Real Estate Agents and Health Insurance: What You Need to Know
Commission-based income and health insurance don't mix easily.
Here's how to navigate coverage when your paycheck isn't predictable.
You closed three deals in March. One in April. Nothing in May. Then two more in June. By August, you're on track for your best year yet, but come November, the market slows down and you're wondering if you'll hit your goal.
Sound familiar?
If you're a real estate agent, you know the feast-or-famine reality of commission-based work. Some months you're celebrating. Other months you're stressing. And somewhere in the middle of all this income volatility, you're supposed to figure out health insurance.
The problem? Most health insurance options assume you have predictable income. They want you to estimate your annual earnings in November for the entire following year. They penalize you if you guess wrong. And they definitely don't account for the fact that real estate agents can have dramatically different financial pictures from one year to the next.
Let's talk about how health insurance actually works when you're in real estate—and what options make sense for your situation.
Why Health Insurance Is Complicated for Real Estate Agents
When you work in real estate, you face unique challenges that make traditional health insurance difficult:
Your income fluctuates dramatically. You might make $120,000 one year and $75,000 the next. You might have $15,000 months followed by $2,000 months. Insurance companies and subsidy calculations don't adapt well to this reality.
You're technically self-employed. Even if you're affiliated with a brokerage, you're most likely classified as an independent contractor, which means you're responsible for your own benefits. There's no HR department handling your health insurance.
You need flexibility for your schedule. You show houses on weekends, meet clients in the evenings, and can't always schedule doctor appointments during regular business hours. You need coverage that works with your life, not against it.
You might work across state lines. If you're licensed in multiple states or you work with clients in different areas, you need coverage that travels with you.
Your spouse might also be in real estate or self-employed. If you're a two-agent household or you're both entrepreneurs, you're navigating this without any employer coverage safety net.
The traditional health insurance system wasn't designed for people like you. But that doesn't mean you don't have good options.
Your Health Insurance Options as a Real Estate Agent
Let's break down what's actually available to you and how each option works with the realities of real estate income.
Option 1: ACA Marketplace Plans (Healthcare.gov)
This is where most agents start. You go to Healthcare.gov during open enrollment (November 1 - January 15), estimate your annual income, and shop for plans.
How subsidies work with commission income:
If you qualify based on income, you can receive premium tax credits that lower your monthly costs. But here's the tricky part: the subsidies are calculated based on your estimated annual income for the entire year ahead.
In November 2025, when you were enrolling for 2026 coverage, you had to predict what you'd earn in 2026. If you underestimated and earned more than expected, you have to pay back some or all of the subsidy when you file your taxes. If you overestimated and earned less, you left money on the table all year by overpaying premiums.
For real estate agents, this guessing game is particularly difficult. How do you know in November 2025 what the market will look like in summer 2026? How do you predict whether you'll close 12 deals or 20?
The 2026 subsidy situation:
This year, the subsidy challenge is even more significant because enhanced premium tax credits expired. Many agents who previously qualified for substantial subsidies now face dramatically higher premiums or no subsidies at all.
If you're single and making over $60,240 (400% of federal poverty level), or married making over $81,760, you're likely facing the full premium cost with no subsidies—and those premiums increased substantially for 2026.
The upside of marketplace plans:
Income-based subsidies if you qualify
No denial for pre-existing conditions
Comprehensive coverage for essential health benefits
Special enrollment if your income changes significantly or you experience certain life events
The downside:
High premiums in 2026, especially if you don't qualify for subsidies
High deductibles ($5,000-$7,500+) even with mid-tier plans
Income estimation challenges for commission-based workers
Narrow provider networks that might not work if you work in multiple areas
Only available during open enrollment (November-January) unless you have a qualifying event
Best for: Agents with lower income years who qualify for substantial subsidies, or those with significant pre-existing conditions who need guaranteed coverage.
Option 2: Private Health Insurance
This option operates completely differently from marketplace plans, and it often makes more sense for real estate agents.
How it works:
Instead of buying a comprehensive government-mandated package, you build coverage in layers. You start with catastrophic protection against major medical expenses (the six-figure hospital stay, the serious accident, the cancer diagnosis), then add coverage for the things you actually use—outpatient doctor visits, prescriptions, preventive care, etc.
Why it works for real estate agents:
No income calculations required. Your premium is based on your age and health, not your earnings. No guessing what you'll make next year. No reconciliation at tax time.
Apply any time of year. Did you just leave a brokerage that offered group coverage? Start your real estate career in June? Finally get around to this in September? You can apply whenever you need coverage—no waiting for open enrollment.
Nationwide portability. If you're licensed in North Carolina and South Carolina, or you work with clients across state lines, your coverage travels with you. No network restrictions that only work in one state.
Customizable to your actual needs. If you're a healthy 35-year-old agent who mainly needs protection against catastrophic events and wants basic preventive care, you build that specific coverage. You're not subsidizing benefits you won't use.
Guaranteed renewable. Once approved, your coverage continues as long as you pay premiums. Your income can go up or down without affecting your coverage or requiring subsidy paybacks.
Direct personal service. When you have questions, you're calling someone who knows your policy and your situation. You're not navigating a call center between showings.
The trade-off:
Private insurance requires medical underwriting. The insurance company reviews your health history to determine eligibility and pricing. If you're generally healthy, this usually works in your favor. If you have significant ongoing health conditions, marketplace plans might be a better fit.
Best for: Healthy real estate agents who don't qualify for significant subsidies, value flexibility and portability, and want to avoid the income estimation headaches of marketplace plans.
Option 3: Spouse's Employer Plan
If your spouse works a traditional W-2 job with benefits, joining their employer plan might be an option.
