Roger Sauerhaft thought he had done everything right. The 38-year-old PR consultant had been running his solo practice in New York since 2021, paying $1,189 a month for what seemed like good health insurance through his state’s individual marketplace. 

In late 2023, he developed a medical issue that required a specialist, and started calling doctors’ offices—only to be turned away again and again. The closest in-network specialist was an hour away in Long Island. 

One medical administrator was honest with him: His plan’s network was too restrictive. He needed broader coverage—but that wasn’t available to him.

“When you’re a solopreneur, your health is your business,” Sauerhaft says. “When you have a problem, you need to get it fixed really quickly. That requires access.”

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Approximately 16.5 million Americans were self-employed as of January 2026, according to the Bureau of Labor Statistics. MBO Partners’ 2025 annual survey puts the number at 72.9 million, counting not just full-time self-employed workers but also part-time and occasional independent earners.

For solopreneurs and small-business owners across the U.S., individual marketplace plans are predominantly HMOs, or health maintenance organizations, which have narrow networks and require referrals to see specialists. PPOs, or preferred provider organizations with broader access, are available on marketplaces in only a handful of states or through employer-sponsored plans.

Most solopreneurs across the U.S. get their insurance from Affordable Care Act marketplaces. Premiums, deductibles, and out-of-pocket costs can eat up a significant portion of their income, and many plans restrict access to care through narrow provider networks. This gap leaves many paying high prices for plans that don’t meet their needs, forcing them to choose between their health and their business—or find creative work-arounds to access better coverage.

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