Health Insurance for CPAs and Accountants Who Run Their Own Practice

Start with the private option

Most accountants I work with who run their own firm end up on a private plan. A private, medically underwritten plan is priced on your age, zip code and health, not on the number at the bottom of your Form 1040. If approved, it can start on the first of any month, and many of these plans use national PPO networks, so a client meeting in another state or a week away after April 15 does not leave you out of network. You answer health questions to apply, and approval is not guaranteed.

Private plans are not ACA Marketplace plans, and benefits and pre-existing condition rules vary by plan. That is exactly why the comparison matters, and why I lay both options out side by side before you choose.

The Marketplace problems a CPA spots right away

You have read the reconciliation forms. Here is how the 2027 rules land on a practice owner:

• Rates keep climbing. KFF's review of 2027 filings from 276 Marketplace insurers found a median proposed increase of 15 percent, on top of a steep rise for 2026.
• The credit ends at a hard line. For 2027, help stops at 400 percent of the federal poverty level: $63,840 for one person, $86,560 for two, $109,280 for three and $132,000 for four. One dollar over and the credit is zero.
• You pay it back in April. If you take an advance credit based on a projection and your final income lands above the line, you repay the entire advance on Form 8962. For a practice whose profit swings with extension season, that is a real exposure.
• Narrow networks. Many Marketplace plans are HMO or EPO designs built around a local network, with little or no coverage outside it except emergencies.
• A high ceiling. The 2027 out-of-pocket maximum is $12,000 for one person and $24,000 for a family.
• One window a year. Open enrollment runs November 1, 2026 to January 15, 2027, with December 15 the deadline for a January 1 start. Miss it and you generally need a qualifying event.

For context, the Bureau of Labor Statistics put the mean annual wage for employed accountants and auditors at $94,750 in May 2025, across roughly 1.45 million jobs, and that figure leaves out self-employed practice owners entirely. A single CPA earning the average employee wage is already past the one-person line, and an owner's profit often sits well above it.

Busy season and open enrollment collide

Here is the timing problem few people mention. The Marketplace window closes January 15, right as organizers, 1099s and payroll filings pile up on your desk. Plenty of accountants either rush the decision or let last year's plan roll over without checking the new rates.

A private plan removes the deadline. Because coverage can start the first of any month if approved, you can review options in May, after the April crunch, or in late October once extensions are filed. If a renewal comes in at a price you do not like, you are not stuck waiting eleven months for the next window.

Leaving a firm to open your own practice

The most common reason a CPA calls me is the move from a regional or national firm to a solo or two-partner practice. When you leave, losing job coverage opens a 60-day special enrollment period for the Marketplace. Federal COBRA applies to employers with 20 or more employees, lasts up to 18 months and can cost up to 102 percent of the full premium, meaning the employer's share, your share and a small fee.

A sensible sequence:

1. Confirm the last day of firm coverage before you give notice.
2. Price a private plan to start the first of the following month if approved, so there is no gap.
3. Keep COBRA in your back pocket. You have a window to elect it, and once elected and paid it reaches back to the day coverage ended, which protects you while underwriting finishes.
4. If a health condition makes private approval unlikely, enroll in a Marketplace plan inside the 60 days.

Our COBRA alternatives guide covers the trade-offs in more detail.

Premiums on the owner's return

As an owner, you likely know the self-employed health insurance deduction better than most clients do. It is available to sole proprietors, partners and more-than-2-percent S corporation shareholders, it is tied to the business that establishes the plan and limited by that business's net earnings, and it is not allowed for any month you were eligible for a subsidized employer plan, including a spouse's. Those rules apply whether the policy is a private plan or a Marketplace plan. General information, not tax advice — confirm with your CPA based on your specific entity structure.

Covering staff without a group plan

Once you hire a bookkeeper or a seasonal preparer, the question becomes whether to offer health benefits. A traditional small-group plan is one route. Two reimbursement arrangements are often simpler for a small firm:

• QSEHRA: for employers with fewer than 50 full-time employees. You set a monthly allowance, and staff buy their own individual coverage that meets the arrangement's rules.
• ICHRA: works for any size employer and lets you set different allowances by class of employee, such as full-time staff versus seasonal preparers.

Both come with notice and documentation requirements, which you will appreciate more than most owners. Our ICHRA guide and small business owner guide walk through the setup.

When the Marketplace is the better fit

I steer some CPAs to the Marketplace, and I will tell you if you are one of them. If you or a family member has a significant health condition, the Marketplace is the guaranteed option: it cannot turn you down or price you on your health. The same goes for a first year in practice when profit will honestly land under the line for your household size, because then the credit can be worth more than anything underwriting saves. Bronze and catastrophic plans have been HSA-eligible since 2026, and the 2027 HSA limits are $4,500 for self-only and $9,000 for family coverage, plus a $1,000 catch-up at 55.

Getting a side-by-side

Everything runs by phone or video, and I am licensed in 31 states, including Florida and Georgia. Send your zip code, the ages on the plan and a short health summary, and I will price private options next to the Marketplace. You can get a quote or call (786) 218-2384. For other professions, see health insurance by occupation.