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Self-Employed in Maryland and Stuck Paying High Health Insurance? Read This.
You built a business, you make good money, and your reward is the most expensive health insurance in the state. Here are the three moves that actually change the number.
Move 1: lower your MAGI, not your income
Subsidies look at modified adjusted gross income. SEP-IRA or Solo 401(k) contributions, the self-employed health deduction, and legitimate business expenses all lower MAGI. Some Marylanders who think they're $10,000 over the cliff are actually under it. Run the numbers with a CPA before open enrollment. Maryland has a progressive state income tax plus a county income tax, so the self-employed health premium deduction helps at the federal, state and local level.
Move 2: price the private market
If you're truly above the line and healthy, private shared-network plans on Cigna, Aetna and PHCS PPO are priced on your health, not your income. Expect 30–50% less than full-price marketplace plans, with a national PPO. Underwritten, so not for everyone — but for the healthy self-employed it's the biggest lever there is.
Move 3: check whether you're really "solo"
A spouse on payroll, a part-time employee, a business partner — any of these can open a small-group plan, which is guaranteed-issue and often priced better than two individual plans.
What doesn't work
Health-sharing ministries (not insurance), fixed-indemnity plans (not major medical), and simply going without. Maryland has no state penalty for going without coverage, but the state tax return asks whether you had coverage so the state can help uninsured residents enroll.
Fifteen minutes with a licensed Maryland agent who quotes both markets usually finds one of the three. Start here.