​Since 2014 the government will pay part (or even all) of your individual health insurance premium if your income qualifies. Thousands of business owners leave this money on the table every year because the official explanation is confusing. This is the short, no-BS version.

1. How the subsidy actually works

• You buy a regular individual plan on Healthcare.gov (or your state’s Marketplace)
• The government sends money (your premium subsidy) every month directly to the insurance company
• You only pay the reduced amount (or nothing if the subsidy is big enough)
• You get the savings immediately — not as a tax refund later

2. Basic rules to qualify (most self-employed people check every box)

• You buy the plan on the Marketplace 
• You don’t have affordable coverage from another job or a spouse’s job 
• Nobody claims you as a dependent 
• You’re a U.S. citizen or lawfully present

That’s it.

3. How much money are we talking about?
It’s based on one number: your **Modified Adjusted Gross Income (MAGI)** for the tax year you want coverage.

Quick way to find your MAGI right now: 

• Open last year’s Form 1040 → Look at **Line 11** (Adjusted Gross Income) 
• Your MAGI is usually pretty close to that number (add back in tax-exempt interest, any taxable Social Security, and Foreign earned money — that’s it)

Use this free subsidy calculator — takes 60 seconds: 

• https://www.kff.org/interactive/subsidy-calculator/​

It will show you exactly what you’d pay in 2026 with today’s generous rules and what you’d pay if Congress lets the enhanced subsidies expire after 2025.
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4. The magic of controlling your MAGI (this is where self-employed people win)
The lower your MAGI, the bigger your subsidy. You have way more control than a W-2 employee.
 
Best legal ways to lower your MAGI in 2026:

• Max out a SEP-IRA, Solo(k), or Simple IRA (you can put away up to $69,000+ depending on income and the type of retirement plan)
• Contribute to an HSA ($4,150 single / $8,300 family in 2026) — note starting Jan 1, 2026, you can now contribute HSA dollars just by being on a Bronze or Catastrophic plan – it doesn’t have to be “HSA-qualified” anymore
• Deduct every legitimate business expense (home office, mileage, equipment, internet, etc.)

Many sole proprietors who gross $100k–$150k end up with a MAGI under $60k after retirement contributions and expenses → resulting in huge subsidies or even $0 premiums.
 
5. The “true-up” at tax time
You tell the Marketplace your estimated 2026 income when you sign up. 

• If your actual MAGI ends up lower → you get extra money back on your taxes 
• If it ends up higher → you'll need to repay some of the subsidy back
  

NOTE: The "original" ACA subsidies (that we will be reverting to as of 1/1/2026 unless Congress acts) had "repayment caps" to mitigate how much you would have to repay if you guessed your MAGI incorrectly.  The Big Beautiful Bill removed those caps. Therefore, you will want to estimate your MAGI conservatively so that you won't have a large repayment at tax time.

You can also adjust your subsidy level mid-year. Just update your income on Healthcare.gov anytime it changes greatly and your monthly payment adjusts automatically for the rest of the calendar year.
 
6. One big caveat about individual plans
Provider networks can be narrower than group plans, especially in some states (Washington is one). Always check:

• Are your preferred doctors and hospital in-network?
• Does the plan cover you if you travel?
• Do you have a kid in college? Check that there are in-network benefits where they live during the school year.

 
YOUR 5-MINUTE ACTION PLAN

1. Pull last year’s tax return
   1. Note Line 11
   2. Add back in tax-exempt interest, any taxable Social Security, and Foreign earned money
2. Calculate your expected 2026 MAGI
   1. Will your retirement deposits change from your last tax filing?
   2. Will your HSA deposits change from your last tax filing? (Note that as of 1/1/2026 you can enroll in any individual Bronze or Catastrophic plan and make HSA deposits - even if that plan is not HSA-qualified.)
   3. Expecting any changes to your income?
   4. What about changes to your itemized “top-line” deductions?
3. Plug your expected 2026 MAGI into the Kaiser calculator https://www.kff.org/interactive/subsidy-calculator/
4. Enroll for an individual medical plan on your state’s Marketplace
   1. Go to: https://www.healthcare.gov/
   2. Open enrollment for 2026 ends January 15th in most states. Enroll by December 15 to lock in a January 1 effective date  or enroll by January 15 to start coverage on February 1.