The reality check:
While employers heavily subsidize employee premiums (often paying 70-80%), they typically contribute little or nothing toward dependent coverage. Adding a spouse often costs $300-$600+ per month.
Do the math: is that dependent premium cost competitive with what you'd pay for your own coverage? Sometimes yes, sometimes no.
Also consider:
You're dependent on your spouse's continued employment
You're tied to their employer's network and plan options
Changes typically only allowed during their open enrollment or after qualifying events
Best for: Agents whose spouse has excellent employer coverage with affordable dependent rates.
Option 4: Brokerage Group Plans
Some larger brokerages offer group health insurance to their affiliated agents. If your brokerage does, this is worth investigating.
What to look for:
Who pays the premium? (You likely pay 100%, unlike traditional employees)
What are the plan options and costs?
What happens if you switch brokerages?
Are you actually getting a group rate advantage?
Many brokerage "group plans" are actually just marketplace plans with a brokerage endorsement. They're subject to the same premium increases and limitations as buying directly on Healthcare.gov.
Best for: Agents whose brokerage offers legitimate subsidized group coverage (rare but valuable if available).
The Tax Advantage Every Agent Should Use
Here's something every real estate agent needs to know: you can deduct 100% of your health insurance premiums as a self-employed person.
This is an "above the line" deduction, meaning you claim it whether you itemize or not. It directly reduces your taxable income.
Example:
You pay $7,200 per year in health insurance premiums. You're in the 24% tax bracket. That deduction saves you roughly $1,728 in taxes, making your effective premium cost $5,472 instead of $7,200.
This deduction applies to:
Medical insurance premiums
Dental insurance premiums
Long-term care insurance premiums (with limits)
Important note: You can only deduct premiums for months when you were not eligible for employer-subsidized coverage through a spouse's plan. Talk to your tax advisor about maximizing this benefit.
Between the self-employment tax deduction and the health insurance premium deduction, you can significantly reduce your tax burden. Many real estate agents don't take full advantage of these write-offs.
Special Considerations for Real Estate Agents
Beyond just choosing a plan, there are specific situations agents face that affect health insurance decisions:
The First-Year Agent Challenge
Starting out in real estate? Your income is unpredictable at best. You might qualify for substantial marketplace subsidies in your first year if your earnings are low, which could make ACA plans very affordable.
But be careful with income estimation. If you have a breakout year and close more deals than expected, you could face a large subsidy payback at tax time.
The Peak Earning Year Problem
Had your best year ever? Congratulations—but if you were receiving marketplace subsidies based on previous years' earnings, you might owe thousands back when you file taxes.
This is where private insurance's disconnect from income is actually an advantage. Your premium doesn't change whether you made $60,000 or $160,000.
The Team Leader Situation
If you lead a real estate team, you might be exploring options to offer some form of coverage to your team members. This gets complicated quickly, as they're likely independent contractors, not employees.
Group coverage requires meeting specific legal and IRS requirements. Consult with a benefits specialist who understands real estate team structures before offering anything to avoid compliance issues.
The Dual-State License Scenario
Licensed in multiple states? Make sure your coverage works across state lines. Many marketplace plans have networks that only function well in your home state. If you're showing properties or meeting clients in another state, out-of-network costs can add up quickly.
Private insurance with nationwide coverage eliminates this problem entirely.
What to Consider When Choosing Coverage
As a real estate agent, your health insurance decision should account for your specific situation:
Think about your typical year:
What's your average annual income over the past few years?
How much do you typically use healthcare services?
Do you have ongoing prescriptions or regular doctor visits?
Are you generally healthy with rare medical needs?
Consider your lifestyle:
Do you work across multiple states?
Do you travel frequently for business or pleasure?
Do you need flexibility in when and where you see doctors?
Evaluate your risk tolerance:
Could you handle a $5,000 deductible if something serious happened?
What's your actual exposure if you had a major medical event?
How much premium can you comfortably afford year-round, even in slower months?
Look at total cost, not just premium:
What's your annual premium cost?
What's your deductible?
What are your likely out-of-pocket costs based on your typical healthcare usage?
What's your worst-case scenario for total annual costs?
Real Talk: What Other Agents Are Doing
In conversations with real estate agents over the years, here's what I've seen work well:
Newer agents or those with lower income years may start with marketplace plans to take advantage of subsidies while they build their business. However, private insurance is still a better fit for many, because of unpredictable earnings - and especially after the marketplace premium hikes in 2026.
Established agents with solid, consistent income frequently switch to private insurance once they no longer qualify for meaningful subsidies. They value the predictability and flexibility more than comprehensive coverage for rarely-used benefits.
Two-agent households often find that customized private coverage for both spouses costs less than two marketplace plans, especially after the 2026 subsidy changes.
Agents who work multi-state or travel extensively almost always prefer portable nationwide coverage (private health insurance) over state-specific marketplace networks.
Top producers typically prioritize service and flexibility over premium cost. They want direct access to help when they need it, not call center hold music. This is the level of support you get with private health insurance.
Let's Look at Your Numbers
Every real estate agent's situation is unique. Your income, health needs, family situation, and business structure all factor into what makes sense for your health insurance.
Want to see what your actual options cost? Reach out through the contact form and we'll schedule a time to review your specific situation. No pressure, no sales pitch—just straight talk about what works for real estate professionals.
You've built a career on helping people navigate one of the biggest financial decisions they'll ever make. Let's apply that same level of attention and expertise to your health insurance decision.
About Cory Gillen: Cory is a licensed health insurance specialist based in Western North Carolina, representing Medical Mutual Protect and providing personalized insurance guidance to individuals, families, and small businesses. No call centers. No runaround. Just direct access to someone who actually cares about your coverage.
