The Self-Employed Attorney's Guide to ACA Marketplace Coverage

I. Income projection is the entire game.

The federal premium tax credit is calculated against your projected modified adjusted gross income for the coverage year, not your prior year's tax return. For a wage-earner this is trivial. For a solo attorney whose income arrives in irregular billable cycles and occasional fee resolutions, the projection is the most consequential number you submit during enrollment.

Project conservatively. The downside of underestimating is reconciliation at filing; the downside of overestimating is forgone subsidy you cannot recover. We bias toward the prior-year actual unless a structural change to the practice justifies otherwise.

II. The deductible math is not what the marketplace shows you.

Marketplace sorting defaults to monthly premium. For self-employed counsel, monthly premium is the wrong sort key. The correct comparison is annual after-tax outlay, which folds in the above-the-line self-employment health insurance deduction and your marginal bracket.

The HDHP is not always the right answer — utilization matters, network depth matters, and a planned procedure changes the calculation — but the after-tax frame is the only frame that produces an honest comparison.

III. Network depth, before price.

We confirm three networks before recommending any plan: the primary care provider, the spouse's regular provider if applicable, and any specialist the household is actively under the care of. The marginal savings on a narrower-network plan rarely justify rebuilding a primary-care relationship mid-year.

IV. The mid-year review.

For practices with materially variable income, we schedule a mid-year MAGI review. A strong second quarter that pushes projected income above the silver-tier cost-sharing threshold can be corrected through estimated-tax planning, deductible HSA contributions, or a deliberate retirement contribution before the year closes. The marketplace does not police this — but the IRS reconciliation does.