Healthcare Alternatives for the Self-Employed: Finding Freedom Beyond Traditional Insurance
Self-employed people can choose from six main options: Marketplace health insurance, COBRA continuation, a QSEHRA for owners who have employees, direct primary care, short-term health insurance, and medical cost sharing such as Knew Health. They differ in monthly cost, doctor choice and how large bills are handled, so the right fit depends on your state, income, health history and how much cost predictability you want.
If you work for yourself, you pay for healthcare out of the same income that runs the business. This guide walks through each option in plain terms, including where Knew Health fits and who it may not suit.
Self-employed? Explore a different approach to healthcare.
Knew Health combines wellness-focused resources, personalized Care Team support, and community-based medical cost sharing. Memberships start at $178/month. See what your monthly contribution could look like.
Knew Health is not insurance, we're a medical cost sharing community. Not available in California, Illinois, Maryland, New York, Oregon, Pennsylvania, Vermont, New Mexico, or Washington. See state availability.
On this page
- What healthcare options do self-employed people and freelancers have?
- Why are health insurance premiums so high, and what are the alternatives?
- What are my healthcare options if COBRA is too expensive?
- How medical cost sharing works at Knew Health
- What a Knew Health Membership includes
- Is Knew Health a good option for self-employed people?
- What members say
- Lowering a medical bill as a self-pay patient
- How to choose
- Frequently asked questions
- Next steps
What healthcare options do self-employed people and freelancers have?
Six options come up most often. The table shows how each one works, and the notes below it cover the details.
| Option | How it works | How you pay | When a large bill arrives | Worth checking |
|---|---|---|---|---|
| Marketplace health insurance | Plans sold through HealthCare.gov or a state exchange under federal and state rules | Monthly premium based on age, location and plan level, reduced by income-based tax credits if you qualify | The plan pays according to its terms once you meet its cost-sharing amounts | Enrollment windows and network limits |
| COBRA continuation | Lets you keep a former employer's group plan for a limited time after you leave a job | Up to 102% of the plan's full cost, because the employer no longer pays a share | Same as the employer plan | 60 days to elect. Only available if you had an employer plan |
| QSEHRA | A business with fewer than 50 employees reimburses them tax-free for individual health costs | Employer-funded, up to $6,450 self-only or $13,100 family in 2026 | Depends on the plan the employee buys | Needs employees. A solo owner generally can't use one |
| Direct primary care | A flat monthly fee for primary care with a local practice | Monthly membership set by the practice | Not designed for large bills, so many people pair it with another option | Whether the practice fits your needs |
| Short-term health insurance | Temporary health insurance for gaps between jobs or plans | Monthly premium set by the insurer | Pays according to its terms. Plans may exclude pre-existing conditions and some essential health benefits | Limits vary by state and are under federal review |
| Medical cost sharing (Knew Health) | A community of Members shares eligible medical costs. Knew Health is not insurance | Monthly contribution from $178, set by age, household type, IUA and tobacco use | After you pay your Initial Unshareable Amount (IUA) for any new eligible illness, injury or pregnancy it becomes eligible for sharing. | Under 65, eight excluded states, pre-existing phase-in, Principles of Membership |
Marketplace health insurance
Marketplace plans follow federal and state rules, so insurers can't turn you away or charge more because of your health history. The enhanced federal tax credits that lowered monthly costs for many enrollees expired at the end of 2025 and haven't been renewed, so many enrollees now pay more ( KFF). Open Enrollment for 2027 coverage on HealthCare.gov runs November 1, 2026 to January 15, 2027, and plans chosen by December 15 start January 1. State exchanges set their own dates ( HealthCare.gov). A qualifying life event can open a special enrollment period. The healthinsurance.org guide for the self-employed covers the details.
COBRA continuation
If you recently left a job with a group health plan, COBRA lets you keep it, usually for up to 18 months. You have 60 days to elect it, and you may pay up to 102% of the full plan cost ( U.S. Department of Labor).
QSEHRA for small business owners
A Qualified Small Employer HRA lets a business with fewer than 50 employees reimburse them tax-free for individual health costs, up to $6,450 for self-only or $13,100 for family in 2026 ( IRS Revenue Procedure 2025-32). It works for owners who have employees. A solo owner with no employees generally can't use one, so check with a tax advisor.
Direct primary care
Direct primary care practices charge a flat monthly fee for primary care, and basic visits typically carry no copay. They don't pay for hospital stays or surgery, so people usually pair them with another option. Knew Health Members get 10% off their monthly contribution when at least half the household is active with a qualifying practice.
Short-term health insurance
Short-term plans fill a gap between jobs or plans. They typically don't have to cover pre-existing conditions or all essential health benefits. In August 2025, the federal agencies said they won't prioritize enforcing the 2024 limits while new rulemaking is pending ( U.S. Department of Labor). States set their own limits, so confirm the rule where you live.
