a collection of health care plan options for small- and mid-size employers. Some of these plans are available for solopreneurs, and others require at least two employees.
Cost sharing
Some self-employed folks recommend medical cost sharing plans, which are generally less expensive per month than health insurance, but come with far greater risks.
Anecdotal stories seem to vary widely about the effectiveness of health cost sharing: some people report being promptly reimbursed for their medical bills and other people report being denied for expenses that seem like they should be eligible under the guidelines. John Oliver, covering Health Care Sharing Ministries on Last Week Tonight, comments that these organizations “don’t have to abide by laws governing insurance products, meaning there is nothing stopping them from placing restrictions on coverage for pre-existing conditions.”
With any cost sharing plan, carefully check who and what is eligible for coverage. These plans are not health insurance and do not fall under the same requirements. Common limitations can include chronic conditions, reproductive healthcare and contraception, tobacco use, hormone therapy, mental health, ADHD and autism, and more.
Some religious organizations offer cost sharing plans, some of which require an affidavit of faith and do not cover certain expenses on a religious basis, for example, a pregnant woman who was unmarried at the time of conception may not receive any help with delivery costs. Nonreligious or less-religious cost sharing plans include CrowdHealth, Zion HealthShare and Sedera, many of which have very mixed reviews
It’s important to understand you are responsible for your own medical bills when using cost sharing. KnewHealth, offering a medical cost sharing membership, states on their website home page, “There’s no legal guarantee of payment, but we maintain a strong track record of sharing eligible bills.” If you’re willing to take on that level of risk, KnewHealth, with its 4.7/5 trust score on TrustPilot, is an option some freelancers recommend. We are not entirely sure what to think about these cost sharing plans, especially the ones that have been involved in lawsuits, so proceed with caution.
Private-practice subscriptions
Doctors now offer monthly or annual memberships for preventative care where you pay them predictable fees with no insurance middlemen. This is called concierge medicine at the high end and direct primary care at the low end and it’s been popularized by companies like One Medical (now part of Amazon).
Lex used to go to a practice in Atlanta that has one time pricing for visits and also offers a subscription through the Pear’d network if you wanted to even out your medical costs. It includes things like your annual physical and lab work, an annual OB/GYN exam, and unlimited urgent care visits. You can search “concierge medicine” or “direct primary care” + your city or state to find practices that offer this.
You can even find concierge medicine in dentistry. We heard from a new dental practice in El Paso, Texas called Prickly Pear Dental Care that they’re seeing more patient demand for options that don’t involve insurance. “While dental insurance premiums haven't been increasing as dramatically as health insurance premiums, prices have been climbing in sneakier ways such as higher deductibles, making dental insurance less appealing to some patients,” said Dr. Flores, who owns the practice.
Dr. Flores is offering memberships for $299/yr per adult patient, $249/yr per additional adult household member, and $199/yr per child under age 14 that include everything you’d need throughout the year, including one emergency exam. She mentioned that at least five other dentists in El Paso have membership plans indicating it’s maybe not as hard to find these as you’d think. For bigger dental expenses, Dr. Flores said to ask about in-house financing or look at third party financing like CareCredit, Sunbit or Cherry, which are kind of like Klarna but for healthcare.
If you have employees that you’re covering with healthcare, you can also negotiate a discount for buying a concierge medical plan in bulk. Delbert Lee, who founded Wynbert Soapmasters, told us he managed to get this subscription cost down to $80/month per employee for his first 5-10 hires.
Medical tourism
Traveling to another country to receive medical care can be cost effective for expensive or multiple procedures, but it's not a good replacement for having an insurance plan for preventative or emergency care.
Dental care is the most common form of medical tourism among US residents, according to the CDC, followed by cosmetic surgery, accessing cancer treatments, reproductive services, and rehab programs. Mexico is the most common medical destination for people coming from the US.
Especially if you have a healthcare plan with a high deductible (or no health insurance) it may be less expensive for large or planned procedures to travel to another country, even including airfare and lodging. For example, a friend of Rey’s traveled to Istanbul for multiple crowns, and the care plus the cost of the trip combined was less expensive than seeing a dentist in Iceland, where she lives.
Medical tourism can be risky because of infection and other complications, including the dangers of air travel soon after surgery. If you do have access to a primary care physician in the US before leaving, they may be able to help reduce the risks by prescribing vaccinations or medications. You can also see a physician after returning, if you have any concerns.
If you’re considering medical tourism, we recommend checking out online reviews for the clinic. Find somewhere that is reputable, licensed and has many success stories.
Ways to reduce your healthcare costs
Even with health insurance or an alternative plan, accessing care can still be really expensive. It may be worth it to search for local resources, low-cost clinics, and online care to reduce your costs.
GoodRX finds and provides coupons for prescription medications. You can search for your medication on their website and find coupons and compare prices between pharmacies. GoodRx self-reports that their users saved an average of 82% on retail prices for prescription medications in 2023. Whether or not you have insurance, this may be a way to save on medication costs.
Many dental schools offer free or low cost services from cleanings to fillings to root canals, regardless of your insurance status. The tradeoff is that you will likely spend more time getting work done than at a regular dentist. They may bring in multiple dental students to examine and work on your mouth. The quality of the work is likely to be high and carefully supervised by an expert, but if you don’t have the patience to sit through dental teaching, this may not be for you.
Eye exams and glasses are not covered by many insurance plans. An in-person eye exam can be important, but you can purchase glasses for much less online (for example, from Zenni Optical).
Planned Parenthood, which offers a variety of services including pregnancy care, vaccines, hormones, and contraception, offers sliding-scale pricing for low income households.
Many health care plans do not cover therapy. A service to help match you with a therapist at a negotiated rate for sessions is one way to reduce costs. Reflect offers therapy in 20 states, starting at $145/session or $110 sliding scale. Revive Health Therapy is launching discounted mental health support for digital creators in California, as mentioned recently in Creator Spotlight, alongside other mental health resources.
If you require gender-affirming health care, check out this deep dive into options for self-employed trans folks from Rey Katz at Amplify Respect.
We may work solo, but healthcare is solved together
It can be scary and time-consuming to navigate changing healthcare plans for 2026. But you’re not alone. Many freelancers and self-employed folks are looking for a plan that works for their budget and talking openly about how they’re solving this for themselves and their families.
We’ve shared these specific options recommended by entrepreneurs to jump start your search and let you know what’s out there. As federal and state requirements shift, organizations are developing new options for entrepreneurs. With the advent of Association Health Plans and organizations like Solo Health Collective, there’s already a much wider range of options than ever before. We’re not saying it’s easy to get coverage, but we are hopeful about some of the solutions coming online and we’d encourage you to take an active role in shaping what you want to see in the market. So much of what’s out there now exists only because people were unhappy with their choices and they wanted something better.
Taking care of your health is such an important part of succeeding as a self-employed founder, and we hope that you find a plan that works for you.
Are you an entrepreneur who’s found a health insurance plan or alternative that you would recommend? Let us know in the comments.
