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Texas · self-employed · 1099 · solo ownersHealth Insurance in Texas for Self-Employed People: How Do You Get It, and What Are Your Options?
By Dick Tracy · Published August 29, 2026 · Updated August 30, 2026
Self-employed in Texas? You get coverage the same way a company gets it for its employees, except you are the company. Four doors: a private plan that is medically underwritten and priced on your health, usually with a true PPO network; a fixed-benefit plan that pays set dollar amounts per service; the healthcare.gov marketplace, which is the right door if you qualify for a subsidy or your health would fail underwriting; and a pre-established ERISA group plan you join as a solo owner. Healthy and over the 2026 subsidy cliff, the private PPO usually wins. Under the cliff, the marketplace with a subsidy usually wins. Managing a serious condition, the marketplace is the safe harbor. I educate, you decide.
I'm Dick Tracy, an independent health insurance broker. I'm licensed in Texas (NPN 20414610), one of 25 states, and I work with 80+ carriers. My desk is in Buffalo, New York, and I work with Texans the way I work with everyone: on the phone or on Zoom, with the actual plan documents on the screen. I left the healthcare side of this business, so there is no gag clause on me. Tips, tricks, and traps, all of them.
Texas, year after year
underwritten health plans
(the deduction is federal only)
Uninsured rate: KFF, Health Insurance Coverage of the Total Population by State. Texas uses the federal marketplace at healthcare.gov.
How to get health insurance in Texas when you're self-employed: the 4 steps
- Find your real income number. The marketplace counts net profit, not gross receipts and not what you pay yourself. Self-employed people get this wrong constantly and it decides everything downstream. The free MAGI calculator walks you through it in two minutes.
- Check it against the 2026 subsidy cliff. One dollar over 400% of the federal poverty level for your household size and the premium tax credit is zero, not smaller. The free cliff calculator tells you which side of the line you are on. Under it: the marketplace is your first stop. Over it: the marketplace is full price, and the other three doors get interesting.
- Get quoted on the doors that fit you, and compare the networks. A plan your doctor does not take is not a cheap plan. In much of Texas the marketplace plans are HMOs and EPOs, which means referrals and nothing out of network. Private and ERISA plans commonly run on the big national PPO networks. That difference is often the whole decision.
- Enroll, and time it right. Marketplace plans have an open enrollment window each fall, with special windows if you lose other coverage. Private underwritten plans and fixed-benefit plans can usually be started any month, and a pre-established ERISA group plan has its own enrollment path. If you are uninsured right now, do not wait for November.
Why Texas is a different ballgame than New York
Most of my clients are in Western New York, where every carrier has to charge a healthy person and a sick person the same premium and nobody can ask a health question. That protects the sick and it punishes the healthy. Texas does not work that way off the marketplace. A Texas carrier can medically underwrite, which means it can ask about your health and price you on the answers. If you are healthy, that is your advantage, and it is the reason a self-employed Texan over the subsidy cliff usually has better options than the same person in Buffalo. The redder the state, the better, and we get shafted in New York. You do not have to.
The four doors, one at a time
Door 1: a private PPO plan priced on your health
This is the door Texans ask me about most, because the word PPO matters here. Underwritten plans ask health questions, and if you pass, your rate reflects you instead of the sickest person in the pool. The networks are the big national ones, the PHCS and MultiPlan type, so you see a specialist without a referral and you are covered when you drive to the next county or fly to the next state. Many are guaranteed renewable, so once you are in, they cannot drop you for getting sick.
Fits: healthy, over the cliff, wants their own doctors and a real network. Does not fit: anyone whose health would fail the questions. That is arithmetic, not judgment, and it is why Door 3 exists.
Door 2: a fixed-benefit plan (what I call the red bucket)
A fixed-benefit plan pays a set dollar amount per service: this much for an office visit, this much per hospital day, this much for a surgery. No network, so you can cash-pay any doctor in Texas, hand in an itemized receipt with the diagnosis and procedure codes on it, and the carrier mails you a check. Premiums usually sit well below a major-medical plan. I explain these honestly because they get oversold: they are a foundation, not a roof. Use one for the everyday layer and put catastrophic protection on top.
Fits: healthy people on a budget who are comfortable shopping for care like they shop for anything else. Does not fit: anyone expecting a big surgery or a chronic-condition year who wants one plan to carry the whole load.
Door 3: the healthcare.gov marketplace
Texas uses the federal marketplace at healthcare.gov. It takes everyone at the same price, no health questions, which makes it the safe harbor if you have a condition that would fail underwriting, and it is the only place a premium tax credit lives. Two things to know for 2026: the subsidy cliff is back, and there is no longer a cap on paying back an overpaid subsidy at tax time. Uncle Sam always comes back to collect. The other Texas-specific thing: check the network before you fall in love with the price. HMO and EPO plans dominate the Texas marketplace, and "your doctor is out of network" is the phone call I get most from people who bought on price alone.
Fits: anyone under the cliff, and anyone whose health rules out underwriting. Watch: narrow networks and a subsidy based on projected income, which moves when you work for yourself.
Door 4: a pre-established ERISA group plan
ERISA is a federal law from 1974 that governs employer benefit plans. There are group plans that already exist under it, and a solo owner can be merged into one. Group rates, a true PPO network, and a policy you own and keep. No payroll, no employees required, one simple compliance step I walk you through. In New York this is the cheat code because it is the only way around community rating. In Texas it is one strong option among several, and for families it is often the winner. Here is the full breakdown.