Medical cost sharing
Medical cost sharing is a community-based approach. Members contribute monthly, and the Community shares eligible medical costs. It is not insurance. The sections below explain how Knew Health's version works.
Why are health insurance premiums so high, and what are the alternatives?
Individual-market premiums reflect the cost of the care a plan expects to pay for, and they're priced by age, location and plan level. People who buy alone have no employer paying a share, and the enhanced federal credits that offset prices for many enrollees expired after 2025. The six options above are the main alternatives. For what's driving next year's prices, see our post on Health Insurance Costs Could Increase Again in 2027.
What are my healthcare options if COBRA is too expensive?
Compare a Marketplace plan, a Knew Health Membership, direct primary care and short-term health insurance while your 60-day election window is open. Ending COBRA on your own usually doesn't open a Marketplace special enrollment period, so compare before you elect or pay.
A Knew Health Membership can start on a date you choose, and your first monthly contribution must be received before it's active. Conditions with symptoms or treatment in the 24 months before you join follow a phase-in schedule. If you're in the middle of treatment, talk to a Care Team member before you leave COBRA.
How medical cost sharing works at Knew Health
Knew Health is a Wellness Membership paired with Medical Cost Sharing: a community-based healthcare alternative for health-conscious individuals, families, and small businesses. Members contribute a set amount each month, and the Community shares eligible costs for new illnesses, injuries and pregnancies.
Choose your Initial Unshareable Amount.
Your IUA is what you pay for each new illness, injury or pregnancy before the Community shares eligible costs. The options are $1,000, $2,500 or $5,000, and the lower your IUA, the higher your monthly contribution.
Use wellness care from day one.
General Wellness Allowances, such as an annual well visit up to $250, carry no IUA and no waiting period.
See any licensed provider and say you're a self-pay patient.
Knew Health has no network restrictions, so you can choose your own practitioner within a range of licensed professionals. The Care Team can help you find providers and get estimates.
Pay your IUA and submit your bills.
Upload itemized bills and proof of your IUA payment in the Member Portal within six months of the date of service. Non-emergency surgeries need prior review.
The Community shares eligible costs above your IUA.
After you've submitted required documentation for an eligible Need, the sharing process begins within a few hours. Share-outs typically arrive within 7 to 14 business days once documentation is complete. For approved surgeries and hospital deliveries, Knew Health can share costs up to two weeks before the date of service.
A Membership pays no more than three IUAs in a Membership year, and additional eligible Needs over $500 in that year can be shared without an IUA.. The Care Team also negotiates billed amounts on eligible Medical Needs, and those negotiations have reduced them by 46% on average.
Illustration only, not a promise of sharing: if an eligible Medical Need comes to $20,000 after negotiation and the Member's IUA is $2,500, the Member pays $2,500 and the remaining $17,500 is eligible for sharing under the Member Guidelines.
Sharing history, and what it doesn't mean.
✓ Since opening in 2018, 100% of eligible Medical Needs have been shared through the Knew Health Community.
Knew Health is not insurance and sharing depends on Member contributions and the Member Guidelines.
Want to see how Membership works first?
Watch our on-demand webinar with Member Care Specialists. They walk through sharing, the IUA and who Knew Health fits.
Or check your price any time: See My Monthly Price. You can also read the Member Guidelines.
What a Knew Health Membership includes
Every Membership includes the same three pillars at every price level.
- Medical Cost Sharing: peace of mind for bigger needs. Eligible costs above your IUA for new illnesses, injuries and pregnancies. There is no annual or lifetime maximum overall, although some Needs have per-Need limits, such as $250,000 for hospitalization.
- General Wellness Allowances: support for staying healthy, from day one. Annual well visits up to $250, screening mammograms up to $500 from age 40, screening colonoscopies up to $2,500 from age 45, and immunizations, with no IUA.
- Tailored Health Support: care and extras, all year round. 24/7 telemedicine at no cost, no-cost lab panels through Evexia Diagnostics plus an $80 lab allowance per Member, two complimentary Health or Life Coaching sessions, a $200 Self-Care Credit per Membership each year for things like chiropractic care, acupuncture or gym memberships, and 35% off supplements.
Pricing depends on the oldest Member's age, household type, IUA and tobacco use. A Member Only household with the oldest Member aged 40 to 49 contributes $234 a month at a $2,500 IUA and $201 a month at a $5,000 IUA. Tobacco or smoked product use adds $195 a month per Membership. Membership is month-to-month with no enrollment fees, and contributions are post-tax, so ask your tax advisor how that applies to your business.
Is Knew Health a good option for self-employed people?
Knew Health may fit self-employed people who are under 65, live in an eligible state, want to choose their own licensed providers and are comfortable paying an IUA before large eligible costs are shared. It doesn't fit everyone, and the Member Guidelines set limits worth reading first.
