Health Insurance for Self‑Employed Business Owners in Texas: Off‑Exchange Options
If you’re self‑employed in Texas, choosing the right health insurance can be daunting. Unlike employees who have access to employer‑sponsored plans, self‑employed business owners must navigate the individual marketplace or alternative options on their own. Many high‑income entrepreneurs find that they don’t qualify for Affordable Care Act (ACA) subsidies, which means paying full price for marketplace plans. In some cases, off‑exchange private health insurance plans through national PPO networks provide more affordable coverage.
Understanding ACA Marketplace Costs
The ACA marketplace offers a range of plans categorized by metal levels (Bronze, Silver, Gold, Platinum). Premiums vary by state and age. According to MoneyGeek’s 2025 analysis, the average premium for a 40‑year‑old buying a Silver plan is $539 per month nationally
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. In Texas, the average monthly cost is about $588 ($7,060 annually)
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. These figures reflect full‑price premiums, not reduced by subsidies.
Most Texans who buy marketplace coverage benefit from premium tax credits; in early 2024 roughly 97% of Texas marketplace enrollees received subsidies averaging $533 per month, lowering their premium to around $51
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. The American Rescue Plan temporarily removed the upper income cap for subsidies through 2025, but eligibility still depends on how the benchmark plan’s premium compares with your income. For self‑employed business owners with high incomes, the benchmark premium must not exceed 8.5% of household income
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. When you pay full price, a marketplace plan’s rates can be double or more than off‑exchange alternatives.
Benefits of Off‑Exchange Private PPO Plans
Off‑exchange plans are health insurance policies purchased directly from insurers, not through the government marketplace. They are not eligible for ACA subsidies, but they often have competitive premiums and broader provider networks. For example, the United Healthcare Choice Plus PPO network offers nationwide coverage through large networks of doctors and hospitals. Unlike some marketplace HMOs, PPO plans typically allow you to see specialists without referrals and access out‑of‑network care.
Because these plans are medically underwritten, premiums are based on your health history and lifestyle rather than community rating. Applicants who are reasonably healthy may secure significantly lower rates than marketplace plans. Off‑exchange plans also offer flexibility for families who travel often or split time between multiple states. Another advantage is the availability of value‑added benefits such as wellness programs, telehealth services, and optional dental or vision coverage. At My Private Health Insurance, we specialize in off‑exchange options through United Healthcare’s Choice Plus PPO and other national networks, tailored for self‑employed individuals and families who exceed ACA subsidy income thresholds.
Special Options for Texas Small Business Owners
Texas has unique rules that can benefit self‑employed couples. The state allows married couples who work together in a business to count as two employees, making them eligible for small‑group health insurance
Small‑group plans often have lower premiums and more robust coverage than individual marketplace plans. If you and your spouse run your business together, you may qualify for a small‑group PPO plan even if you don’t have additional employees. Our agency can help you determine whether a group or individual plan is best for your situation.
Texas also has a competitive marketplace with 16 insurers offering individual plans for 2025, but rates vary widely. UnitedHealthcare’s 2025 filings indicated an average rate increase of about 8.94%, while some insurers requested increases over 20%
Off‑exchange plans can provide rate stability since they are not tied to marketplace fluctuations. So there are options for small business owners in Texas to get affordable health insurance, especially when it’s less than 5 employees.
How to Choose the Right Health Coverage
When comparing ACA marketplace and off‑exchange plans, consider your income, expected healthcare usage and provider preferences. If an ACA plan might be more affordable because you expect to qualify for subsidies, an ACA plan might be the best option. If you expect to pay full price, a private PPO plan could save you money and offer a broader network. Evaluate the monthly premium, deductible and out‑of‑pocket maximum, as well as ancillary benefits like telehealth and wellness programs.
It’s also important to think about future changes. The enhanced ACA subsidies are set to expire after 2025 unless Congress extends them. Off‑exchange plan underwriting can change if your health status changes, so enrolling while healthy may secure a lower rate. Work with a licensed agent to review your options annually.
Next Steps
Navigating the world of health insurance as a self‑employed business owner doesn’t have to be overwhelming. If you live in Texas and have questions about off‑exchange private health insurance, we’re here to help. Our team at My Private Health Insurance specializes in assisting self‑employed individuals and small business owners who exceed ACA income limits. We’ll compare marketplace plans and off‑exchange health insurance options to find coverage that fits your budget and lifestyle.
For more health insurance options for small businesses in Texas visit below