Going on Your Own as a Solopreneur? Here’s What to Know About Health Insurance

If you are considering joining the millions of people who are starting their own small business – alone or with a partner – it takes courage and moxie, plus plenty of research to ensure all the details are covered.

That includes health insurance.

Leaving the safe fold of your group health insurance plan at work may give you pause. “Yet there are good, affordable options for solopreneurs,” said Brad Meyer, Director of Consumer Sales at Avera Health Plans. “Foregoing health insurance to cut your costs is risky. If you have a health event, large bills could threaten your savings and financial future.”

Health Insurance Options for the Self-Employed

Your options may include:

Insurance through your spouse’s employer: If you’re married, this is the first option to look into, if the plan is affordable (less than 9.02% of your expected income). If it’s affordable, you should certainly consider that option because you might not qualify for tax credits that reduce premiums on federal Marketplace plans if you have access to affordable coverage through your spouse.

Insurance through your parents: If you are under age 26, you can still be covered on your parents’ plan.

Federal Health Insurance Marketplace: If you’re truly a solopreneur with no partners, this is a great option for getting individual or family coverage outside of group insurance through an employer. Most people qualify for tax credits for lower premium costs. When you lose coverage by leaving a job, you have a special enrollment period to sign up on the Marketplace. Or, open enrollment begins Nov. 1. You can enroll through Dec. 15 for coverage that begins Jan. 1. The last date to make changes or sign up for coverage that begins Feb. 1 is Jan. 15.

If you’re looking for a time-saver, Avera Health Plans offers a sign-up link that takes an average of nine minutes for new enrollees, and four minutes for renewals.

COBRA coverage through your former employer: This option is typically more expensive and only meant for short-term coverage during a time of transition.

Small group insurance: It’s possible to set up small group insurance if you have a business partner or an employee. You can set up small group coverage for as few as two employees, up to 50 employees. “At Avera Health Plans, a new business can set up small business coverage anytime, year around,” said Jordan Anderson, Senior Director of Group Sales at Avera Health Plans. “There are choices between robust provider networks, or direct networks for more affordable premiums.” Direct plans have a selected network of providers that may be within one health system, like Avera. The best way to look into this is to talk to an agent and get a quote to compare the costs.

Medicare and related products: If you are age 65 or older, Medicare plus a Medicare Supplement Plan may be your best bet.

Do the Math and Check the Details

Whatever situation applies to you, do the math and count the costs, looking at deductibles, co-pays and coinsurance. Plans with lower premiums may have higher out-of-pocket costs. Understand that you could be responsible for the maximum out-of-pocket cost listed on the plan if you or one of your covered dependents has a health issue.

If your work requires travel, check the details. “Look for plans that offer expanded network offerings so you have access to care and providers wherever you go,” Meyer said. “Your plan may partner with other systems, networks or insurance companies for in-network coverage if you need urgent or emergency care when outside your home coverage area.”

Traditional or High Deductible Plan?

Broadly, plans fall into two types – traditional and high deductible health plans. “Choose your plan based on your health expenses, age and condition,” Meyer said. “If you’re under 30 and healthy, a high deductible or catastrophic plan might fit best.” Those plans offer a lower premium and high deductible yet include some services, like preventive exams, covered at 100%.

If you pick a high deductible health plan, it is paired with a health savings account (HSA) that can save money as well. You can use the account to set aside pre-tax dollars to pay for qualified health expenses, and your savings roll over from year to year.

When making your decision, consider the following:

• Who do I see for care now; will they still be in-network under the new plan?
• How would my medications be covered under the new plan?
• What happens if I need a specialist?
• Can I access my health and plan information online?
• Do any of my family members have special needs?

“It’s a case of knowing the facts and fully exploring the pros and cons,” Meyer said.

Maximize Your Health Insurance Investment

Affordable Care Act-compliant plans, like individual or family plans on the federal Marketplace or small group coverage, provide 10 essential care categories, including annual preventive visits and recommended screenings. “Taking advantage of all the benefits that are 100% covered and free to you is a wise financial move – in more ways than one,” Meyer said. “Any health problem that’s discovered can be treated earlier when it’s still minor, rather than later as a major health problem.”

There also may be value-added benefits, such as discounts to fitness centers or virtual visits. For 2025, Avera Health Plans is offering MyWeighForward health insurance plans that cover health care services like other plans do, but also give people access to health coaching and weight loss medications to be successful in weight loss. Specifically for people with a certain body mass index (BMI) and their family members, these plans are currently only available in Brown, Lincoln and Minnehaha counties in South Dakota with individual and family plans as well as small and large group employer plans.

You can also save money by always seeing in-network providers, and checking first with your health insurance company if you have a medical need that requires services or specialty care that is out of network.

“With some planning and research, you can get individual insurance and still achieve your entrepreneurial dreams,” Anderson said.