Who Knew Health may fit
- Freelancers, solo founders and small business owners who want one predictable monthly contribution and wellness care from day one.
- People who want to see any licensed provider, including licensed integrative practitioners, without network restrictions. Some alternative treatments need prior written approval.
- Households comfortable paying an IUA of $1,000, $2,500 or $5,000 for each new Medical Need, with a cap of three IUAs per Membership year.
Limits to know before you join
Knew Health is not insurance, we are a medical cost sharing community.
- Location and age. Membership isn't available in California, Illinois, Maryland, New York, Oregon, Pennsylvania, Vermont, New Mexico, or Washington, and Members must be under 65.
- Conditions you already have. A condition with symptoms, diagnosis or treatment in the 24 months before you join is shared on a phase-in schedule: $0 in year one, up to $25,000 per Need in year two, up to $50,000 in year three and up to $125,000 from year four. Controlled high blood pressure, high cholesterol and diabetes aren't treated as pre-existing if you weren't hospitalized for them in the prior 12 months.
- Maternity. A pregnancy can be shared when it begins after 90 days of Membership and the due date falls after the first 12 months, with a $5,000 Maternity IUA.
- Care that isn't shareable. Mental health treatment, dental care except accidental injury, vision correction, fertility treatment, sleep apnea care, and diabetic medication and supplies aren't shareable. The Self-Care Credit can go toward counseling.
- Contributions. Sharing depends on Member contributions. The Guidelines explain how Needs would be prorated if contributions fell short in a month, and the Community hasn't needed to do that to date.
- Principles of Membership. Members agree to the Principles of Membership, which include health-conscious living commitments and mediation followed by binding arbitration for disputes.
If your situation involves ongoing treatment, a pregnancy or a business with employees, a person can answer that better than an article. Talk to a Care Team member.
What members say
"the only negative thing I can say, is I wish I found them sooner!"
– JoAnne M., small business owner and Knew Health Member, Trustpilot, August 2026 ( full review)
Read more Member reviews on Trustpilot.
Lowering a medical bill as a self-pay patient
Whatever option you choose, you can often lower a bill by asking. Ask for an itemized bill and check it line by line. Ask for the self-pay or cash-pay rate. Ask about payment plans and financial assistance, especially at nonprofit hospitals. Offer a lump-sum payment in exchange for a discount. Knew Health Members also have a Care Team that negotiates on eligible Medical Needs.
How to choose
Ask each option three things: what you pay each month, what you pay before a large bill is handled, and what isn't handled at all. Then match them to your situation.
- You just left a job. Compare COBRA, a Marketplace plan and Knew Health while the 60-day election window is open.
- You run a business with employees. Look at a QSEHRA, the Marketplace and the Knew Health Business Membership, which is priced by contacting the team.
- You have no ongoing treatment and want one predictable monthly amount. Marketplace plans, direct primary care paired with another option, and Knew Health are each worth a closer look.
Frequently asked questions
Is Knew Health health insurance?
No. Knew Health is not insurance, we're a medical cost sharing community. The Membership doesn't satisfy state or federal requirements for healthcare coverage or minimum essential coverage.
What happens if I have a large medical bill?
You pay your IUA for that Need, submit itemized bills in the Member Portal within six months of the date of service, and the Community can share eligible costs above your IUA. After you've submitted required documentation for an eligible need, the sharing process begins within a few hours.
Can I choose my own doctor?
Yes. Knew Health has no network restrictions, so you can choose your own practitioner within a range of licensed professionals. Sharing can be limited to usual, customary and reasonable prices.
How much does Knew Health cost?
Memberships start at $178/month, based on the oldest Member's age, household type, IUA and tobacco use. Tobacco use adds $195 a month per Membership. The Cost Calculator shows your amount in about 60 seconds.
How are pre-existing conditions handled?
Conditions with symptoms, diagnosis or treatment in the 24 months before joining follow a phase-in: $0 in year one, up to $25,000 per Need in year two, $50,000 in year three and $125,000 from year four. The Care Team can review your situation.
Where is Knew Health available?
Knew Health isn't accepting new Members in California, Illinois, Maryland, New York, Oregon, Pennsylvania, Vermont, New Mexico, or Washington. Members must be under 65.
Next steps
Enrollment windows and COBRA deadlines move quickly, so it helps to start the comparison early.
Choose your next step.
Get your price in about 60 seconds, or talk through your situation with a member of the Care Team.
Prefer to call? (855) 542-0050
Knew Health is not insurance, we're a medical cost sharing community. Knew Health is not an insurance company nor is the membership offered through an insurance company. Knew Health Membership does not satisfy state or federal requirements for healthcare coverage or minimum essential coverage. This is not a legally binding agreement to reimburse or indemnify you for medical expenses you incur. There is no guarantee of payment of medical expenses you incur. Past sharing history does not guarantee future sharing.
