Your Insurance Detective › Self-employed with no employees
If you're self-employed, 1099, or a solo business owner in Buffalo with no employees, here's the myth I bust most often: the individual marketplace is not your only option, no matter who told you it was. There are real plans built for owners without a payroll, and because New York is community-rated, your rates aren't based on your health. My job is simple: I educate, you decide.
I'm Dick Tracy, an independent health insurance broker right here in Western New York — and helping exactly these people is what I do. I left the healthcare side of this business so there's no gag clause on me. I'll tell you the tips, the tricks, and the traps. So if you've been waved off to the marketplace, let's back up and look at what's actually on the table.
Here's the thing nobody says out loud: a lot of brokers only work with businesses that have W-2 employees. So when a solo or 1099 owner calls, they get waved off to the marketplace — not because that's your only option, but because that's the only kind of client that broker serves. That's a limit on who they work with, not a limit on what's available to you. Get a second opinion before you settle.
The marketplace works fine for some people, but it has a specific trap for business owners. Subsidies are based on your projected income, and if your income comes in higher than you estimated — which happens all the time when you run your own business — those subsidies can get clawed back at tax time. Uncle Sam always comes back to collect. Add in the expense and the narrow networks, and it's often not the deal it looks like. Compare before you commit.
Beyond the marketplace, a solo or 1099 owner can often use private off-marketplace plans, guaranteed-renewable fixed-benefit plans that pay set benefits regardless of network, and inexpensive add-ons like accident and critical-illness coverage. A lot of owners do best combining a foundation plan for the everyday stuff with a catastrophic plan for the big events — so you're covered top to bottom without overpaying for one bloated plan that tries to do everything.
A spouse's employer group plan is often a great deal when the employer pays most of the premium. But the employer owns the rights to that coverage — if the covered spouse leaves the job or their health changes, the whole family can get pushed into guaranteed-issue marketplace coverage. One smart play is keeping the spouse on the group plan while putting the rest of the family on a separate private plan, so a single job change doesn't blow up everyone's coverage at once. Pack the parachute before the plane goes down.
Yes. Being self-employed, solo, or 1099 does not make the marketplace your only option, even though a lot of owners are told exactly that. There are real plans built for owners without a payroll, and because New York is community-rated, your rates aren't based on your health. If someone convinced you otherwise, get a second opinion before you settle.
Because many group brokers only work with businesses that have W-2 employees, so solo and 1099 owners get waved off to the marketplace. That's a limit of who that broker serves, not what's available to you. An independent broker who works with individuals can show you private off-marketplace plans and fixed-benefit strategies the group world never mentions.
Not always, but it has traps. Subsidies are based on projected income, and if yours comes in higher than estimated — common for business owners — they can be clawed back at tax time. The plans can also be pricey with narrow networks. It works for some, but compare it against private and fixed-benefit options before assuming it's your cheapest or only route.
Beyond the marketplace: private off-marketplace plans, guaranteed-renewable fixed-benefit plans that pay set benefits regardless of network, and add-ons like accident and critical-illness coverage. Many owners do best combining a foundation plan for everyday claims with a catastrophic plan for big events. The right mix depends on your health, budget, and how you use care.
It can. A spouse's group plan is often a great deal when the employer pays most of the premium — but the employer owns the rights, so a job change or health change can push the family into guaranteed-issue coverage. A common strategy is keeping the spouse on the group plan while putting the rest of the family on a separate private plan.