Individual Health Insurance for High-Income Earners Without Subsidies
- 2 days ago
- 8 min read
If you’ve ever typed “individual health insurance” into a search bar while earning a solid income, you’ve probably felt the same whiplash we see all the time: the plans are there, but the pricing looks like it assumes you’re getting a subsidy you don’t qualify for. High-income earners often land in an awkward middle ground. You’re responsible with your health, you want strong access to doctors and hospitals, and you’re willing to pay for quality—yet you still don’t want to overpay for a plan that feels restrictive or doesn’t match how you actually use healthcare.
This is the lane for people who don’t get insurance through work and don’t qualify for ACA premium tax credits. That includes self-employed professionals, high-earning consultants, 1099 contractors, business owners, early retirees under 65, and anyone whose household income puts subsidies out of reach. The goal here is simple: understand what changes when subsidies are off the table, what plan types are realistically available, and how to compare options so you end up with coverage that fits your life instead of a plan you tolerate.
Here’s the practical roadmap we use when guiding clients through this exact situation. First, we identify whether you’re primarily comparing marketplace plans, private medically underwritten plans, or both. Second, we clarify what you actually mean by “good coverage,” because that phrase can hide three very different priorities: broader provider access, lower out-of-pocket exposure in a high-claim year, or a smoother everyday experience when you need routine care. Third, we pressure-test the plan against real life—your preferred doctors, the states you spend time in, the prescriptions you don’t want to disrupt, and how quickly you want to be able to see specialists.
Most people in this category don’t need more information. They need a clean decision process. We’ve found that once you understand the differences between marketplace plans and private medically underwritten options, the confusion drops fast. From there, it becomes a practical comparison: networks, plan design, eligibility, and what your worst-case exposure looks like in a year you actually need care. And just to keep expectations grounded, there isn’t one perfect plan for all high-income earners. There’s the right plan for your priorities, your health profile, and the kind of access you want to have when you need care quickly.
When subsidies disappear, the whole marketplace equation changes
Marketplace plans (ACA plans) are built around a structure where many households qualify for premium assistance based on income. When your income is above the threshold, you can still buy the plan—but you’re paying the full, unsubsidized premium. That’s not a penalty and it’s not a mistake. It’s simply how the system is designed. The tough part is that the retail premium can feel out of proportion to what you get, especially if the network is narrow or the plan is structured like a high-cost “pay first, then get help” setup.
ACA plans are generally priced using community rating. That means the base premium is primarily driven by age, location, and tobacco status—not your personal health history. If you’re healthy, that community-based pricing often means you’re paying a rate that doesn’t reflect your risk profile. For some high-income earners, the premium starts to feel like a blunt instrument: expensive, standardized, and not especially tailored.
Network design is also a common pain point. Many marketplace options are HMOs or EPOs, which can be perfectly workable for some people, but frustrating for others. If you’re used to PPO-style access, travel frequently, want to see specialists without referral loops, or you have preferred doctors in certain hospital systems, you may feel boxed in. We regularly see clients pay more than they expected and still feel like they’re operating inside a smaller network than they had before.
Another reality is that plan value is not just the premium. When you’re unsubsidized, it’s easy to focus on the monthly number and overlook the mechanics that determine the year’s actual cost: deductible, coinsurance, copays, out-of-pocket maximum, and how the plan treats out-of-network care. A plan that looks reasonable on premium can become irritating fast if every meaningful visit is out-of-network, requires authorization hurdles, or forces you into a limited list of providers.
Private coverage can be a better fit, but eligibility matters
When high-income earners say they want private health insurance, they’re usually describing one of two needs: better access (often PPO-style networks) and a premium that makes sense when subsidies aren’t part of the equation. One category that often comes up in these conversations is medically underwritten private health insurance. Underwriting means the carrier reviews health history to determine eligibility and pricing. That’s very different from ACA plans, which are guaranteed-issue.
For healthy applicants, underwriting can work in your favor. We’ve found that people who maintain decent health metrics and don’t have significant chronic conditions often qualify for private options that are competitive—sometimes substantially—against unsubsidized marketplace premiums. The tradeoff is simple and important: not everyone qualifies. If you have certain pre-existing conditions, private underwriting may decline coverage or offer modified terms, and the marketplace remains the reliable path.
The network question is where private PPO options often feel like a relief. PPO-style plans typically offer broader provider access and less friction when you want to see a specialist. For high-income professionals, this isn’t a luxury; it’s practical. Time matters, and access matters. If you have a preferred hospital system, a specialist relationship you want to keep, or you spend time in more than one state, the ability to operate in a wider network can be the difference between coverage on paper and coverage you actually use.
Private plans can also be appealing because many allow year-round enrollment. Marketplace coverage generally has an annual open enrollment window unless you qualify for a special enrollment period. People leaving a corporate job, relocating, or transitioning between contracts don’t always want to wait for a window. A year-round option can help prevent coverage gaps, which is especially relevant for anyone managing prescriptions, ongoing care, or simply wanting peace of mind.
