I had a breakout year and made $350,000. I went to renew my Healthcare.gov (ACA) plan, and the premium jumped to $1,800/month with a $9,000 deductible because I lost all subsidies. I’m healthy, 28 years old, and feel like I’m being robbed.
Key Takeaways
- The Subsidy Cliff: ACA (Obamacare) subsidies are based on income. At $350k, you pay full price. The plans are “guaranteed issue” (cover pre-existing conditions), which makes them expensive for healthy people.
- Private Medically Underwritten Plans: If you are healthy, you can buy “Private” PPO insurance. These plans check your medical history. Because they reject sick people, the premiums are 40-60% lower.
- PEOs (Professional Employer Organizations): You can join a PEO (like Justworks or Opolis for freelancers) to get access to “Group Rates” usually reserved for big companies.
- HSA (Health Savings Account): High-income creators needs tax shelters. An HSA allows you to pay medical bills with pre-tax dollars.
The “Why” (The Trap): Community Rating
ACA plans use “Community Rating.” The healthy subsidize the sick.
If you are a high-earning, healthy creator, you are overpaying to support the pool.
The Alternative: Private plans use “Medical Underwriting.” They assess your risk.
Warning: Private plans do NOT cover pre-existing conditions and are not ACA-compliant (meaning you might pay a penalty in some states like CA/NJ/MA).
The Investigation: I Called Them
I quoted health insurance for a 28-year-old making $350k.
1. Healthcare.gov (ACA)
- Quote: $1,650/month for a Silver PPO. $8k deductible.
- Pros: Covers everything (maternity, mental health).
- Cons: insanely expensive.
2. Private PPO (UnitedHealthcare Golden Rule / Cigna)
- Quote: $750/month. $5k deductible.
- Pros: Nationwide PPO network. Cheap.
- Cons: Had to answer 50 medical questions. If I get cancer next year, the premium might spike or renewal could be tricky (though “guaranteed renewability” helps).
3. Opolis (Web3/Freelancer Co-Op)
- The Verdict: By “hiring” myself through their PEO, I got access to a Group Plan (Kaiser/Anthem) that was cheaper and better than the open market.
Comparison Table
| Feature | ACA (Obamacare) | Private Underwritten | PEO / Group |
| Cost | High ( | Low ( | Medium ( |
| Pre-Existing Conditions | Covered | Excluded | Covered |
| Network | Often narrow (HMO) | Broad (PPO) | Broad (PPO) |
| Tax Deductible? | Yes | Yes | Yes |
Step-by-Step Action Plan
- Assess Health: Do you have chronic conditions (Diabetes, etc.)? If YES, stay on ACA. If NO, look at private.
- Check PEOs: Look at Gusto, Justworks, or Opolis. Merging your payroll and health insurance often saves money.
- Max the HSA: If you have a high deductible, put $4,300 (2026 limit est.) into an HSA. It reduces your taxable income.
- Shop in November: But remember, private plans can be bought year-round. You don’t have to wait for Open Enrollment.
FAQ
Is “Health Sharing” good?
(Christian Healthcare Ministries, etc.) NO. It is not insurance. They have no legal obligation to pay your bills. High risk for high-net-worth creators.
Can I deduct premiums?
Yes, self-employed health insurance is an “Above the Line” deduction on your 1040.
What if I get pregnant?
Private plans often exclude maternity. If you plan to start a family, switch to ACA during Open Enrollment.