Still confused? Talk to your CPA or a licensed broker who specializes in self-employed clients (many work on commission paid to them directly by the insurance company, so it’s free to you to access their expertise).

​Bottom line: Your gross revenue doesn’t matter — your taxable profit after "top-line" deductions does. A few smart moves can drop your MAGI enough to qualify for hundreds or thousands of dollars a month in free money from the government.
 
Don’t pay full price for health insurance if you don’t have to.

The government is shut down and the main sticking point is the end of the pandemic-era subsidies at the end of 2025. Here's a look at how the sunsetting will impact people in Washington state.

The newly enacted "One Big Beautiful Bill" is ushering in positive changes for HSAs. 

We're getting our first look at carriers' proposed 2026 rates. 

"​The future of virtual healthcare is rapidly evolving, driven by advancements in technology, increased patient demand, and a shift toward more accessible and efficient healthcare solutions."

The Washington State Office of the Insurance Commissioner (OIC) released approved 2025 rates for 11 of the 13 individual carriers who will offer options in the state.  We are still waiting to see final approvals for Asuris NW and Providence Health plan. Currently we have 14 individual medical carriers, so we will be losing one option (PacificSource) as we enter the new year.  While requested increases ranged from 4.5% to 23.8%, the final approvals fall between 5.7% and 23.7%.
 
Carriers Approved
Of the 11 individual carriers that have been approved, many finalized their plans at or below their requested rate adjustment. Four carrier’s rates have been approved at a higher level than initially requested: Community Health Network, Kaiser NW, Kaiser WA, and United Healthcare.

There are five carriers who received a double-digit increase for 2025.

• United Healthcare (23.7%)
• Regence BlueShield (22.8%)
• Regence BlueShield of OR (16.7%)
• Premera Blue Cross (14.9%)
• Bridgespan (14.9%)

For comparison, there were three carriers with double-digit increases in 2024 and six in 2023.

There are no carriers who were approved for a decrease in rates in 2025. For comparison, there were three carriers with rate decreases in 2024 and two in 2023.

To see our 2025 Individual Rate Tracking spreadsheet for more in-depth information about each carrier’ requested rate change and final approval, log in (or create an account) HERE. Scroll down to our Monthly Freebie Section.
 
Changes to County Coverage
In 2025, we will see one carrier exit the individual marketplace in Washington (PacificSource) which currently serves Clark, Pierce, Spokane, and Thurston counties. This will affect roughly 4,000 current customers. Options will remain for these individuals: Clark county will have 7 carriers offering benefit plans, Pierce county 9, Spokane county 9, and Thurston county 8.

Only one carrier, Lifewise, will be eliminating coverage in some counties. They will be dropping Clallam, Jefferson, and Mason counties. They will also be adding coverage in Grays Harbor. Two other carriers will be expanding their county lists. Community Health Network will be adding Lincoln county. And Ambetter (Coordinated Care) will be expanding into Clark, Cowlitz, Island, San Juan, Skagit, and Whatcom counties, becoming the only carrier in 2025 to offer individual coverage state-wide.
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All counties continue to have at least 3 carriers offering individual medical coverage as we head into 2025. King, Pierce and Spokane counties continue will have the most carriers available, at 9.  A full summary of carrier offerings by carrier and county can be found on our agent website. Log in (or create an account) HERE. Scroll down to our Monthly Freebie Section.
 
Comparing 2025 to Past Years
For the fourth year in a row, at least one carrier has requested an increase of over 16% to their average individual medical rates in Washington state.

The details and implementation of Washington State's long term care program, WA Cares, are still being ironed out in the state legislature. Here is what we know so far.

The carriers have submitted 2023 rates to the OIC for review. Let's take a peek at what is in store for next year's individual and small group premiums.

The flurry of announcements out of Olympia in advance of the WA Cares Fund implementation have done nothing to fix the inherent problems of the program, but have created a snowstorm of questions and confusion. Here's our take.