It’s worth saying clearly: private coverage is not better in every case. It’s better when you qualify and when the plan design matches your needs. If you’re managing a complex medical situation, the guaranteed-issue nature of marketplace coverage can be the safer choice. The smarter approach is not to pick a side; it’s to compare what you can actually get based on your health profile and the kind of access you want.
Think like a high-income earner: compare the plan experience, not just the brochure
High-income earners often have a different relationship with risk. Many people in this bracket can handle routine medical costs without stress. The real reason insurance matters is protection against high exposure in an unexpected year—accidents, surgeries, hospitalizations, major diagnostics, and complex treatment plans that rack up costs quickly. So instead of asking what’s the cheapest plan, we typically encourage a better question: what’s the plan that protects me well and still lets me use healthcare the way I prefer?
Start with your non-negotiables. If keeping certain doctors matters, the provider network comes first. If you travel often, you want to understand how the plan works outside your home area. If you want freedom to see specialists without referrals, that should be part of your filter early, not a footnote after you’ve already chosen.
Next, look at how the plan behaves in real life. A lot of frustration comes from misunderstanding what triggers the deductible, when coinsurance kicks in, and how prescriptions are treated. Two plans can share a similar premium and still feel wildly different once you start using them. One plan might be heavy on deductible exposure, meaning you pay the first chunk of costs before the plan shares. Another might have copays for common services that make routine care feel smoother. Neither is automatically better. It depends on how you actually use healthcare.
Out-of-pocket maximum matters more than people think—especially for high-income earners who assume they can just handle it. You can handle a lot until you hit a year with real claims activity, and then the out-of-pocket maximum is the ceiling that protects you. We’ve found that people often regret not paying attention to this number when they end up in a high-use year. It’s not about being pessimistic; it’s about being realistic.
Don’t ignore the out-of-network rules either. Some plans technically have out-of-network coverage but in a way that’s hard to use. Others may provide broader out-of-network access with different reimbursement structures. If you’re choosing a plan because you want freedom, confirm exactly how that freedom is treated in writing. That includes whether balance billing may apply and how the carrier determines allowed amounts.
Prescription coverage can also be a quiet deal-breaker. Even if you’re healthy, you may rely on one or two medications you don’t want to swap. Formularies differ, and the best plan on paper can become a headache if your medication ends up in a higher tier or requires step therapy. A quick review of your current prescriptions and preferred pharmacies should be part of any serious comparison.
There’s also a timing element that high-income earners sometimes underestimate. If you’re leaving an employer plan, your enrollment window, your start date, and your continuity of care can all matter. We often see people focus on the best plan and forget to ask, can I start it when I need it, and can I keep my care uninterrupted? The plan that starts on time and supports your provider relationships can be the better move even if the premium difference is not dramatic.
Common high-income scenarios we see, and how the strategy shifts
A lot of high-income earners buying individual health insurance fit into predictable scenarios, and each one changes what best looks like. The most obvious is the self-employed professional: consultants, agency owners, real estate professionals, attorneys, and high-earning contractors who need coverage that feels stable year-round. In that situation, we often see people prioritize strong networks and predictable plan behavior because they’re running a business and don’t want insurance friction to steal time.
Another common scenario is someone leaving a corporate role—either voluntarily or through a transition—who wants an individual plan that doesn’t feel like a downgrade. This group often cares about maintaining doctor relationships and staying inside certain hospital systems. If that’s you, the right approach is typically network-first: confirm access, then confirm plan design, then compare premium. Doing it in the reverse order tends to create regret.
Early retirees under 65 are another major category. This group is often bridging to Medicare and wants a plan that’s dependable for a few years without constant disruption. The important piece here is planning for how premiums and plan availability can change over time. We can’t predict every carrier shift, but we can choose a structure that’s less likely to create a surprise mid-bridge.
Then there are high-income earners who travel frequently—executives, remote professionals, and people whose work spans multiple states. For these individuals, a plan that only works well in one local network can be limiting. If you’re on the road a lot, you want to be very clear about emergency vs non-emergency coverage and what happens when you need care away from home.
Finally, there are families where one spouse has access to employer coverage and the other doesn’t, or where the employer plan is available but not desirable. In those cases, splitting strategies can sometimes make sense—keeping dependents on one plan and placing the other spouse on an individual option. It’s not always the best move, but it can be worth evaluating if network needs or premium structures are dramatically different.
If you want a simple gut-check before comparing plans, keep this mental checklist in mind. First, confirm network access for the providers you’d actually use, not just the big-name hospital system. Second, confirm how the plan treats specialist visits, imaging, and urgent care, because those are the services that create surprises. Third, confirm your worst-case number for the year (your out-of-pocket maximum and any out-of-network exposure rules). When those three are clear, you’ll feel much more confident about whether a plan is truly a fit.
If you want help comparing your options, Budd Health Advisors can walk through the marketplace and private side with you and map out what you actually qualify for. You can also follow us on Facebook at facebook.com/buddhealthadvisors for ongoing guidance and quick explanations that make this process easier. If you'd like to learn a little more about your options you can always visit our page on Private Health Insurance, or simply schedule a free consultation with one of our advisors.
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