Freelancing has its perks—flexibility, independence, creative freedom—but one major downside is the lack of employer-sponsored health insurance. As a freelancer, contractor, or self-employed worker, you’re on your own when it comes to health coverage.
Fortunately, you have options. Whether you’re just getting started or looking to improve your current plan, this article covers everything you need to know about getting health insurance as a freelancer, including ACA Marketplace plans, freelancer associations, health-sharing ministries, and other alternatives available in 2025.
Option 1: The ACA Marketplace
The Affordable Care Act (ACA) Marketplace is the most popular and widely available health insurance option for freelancers. You can shop for coverage at Healthcare.gov or your state’s exchange.
Why it’s a good option:
You can’t be denied for pre-existing conditions
All plans cover the 10 essential health benefits, including hospitalization, mental health, and maternity care
You may qualify for premium tax credits and cost-sharing reductions based on income
In 2025, premium subsidies are still expanded thanks to the Inflation Reduction Act, which means many freelancers earning under 400% of the federal poverty level pay very low premiums—and some pay $0/month for Bronze or Silver plans.
Enrollment tips:
Open Enrollment runs November 1 to January 15
Qualifying life events (like losing employer coverage or moving) allow for Special Enrollment Periods
Use estimated net income from your freelance work to determine subsidy eligibility—don’t forget to subtract business expenses
Try this tool to estimate savings: Healthcare.gov Savings Calculator
Option 2: Freelancer and Professional Associations
Several national and local freelancer groups offer access to group health plans or discounted insurance options. While they won’t always offer better pricing than the ACA Marketplace, they can be worth exploring.
Examples include:
Freelancers Union: Offers access to ACA-compliant plans and supplemental insurance in select states
https://www.freelancersunion.orgNational Association for the Self-Employed (NASE): Offers health discount programs, telemedicine, and grants
https://www.nase.orgLocal Chambers of Commerce or industry-specific associations (e.g., writers’ guilds, artists’ collectives)
Important: Association plans may not always meet ACA standards—especially if they’re self-funded or marketed as “health benefits” rather than true insurance. Always read the fine print.
Option 3: Health-Sharing Ministries and Cooperatives
Health-sharing ministries are not insurance, but they can function similarly for some people. Members contribute monthly to share one another’s medical expenses, often through a religious or ethical organization.
Popular options include:
Medi-Share
Liberty HealthShare
Christian Healthcare Ministries
Sedera (a non-religious alternative)
Pros:
Lower monthly “share” amounts than ACA plans
Can help cover large, unexpected medical bills
Cons:
No legal obligation to pay your bills
Often exclude coverage for pre-existing conditions, mental health, or pregnancy
May have strict lifestyle or religious requirements
Not eligible for ACA subsidies
Health-sharing can work for healthy freelancers looking for catastrophic protection, but it’s risky compared to regulated insurance.
Option 4: Short-Term Health Insurance
Short-term health insurance offers limited coverage for a defined period—typically up to 12 months. These plans are often marketed to freelancers and gig workers.
Pros:
Very low premiums
Quick enrollment, often same-day
Cons:
Doesn’t cover pre-existing conditions
May exclude maternity, mental health, and prescriptions
Not ACA-compliant, so doesn’t meet essential coverage standards
Cannot use subsidies to lower cost
Use only as a temporary bridge, not a long-term solution.
More here: What Are Short-Term Health Plans?
Option 5: Medicaid (for Low-Income Freelancers)
If your net income is low—particularly if you’re in your first year freelancing or between gigs—you may qualify for Medicaid.
Coverage is free or very low-cost
Includes essential benefits, often with no premiums or deductibles
Eligibility depends on your household size and state rules
As of 2025, 40 states + DC have expanded Medicaid, allowing adults to qualify with incomes up to 138% of the federal poverty level. That’s roughly $20,783/year for an individual.
Check eligibility here: Medicaid.gov Eligibility Guide
Option 6: COBRA (If You Recently Left a Job)
If you recently left a traditional job and were covered under a group plan, you may be eligible for COBRA continuation coverage. This allows you to stay on your old plan for up to 18 months.
Pros:
You keep the same coverage and provider network
No new deductible
Cons:
You pay the full cost of the plan (plus a 2% admin fee)
Expensive compared to Marketplace plans with subsidies
Use COBRA as a short-term option, then compare it to ACA plans during Open Enrollment.
How to Choose the Best Option
Ask yourself the following:
How steady is your freelance income?
If unpredictable, a low-premium ACA plan with high deductibles may be best
Do you qualify for subsidies or Medicaid?
Check Healthcare.gov or your state exchange
Do you need access to specific doctors or medications?
Verify networks and formularies before enrolling
Do you want to prioritize low premiums or lower out-of-pocket costs?
Bronze plans = low premium, high deductible
Silver/Gold = higher premium, lower deductible
Tax Deductions for Freelancers’ Health Insurance
Good news: freelancers can deduct 100% of their health insurance premiums on their federal tax return, as long as:
You are self-employed
You’re not eligible for another employer-sponsored plan (e.g., through a spouse)
Your business had income for the year
This applies to medical, dental, and qualified long-term care insurance for you, your spouse, and dependents. The deduction lowers your adjusted gross income (AGI)—not just your itemized deductions.
Bottom Line
Freelancers may not have employer-sponsored coverage, but they have more health insurance options than ever in 2025. From ACA Marketplace plans with subsidies to association benefits and Medicaid, there’s something for every budget and situation.
The key is to research, compare costs and benefits, and make sure you’re not going uninsured—because the financial consequences of a health emergency could derail your freelance future.
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