The usual advice about health insurance for self-employed coaches is to pick a plan once and let it renew. For 2027, that’s the advice most likely to cost you money.
Premiums are rising again, the extra federal help many people relied on is gone, and the safety net that limited what you might owe back at tax time has been removed. None of that means coverage is out of reach. It means the choices you make before December 15 matter more than they have in years, especially when your income moves around the way a coach’s often does.
A quick word on scope before we start. This isn’t insurance or tax advice. It’s a plain guide to what changed and the decisions worth thinking through, so you walk into enrollment (or into a conversation with a licensed agent or accountant) with better questions.
What’s changing for 2027 coverage
Four changes matter most if you buy your own coverage on the marketplace.
**Premiums are going up.** Insurers proposed a median increase of 15% for 2027, according to KFF’s review of filings from 276 insurers across all 50 states and DC. Those are proposed rates, not final ones, and final numbers usually show up around the start of enrollment. For context, the same analysis found that 2026 increases were proposed at 18% and finalized at 20%.
**The enhanced premium tax credits are gone.** The larger subsidies that had been in place for several years expired at the end of 2025. Under the rules that apply now, the premium tax credit is available for household incomes between 100% and 400% of the federal poverty level. HealthCare.gov lists the 2026 poverty level as $15,960 for one person. Unless Congress restores the enhanced credits, earning just past that upper limit can mean losing help entirely, not gradually.
**There’s no cap on paying subsidies back.** If you take the credit in advance and your actual income comes in higher than you estimated, you repay the difference when you file. The IRS says the repayment limits that used to cap that amount no longer apply, starting with tax year 2026. Your 2026 return, filed in early 2027, is the first one affected.
**Bronze plans now work with health savings accounts.** IRS Notice 2026-5 confirms that bronze and catastrophic plans bought through an exchange count as HSA-compatible for months after December 31, 2025. That opens a door that was mostly closed before.
Why uneven income makes this harder
A salaried employee estimates next year’s income by looking at their offer letter. You estimate it by guessing how many clients you’ll sign, how many will renew, and whether that corporate contract comes through in March or slips to June.
The marketplace asks for your best estimate of the coming year’s household income, and it sets your advance credit from that number. Guess low and you get a bigger credit now, then a bill at tax time. With the repayment caps gone, that bill has no ceiling. Guess high and you pay more each month than you needed to, though you get the difference back when you file.
Neither mistake is fatal. One of them can arrive as a surprise in April, though, and that’s the one worth planning around.
Four decisions to make before December 15
Open enrollment on HealthCare.gov starts November 1. December 15 is the last day to pick a plan for coverage starting January 1, and enrollment closes January 15 (with coverage starting February 1). States that run their own exchanges can set different dates, so check yours.
1. Project your income conservatively
Start from your realistic year, not your hopeful one. Look at what you actually earned over the past twelve months, then add only the clients and contracts you’re confident in. If you’re weighing a move from a day job to full-time coaching, our post on when to quit your job for coaching covers the health coverage gap that catches many coaches off guard, including COBRA and the special enrollment window when job coverage ends.
Then think about where you sit relative to that 400% limit. If your realistic income lands just above it, a few decisions (like the timing of a big invoice or a retirement contribution) might change your picture. That’s a conversation for your accountant, and a good one to have before you enroll rather than after.
A simple revenue and expense forecast makes this much easier. Our free worksheet walks you through estimating both, so you have an actual number to bring to the application instead of a hunch.
Estimate Your Expenses and Revenue
Use this three-page worksheet to figure your projected start-up costs and ongoing costs for starting a life coaching business. Then compare costs to your potential income to weigh the viability of your new venture.
2. Plan to update your estimate during the year
Your estimate isn’t locked in. HealthCare.gov asks you to update your application as soon as possible when your income or household changes. If you land two new clients in the spring, report it then. Your advance credit adjusts, and you avoid a larger balance due at tax time. If income drops, you may qualify for more help.
Put a reminder on your calendar for once a quarter. It takes ten minutes, and it’s the most practical protection you have against an April surprise. Pair it with your regular bookkeeping routine, since you’ll be looking at the same numbers anyway.
3. Compare plans instead of auto-renewing
Letting your current plan roll over is easy. With proposed increases this large, it’s also risky. Your insurer might raise rates more than its competitors, change its network, or adjust the deductible. Your subsidy might be calculated differently too.
Log in, look at what your current plan will cost for 2027, and compare it against at least a few alternatives in your area. Check whether your doctors are still in network. Look at the out-of-pocket maximum as well as the monthly premium. For 2027, the federal cap on out-of-pocket costs for marketplace plans is $12,000 for an individual and $24,000 for a family, so know where your plan falls within that range.
4. Weigh a bronze plan with an HSA
This is the newest option, and it deserves a real look. Bronze plans tend to have lower premiums and higher deductibles. Now that HealthCare.gov confirms all bronze and catastrophic plans work with health savings accounts, you can pair a lower premium with an account that lets you set money aside for medical costs.
For 2027, the IRS limits HSA contributions to $4,500 for self-only coverage and $9,000 for family coverage. In a strong month, you can put some money away. In a lean month, you don’t have to.
The tradeoff is real, though. A high deductible means you’ll pay more of your own costs before coverage kicks in. If you expect regular care, a plan with a higher premium and lower deductible might cost less over the year. Catastrophic plans are another option for people under 30 or those who qualify for a hardship exemption, but they don’t qualify for the premium tax credit.
Questions to take to an agent or accountant
You don’t have to work this out alone. A licensed insurance agent can compare plans in your area, and an accountant can help with the income side. Bring these:
- Based on my realistic income, how close am I to the 400% limit, and does anything I control change that?
- How much of my 2027 premium could I owe back if my income comes in higher than I estimate?
- Do I qualify for the self-employed health insurance deduction, and how does it interact with the premium tax credit?
- Would a bronze plan with an HSA cost me less over the year than the plan I have now?
These questions belong in the same file as the rest of your setup decisions. If you haven’t looked at the other pieces yet, our guide to legal requirements for a coaching business covers business insurance, and a coaching business plan is a natural place to record what your coverage costs.
Health insurance is one of the real costs of working for yourself, and it’s often the one people underestimate when they first make the leap. Giving it an hour before December 15 is time well spent. You do important work for your clients. Taking care of your own coverage is part of keeping that work sustainable for years to come.
