Self-Employed Health Insurance in Virginia
Working for yourself in Virginia means you pick your own health plan, and the right one depends on your income, your health and a few rules that only apply in Virginia. Individual premiums in Virginia are set to rise 15.8% to 16.9% on average for 2027, and with the enhanced tax credits gone, anyone above the subsidy line pays the full increase.
Private health insurance in Virginia
Most people I help in Virginia end up on a private plan, not a Marketplace plan. Private, medically underwritten health insurance is priced on your age, zip code and health instead of your income, so a strong year never raises your premium and there is no tax credit to pay back in April.
Why people leave the Marketplace
- Premiums keep climbing. Virginia Marketplace premiums are rising 15.8% to 16.9% on average for 2027.
- The subsidy cliff. Above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) you pay full price.
- Surprise tax bills. Underestimate your income and you repay the tax credit in April.
- Narrow networks. Many plans are local HMOs or EPOs that need referrals and cover little outside the area.
- High out-of-pocket costs. 2027 out-of-pocket maximums reach $12,000 per person and $24,000 per family.
- One window a year. Outside open enrollment you need a qualifying life event to enroll or switch.
What a private plan does differently
- Start any month. If approved, coverage can begin the first of next month, with no wait for open enrollment.
- Networks that travel. Many private plans use national PPO networks, which can give you in-network doctors outside Virginia too. Networks vary by plan.
- Can cost less than full-price Marketplace plans for some healthy applicants above the subsidy line.
- Accident coverage the Marketplace does not offer. A private plan can be paired with accident coverage, a separate policy. What it includes varies by plan.
- Approval is based on health. You answer health questions, and acceptance is not guaranteed.
With a significant health condition, or income low enough for a large tax credit, a Marketplace plan can be the better fit, and I will tell you if it is. Either way you see both side by side.
Private plans are not ACA Marketplace plans. Benefits, exclusions and pre-existing condition rules differ by plan and by state, so review the plan details before you enroll.
Get a private plan quoteLearn more: coverage not based on income · how underwriting works · private vs Obamacare · PPO plans for individuals · switching from the Marketplace
Who works for themselves in Virginia
Virginia has 880,366 small businesses, 99.6 percent of all firms, and they employ 1.6 million people, by the SBA Office of Advocacy's 2025 count. Most of them, 722,562, have no employees beyond the owner. Professional, scientific and technical services lead by a wide margin with 109,225 one-person firms, reflecting the state's many consultants and contractors. Transportation and warehousing follows with 99,301, then real estate, other services such as repair and personal care, and construction. Each of those owners has to find and pay for health coverage without an employer plan.
How Virginia taxes self-employed health premiums
Virginia's income tax starts from federal adjusted gross income under Code section 58.1-322, so the federal self-employed health insurance deduction and the HSA deduction carry through to the state return. Virginia conforms to the federal tax code as of a fixed date, with some exceptions. Rates are graduated, topping out at 5.75 percent. Virginia also lets you subtract long-term care insurance premiums that you did not deduct on your federal return. General information, not tax advice — confirm with your CPA based on your specific entity structure.
Virginia options beyond the Marketplace basics
Several 2027 changes matter to self-employed Virginians. State law eliminated the tobacco rating factor in ACA markets for 2027, so smokers will not pay a tobacco surcharge on Marketplace plans. One insurer that held about 8 percent of individual enrollment leaves the market after 2026, and the Bureau of Insurance says most of the state will see only two insurers on the exchange. Virginia also has a 2022 law allowing an association health plan for real estate salespersons, but federal regulators ruled in 2023 that it must follow federal market rules, so check whether any plan is actually offered.
Virginia at a glance for people who work for themselves
Virginia buyers shop on Virginia's Insurance Marketplace, the state-run exchange and the only place to apply for federal premium tax credits and the new state help called Virginia Premium Savings. Starting with 2027 plans, Virginia Premium Savings lowers premiums for households earning 138 to 250 percent of the federal poverty level, is applied after any federal credit, and is paid from a fixed state appropriation, so funding may not reach everyone who qualifies. Virginia also runs a state reinsurance program, administered by the Bureau of Insurance and approved through 2027, that helps hold down individual-market premiums. The enhanced federal credits ended after 2025, and excess advance credits must now be repaid in full at tax time, so self-employed tradespeople should keep their income estimate current. Leaving a small employer gives you 12 months of state continuation, short-term plans are held to three months at a time and six months in any year, and open enrollment runs to January 29, 2027.
Other Virginia rules to know
- Leaving a small employer: Virginia requires insured group plans that are not subject to federal COBRA, which generally means employers with fewer than 20 employees, to offer 12 months of continuation after at least three months of coverage, at the group rate plus an administrative fee of up to 2 percent.
- Short-term plans: Virginia law caps short-term plans at an initial term of three months and no more than six months of coverage in any 12-month period, a state limit that applies regardless of how federal rules are enforced.
- Where to enroll: Virginia runs its own exchange, Virginia's Insurance Marketplace, and open enrollment for 2027 coverage runs November 1, 2026 to January 29, 2027, with a December 15 deadline for coverage that starts January 1. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 15.8% to 16.9% on average, small-group plans about 10.7%. See the Virginia 2027 rate page.
Private plan or Marketplace
Above 400 percent of the poverty level, a Marketplace plan costs full price. A healthy self-employed buyer in that range may pay less with a private, medically underwritten PPO priced on health rather than income, and if approved, it can start the first of any month. With a health condition, or with income low enough to qualify for a credit, the Marketplace is usually the better choice because approval is guaranteed.
Estimating income when it changes every month
The Marketplace credit is based on this year's projected net income from Schedule C or your K-1, not gross revenue. Estimate conservatively, update it when a big contract lands, and remember that above the line you repay the entire advance credit.
An HSA as a second retirement account
For 2027 every bronze and catastrophic plan is HSA-eligible, and the contribution limits are $4,500 for self-only coverage and $9,000 for family coverage, plus $1,000 at 55 or older.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
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Virginia questions
Where do Virginia residents enroll in 2027 coverage?
Virginia runs its own exchange, Virginia's Insurance Marketplace, and open enrollment for 2027 coverage runs November 1, 2026 to January 29, 2027, with a December 15 deadline for coverage that starts January 1.
What continuation rights does Virginia give after leaving a small employer?
Virginia requires insured group plans that are not subject to federal COBRA, which generally means employers with fewer than 20 employees, to offer 12 months of continuation after at least three months of coverage, at the group rate plus an administrative fee of up to 2 percent.
How much are Virginia premiums rising for 2027?
Individual-market premiums are set to rise 15.8% to 16.9% on average, and small-group plans about 10.7%.
Can self-employed people deduct health insurance premiums?
Usually, if you are not eligible for an employer plan through a spouse, the federal self-employed health insurance deduction lets you deduct premiums for yourself and your family. General information, not tax advice — confirm with your CPA based on your specific entity structure.
When can a self-employed person buy health insurance?
Marketplace plans need open enrollment, November 1 to January 15 for 2027, or a qualifying event. Private plans can start the first of any month if you are approved.
Sources: advocacy.sba.gov, law.lis.virginia.gov, law.lis.virginia.gov, www.scc.virginia.gov. Facts checked October 2026. See all Virginia health insurance rules.
Self-employed in other states
Written by Frank Caballero, licensed health insurance agent in Virginia and 30 other states, NPN 21032307.