Use your facts
The calculator takes your income, state and current cost and does the arithmetic.
Sole proprietor
Sole proprietor health coverage, and why group carriers will not talk to you
You file a Schedule C. There is no separate entity, no payroll and no W-2. As far as a group carrier is concerned there is no employer here at all, so there is nothing for a group plan to attach to.
That is why you are on the individual market, and this year that market stopped discounting your current cost.
Two problems
The two problems, and they are not the same.
Most sole proprietors are dealing with both at once and treating them as one.
The first is cost. Your subsidy is gone or shrinking, so you are seeing the real cost of individual coverage for the first time.
The second is quality. What you can afford as an individual is usually a narrow network HMO, with referrals for specialists and problems the moment you leave your region.
Shopping harder on the individual market can sometimes help the first. It rarely helps the second, because the good networks are not sold to individuals at those cost drivers.
Change
What changes.
Group coverage requires an employer and an employee. Co-employment supplies both. The owner becomes a W-2 employee of the co-employer, and coverage comes from an established group master plan.
For a sole proprietor this is a bigger change than for an owner already running an S-corp, because you are starting without payroll or an entity. Whether that groundwork is worth doing is exactly what the arithmetic answers, and how you do it is a conversation with your CPA.
The licensed provider still makes the final call.
Calculator first
Work out whether it is worth it.
Remove what does not fit
It rules out what you do not qualify for and shows what remains.
Keep the honest answer
If the answer is that you should stay exactly where you are, it will say that.
Line
Where the line usually falls.
This tends to make sense once your income has moved past the point where the marketplace subsidises you, and once what you are paying has stopped feeling reasonable. Below that, the individual market with a credit behind it is often still the better answer.
We would rather tell you that now than after a discovery call.
Move to
What you would be moving to.
A group-plan path. No specialist referrals, a network that works in any state, and a much wider provider list than a regional HMO.
Dental, vision, retirement through Vestwell and workers compensation are available through the same structure and are entirely optional.
For the network details, read the Group-plan access page.
Objections
The questions sole proprietors ask first.
I do not have a business, really. It is just me.
That is a sole proprietorship, and it is what this page is about.
I do not want payroll and paperwork.
Fair. Run the number first, because that tells you whether the paperwork buys you anything.
My income moves around a lot.
Common, and it is also why the removal of the repayment cap on advance credits matters this year. Enter what you realistically expect.
Is this just an association plan?
No. It is group coverage through co-employment, underwritten by the licensed provider.
FAQ
Sole proprietor coverage questions.
Find out whether the structure is worth building before you build any of it.