Start by naming the two problems
Self-employed healthcare feels impossible mostly because two unlike problems get mixed together. One is frequent and small: sick visits, refills, follow-ups, results, the question of whether this needs attention. The other is rare and potentially enormous: a hospital admission, surgery, a serious accident. A product that solves one of those does not solve the other, and no amount of shopping will make it.
The realistic options, and what each is for
| Option | What it is for | Is it insurance? |
|---|---|---|
| Individual health insurance | Protection against hospital, surgical and catastrophic costs | Yes |
| Coverage through a spouse's or partner's employer | Same protection, often at lower cost to the household | Yes |
| Membership primary care (direct primary care) | Routine primary care at a known monthly price | No |
| Paying per visit as needed | Occasional care with no monthly commitment | No |
| Health care sharing arrangements | Cost sharing among members; terms and exclusions vary greatly | No — read the terms carefully |
Anything in the bottom three rows leaves you exposed to a large medical bill. We will never tell you that a Presence membership replaces insurance, because it does not.
Why the routine part hurts the most when you are 1099
- Time away from work has a direct cost, so care gets postponed until it is worse.
- Without a plan negotiating for you, each visit price is whatever the practice charges.
- Prescriptions, labs and imaging all bill separately, so a simple problem becomes three bills.
- Income is uneven, and unpredictable healthcare costs land in the wrong months.
Making the routine part fixed and predictable is the practical win available to you today, whatever you decide about coverage.
How Presence fits
Virtual Family Care is $19.99 a month for everyone in the household: unlimited virtual visits, pediatric virtual care included, and no copay for membership-covered care. Local in-office visits at our North Richland Hills practice are $129 each on that plan. Virtual + Local In-Office Care is $29.99 a month and includes two local in-office visits per membership year for the household, then $99 for each additional local visit. If you want a full primary-care relationship with more intensive access, individual unlimited membership is $79 a month for ages 19–44, $89 for ages 45–64 and $109 for 65 and over, with family unlimited at $219 for up to five people and $29 a month for each additional child. Everything is on membership pricing.
For a working day that cannot stop, the useful part is usually access: a visit at a time that does not cost you a job, and a provider who already knows your history. Self-employed healthcare covers this in more detail, and 1099 contractors is written for contract work specifically.
Questions to answer before you decide
- How many times did your household actually seek care last year?
- What would a hospital admission do to your finances today?
- Are you carrying a deductible so large that you avoid care you need?
- Do you have prescriptions or a condition that needs regular monitoring?
- Is anyone in the household under 13, and therefore virtual-only for our care?
If the answers point to frequent routine care plus real catastrophic exposure, the usual structure is insurance for the catastrophic part and membership for the routine part. If you use almost no care, paying per visit may genuinely cost less — and we will say so.