When you run your own therapy practice, you control your caseload, but you're also responsible for buying health insurance. Here's how therapists and counselors in private practice are managing that expense and keeping their coverage affordable this year.
Hi, I'm Sam Jaber, and I work as a licensed health insurance broker out of Tampa. I hold licenses in 36 states, and I handle every conversation over the phone. Whether you work from an office or provide telehealth services from your house, your location doesn't change how we work together.
More and more of the people reaching out to me are therapists and counselors. A lot of them started out working for an agency, hospital program or group practice, spent several years getting fully licensed, and eventually decided to open their own office. Having control over your practice feels great, but there's another side to it. The health insurance you had through your previous employer doesn't follow you when you leave.
Your work involves guiding people through complicated choices every day, so I want to make your own insurance decision easier. One important question usually points us in the right direction, with a few different circumstances to consider afterward. Take a look below and see which situation matches yours.
Here's the main question: do you expect your household income to fall below the subsidy threshold during the year you're getting coverage?
The cutoff is approximately four times the federal poverty level. For someone living alone, that works out to slightly more than $60,000 annually. As you add people to the household, the income threshold increases accordingly.
A lot of therapists running their own practices have income that falls near this cutoff, so understanding where you stand is especially important. Since you work for yourself, we're looking at the practice's net income rather than everything it collects. That means subtracting expenses such as office rent, EHR software, billing services, liability insurance, continuing education and other operating costs. Even with a packed appointment schedule, your income after those deductions might still fall below the threshold.
When your income falls below that threshold, a marketplace plan will generally be your most affordable route. Financial assistance is available only through marketplace coverage, and if you're a counselor earning close to the cutoff, that subsidy could make a substantial difference in your monthly premium.
Estimating your earnings is usually the challenging part. When you run a private practice, your income can shift because clients cancel appointments, take time away during holidays, or because insurance panels delay payments. You apply using projected earnings, but if your actual income ends up higher, the difference gets reconciled when you file your taxes. That may mean paying back some of the subsidy. The guidance on healthcare.gov for people with uneven earnings is to report the best estimate they have now and revise it whenever their circumstances change. I'll help you follow that approach.
Next step: Give me the numbers from last year, and we'll put together a reasonable income projection you feel comfortable using. From there, we'll choose coverage that makes sense for that estimate.
Once your income exceeds the subsidy threshold, you're responsible for the entire premium without financial assistance. Marketplace coverage is still available, but paying the full price can feel excessive when everyone in your household is healthy and doesn't use much medical care.
That's when I introduce another possibility for clinicians who are healthy: medically underwritten private coverage purchased outside the marketplace. The application includes questions about your health, and the insurance company reviews those answers to determine whether you'll qualify and under which conditions. If you're in good health, the premium may be considerably lower than what you'd pay for a marketplace plan without subsidies.
One advantage of these plans is that they use PPO networks extending nationwide instead of restricting you to a single local area. That flexibility can matter when you divide your time between different locations or have relatives living in another state.
Your medical history matters because the insurer uses your health information to make its decision. Previous diagnoses could result in an application being declined or certain conditions being excluded. That's why we'll review everyone's history carefully and truthfully before submitting anything. Coverage details aren't identical from plan to plan either, so I'll explain exactly which benefits each option provides before you decide.
Next step: Give me a call so I can compare a nationwide PPO quote with the full marketplace premium for everyone in your household.
Leaving an employed position generally means losing the health insurance that came with it. When that happens, you typically have a 60-day special enrollment period to purchase marketplace coverage without waiting for open enrollment. COBRA requires some planning, though. If you voluntarily terminate COBRA before it expires, that decision doesn't create another enrollment opportunity. We'll work out the timing before making the change instead of rushing into it.
It's difficult to know exactly what you'll earn during your first year running a private practice. Maybe you'll gradually add clients and build your schedule, or perhaps you'll bring an existing caseload and get busy quickly. We'll consider both possibilities and choose based on the year you realistically expect.
Next step: Reach out before you finish your last day with the agency. That gives us time to arrange new health insurance so your coverage begins as soon as the previous plan ends.
Depending on your location, the marketplace might offer nothing beyond HMO and EPO coverage, or its PPO premiums might be more than you're comfortable paying. You still have another possibility. For healthy applicants, I can provide nationwide PPO quotes throughout all 36 states where I hold a license. We can go over the pricing together during a brief phone conversation.
You can call without preparing anything, although having the following information handy makes things easier:
There's no fee for getting my help. When you enroll in coverage, the insurance company compensates me directly. Your monthly premium doesn't change based on whether you work with me or purchase the plan another way.
Straight answers, no sales pitch.
Yes, in many situations. However, the deduction for self-employed health insurance cannot exceed your practice's net profit. It also isn't available for months when you were eligible for employer-sponsored coverage, including insurance offered through your spouse's job. Your tax preparer can review your circumstances and verify whether the deduction applies.
Look at your previous tax return along with what you've earned in recent months to project your income for the year as accurately as possible. Whenever your earnings change, revise that estimate through the marketplace. Making those adjustments quickly can reduce the possibility of having to repay subsidy money when you complete your taxes.
When you lose coverage through an employer, you generally have 60 days to choose a marketplace plan. If you're considering a medically underwritten private plan instead, start the application early enough to allow time for approval.
Absolutely. If you're healthy and your earnings put you above the subsidy cutoff, I can provide quotes for private coverage using PPO networks with nationwide reach. I offer those quotes across every one of the 36 states where I'm licensed.
Tell me approximately how much your practice brought in after expenses last year, who needs coverage, and which providers you'd like to continue seeing. With that information, I can explain which direction makes sense and what you'd pay. And if your current coverage is already a good fit, I'll be upfront about that too.
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