Fits: owners who want a group-style PPO and a policy that does not change when their income does.
How much does private health insurance cost per month in Texas?
I do not quote premiums on this page, and I would be suspicious of any page that does. The honest answer depends on five things: your age, your county (Harris prices differently than Lubbock), tobacco use, the network you choose, and whether the plan is underwritten. The first four move every plan. The fifth is the one that matters for a healthy self-employed person, because underwriting is the only lever that lets a carrier price you on your health instead of on everyone's. On the marketplace that lever does not exist. Off the marketplace in Texas, it does. Give me those five facts and I will give you real numbers from real carriers, usually the same day.
And about "cheapest": the cheapest plan is the one that costs least on the day nothing happens. The best plan is the one that costs least on the day something does. What kind of tank should we build? That is the question, not "what is the lowest premium."
Which door is for me?
Healthy, income over the 2026 cliff, no subsidy coming
Door 1 first, then price Door 4 against it. A private underwritten PPO usually beats an unsubsidized marketplace HMO on both price and network. If the whole family is going on, the ERISA group plan can pull ahead.
Healthy, income under the cliff
Door 3, and check the network. A real subsidy is hard to beat. Confirm your doctors are in the plan before you enroll, and estimate your income honestly, because there is no repayment cap in 2026 if you guess low.
A recent serious diagnosis or a condition that would fail health questions
Door 3, for now. The marketplace cannot turn you down or charge you more. Take it, get well, and we revisit the other doors at a later open enrollment.
Healthy, tight budget, and you shop for everything
Door 2, with a catastrophic layer on top. Foundation and roof, not one bloated plan that tries to be both.
Spouse has a group plan through their job
Look before you leap. The employer owns the rights to that coverage. One job change and the whole family is shopping at once. Some families keep the employee on the group plan and put everyone else on a private plan, so a single layoff cannot take out everybody.
Don't forget the write-off
Whichever door you pick, the premiums are usually deductible on your federal return through the self-employed health insurance deduction, no itemizing required, capped at your net profit minus half your self-employment tax, and only for months you were not eligible for an employer plan. Texas has no state income tax, so the savings are federal, but they are real. Run your number on the free self-employed deduction calculator, then confirm with your tax professional. And remember the plan is the bigger lever than the deduction. A cheaper plan saves you money twelve months a year. The deduction only gives some of it back in April.
Common questions from self-employed Texans
How do I get health insurance in Texas if I am self-employed?
Four steps. First, figure out your 2026 income the way the marketplace counts it, which for a self-employed person is net profit, not gross receipts or your draw. Second, check that number against the 2026 subsidy cliff at 400% of the federal poverty level. Under it, start with the healthcare.gov marketplace and its premium tax credit. Over it, or healthy and not wanting a marketplace plan, get quoted on a privately underwritten plan, a fixed-benefit plan, and a pre-established ERISA group plan. Third, compare the networks, because a cheap plan your doctor does not take is not cheap. Fourth, enroll. Marketplace plans have an open enrollment window each fall; private plans can usually be started any month.
Can a self-employed person in Texas get a PPO plan?
Yes, and it is one of the main reasons people leave the Texas marketplace. Marketplace plans in much of Texas are HMOs or EPOs, which means a referral to see a specialist and no coverage outside the network. Privately underwritten plans and pre-established ERISA group plans commonly use the big national PPO networks, the PHCS and MultiPlan type, so you can see a specialist without a referral and keep coverage when you travel. The trade: an underwritten plan asks health questions, so it fits healthy people. If your health would not pass, the marketplace remains the door that cannot say no.
How much does private health insurance cost per month in Texas?
It depends on your age, your county, tobacco use, the network, and whether the plan is medically underwritten. Marketplace plans in Texas cannot price on your health, so a healthy 45-year-old and a 45-year-old with a heart condition pay the same premium. Privately underwritten plans can price on your health, which is why a healthy self-employed Texan who does not qualify for a subsidy usually pays less on one. Nobody can give you an honest number without those five facts. Bring them to a broker and get an actual quote instead of an internet average.
What is the best health insurance in Texas for self-employed people?
The best plan is the one that fits your health, your income, and your doctors, in that order. Healthy and over the 2026 subsidy cliff: a privately underwritten PPO plan, priced against a pre-established ERISA group plan, usually wins. Under the cliff: a subsidized marketplace plan is hard to beat on price, so start there and check the network. Managing a serious condition: the marketplace, because it takes everyone at the same rate. Healthy on a tight budget: a fixed-benefit plan for everyday care with catastrophic protection on top.
Can I deduct my health insurance premiums as a self-employed person in Texas?
Usually, yes. The self-employed health insurance deduction lets you write off health premiums for you, your spouse, and your dependents on your federal return without itemizing, capped at your net self-employment profit minus half of your self-employment tax, and only for months you were not eligible for an employer plan, including a spouse's. Texas has no state income tax, so the savings are federal only. Run your own numbers on the free self-employed deduction calculator and confirm with your tax professional.
Thirty minutes on the phone or Zoom, no fee, no hard sell. Bring your age, county, tobacco status, a rough income number, your doctors, and how you use care. I price the doors that fit you from the carriers I work with and put them side by side. I educate, you decide.
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