The Quick Answer: If you are self-employed or a 1099 worker, your health coverage options changed in 2026. The enhanced ACA premium tax credits that many freelancers relied on expired at the end of 2025, and the average marketplace enrollee’s monthly premium payment, after tax credits, rose 58% this year, from $113 to $178 [1].
Important: Direct Primary Care is a membership arrangement with a doctor for primary care services. It is not insurance and doesn't meet ACA minimum coverage requirements on its own. Health sharing plans are not insurance. Sharing of medical costs among members is voluntary and is not guaranteed the way payment is under an insurance contract.
Health sharing programs are not available in every state. The program we most often recommend is not currently accepting new members in California, New Mexico, Pennsylvania, Vermont, or Washington. Ask an advisor about options where you live.
The good news: the core ACA premium tax credit program still exists for people under 400% of the federal poverty level. Alternatives like CHOICE Arrangements (Custom Health Option and Individual Care Expense Arrangements, formerly ICHRA), health sharing, and Direct Primary Care have also matured into real options worth comparing before this year’s open enrollment window [4][6]. This guide walks through what changed, what your real options are, and the timing that matters most this fall.
If you buy your own health insurance because you are self-employed, freelance, or work as a 1099 contractor, you have probably felt this year’s changes directly, even if you were not entirely sure why your premium moved the way it did. This guide is meant to explain exactly what happened, and more importantly, what to do about it before this year’s enrollment window.
What Actually Changed in 2026
During the pandemic, Congress temporarily enhanced ACA premium tax credits, increasing the subsidy amount and removing the income cap that had previously limited who could qualify. Those enhancements were extended through 2025, but expired on schedule at the end of that year without a further extension from Congress [1][3][5].
This did not eliminate ACA subsidies. The original premium tax credit program, in place since the ACA’s creation, is still fully active for people between roughly 100% and 400% of the federal poverty level [5]. What went away was the temporary enhancement: larger credit amounts, and the ability for people above 400% of the poverty level (about $63,000 for a single person or $129,000 for a family of four in 2026) to qualify at all [5][3].
The practical result, according to KFF’s tracking of 2026 marketplace data: the average monthly premium payment among marketplace enrollees, net of any tax credit, rose 58% this year [1]. For households that lost eligibility for the enhanced credit entirely, the increase was steeper, and many of those households either bought down to a leaner Bronze plan or left the marketplace altogether [1].
Why This Hits Freelancers and 1099 Workers Specifically
The people most affected by this change are, almost by definition, the audience this guide is written for: part-time workers, gig workers, small business owners, and the self-employed, the exact groups who rely on the individual marketplace because they do not have access to an employer plan [3]. If your income puts you above the 400% of poverty threshold this year, that hard cutoff means even a small amount of income above it can mean thousands of dollars in additional annual premium cost, since it is a cliff, not a gradual phase-out [3][5].
Your Real Options for 2027 Coverage
1. Marketplace coverage, with a closer eye on income. Because the 400% of poverty cliff is a hard line, some self-employed households can meaningfully lower their premium by managing their Modified Adjusted Gross Income (MAGI): contributing to a traditional IRA, maxing out HSA contributions if eligible, or timing certain deductible business expenses. This is not a loophole, it is simply how the subsidy is calculated, and if you are near the threshold, it is worth running the numbers before you file your 2026 return, not after [3].
2. Direct Primary Care plus a health sharing plan. This layered approach pairs a flat monthly DPC membership, which gives you unlimited primary care visits with no copay, with a health sharing plan that shares eligible costs for larger, unexpected events like emergency room visits, surgery, or hospitalization [6][7]. DPC membership fees vary by region and practice; our guide to what Direct Primary Care costs in 2026 breaks down current prices. For some healthy households, the combined monthly cost can come in below an unsubsidized marketplace plan, but that depends on your age, household size, and the programs you choose. Because this approach is not tied to the ACA marketplace, the 2026 subsidy changes do not affect it.
3. An HDHP paired with an HSA, and DPC if it fits your budget. If you want to stay within traditional insurance, pairing a high-deductible health plan with an HSA remains one of the more tax-efficient options for a healthy, self-employed individual. As of January 1, 2026, DPC membership fees are also HSA-eligible up to $150 a month for individuals and $300 a month for families, when paired with a qualifying HDHP, adding another layer of tax efficiency to this combination [8]. Above those amounts, the membership no longer fits within the HSA rules [8].
4. A CHOICE Arrangement, if you have even one employee. This one is easy to overlook: if you are self-employed and have hired even a single W-2 employee, you may be able to set up a CHOICE Arrangement through your business, which reimburses the cost of individual health insurance tax-free under the arrangement’s rules. Whether you, as the owner, can also participate depends on how your business is structured (see the FAQ below).
This is general educational information, not tax or legal advice. Talk with a qualified tax professional about how this applies to your situation.
Comparing the Real Costs
| Strategy | Typical Monthly Cost (Individual) | Best For |
|---|---|---|
| Marketplace plan, subsidized (under 400% FPL) | Varies by income, but credit still available | Lower-income self-employed households |
| Marketplace plan, unsubsidized (over 400% FPL) | Full premium, no credit | Households who need ACA’s full regulatory protections regardless of cost |
| DPC + health sharing | Varies by age, household size, region, and program | Healthy individuals who rarely need specialist or hospital care |
| HDHP + HSA (+ optional DPC) | Varies by plan, lower with HSA tax savings | Self-employed workers who want to stay within traditional insurance and build tax-advantaged savings |
Want a starting point for your own numbers? The Quick Rate Estimator shows individual and family health insurance options in under 60 seconds.
Timing: What to Watch This Fall
ACA Marketplace open enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 in most states, and December 15 is the deadline for coverage starting January 1 [9]. Dates vary in some state-run marketplaces. If you are planning to compare a marketplace plan against DPC plus health sharing, or against an HDHP strategy, aim to decide before December 15 so your new coverage starts with the new year.
Frequently Asked Questions
Did ACA subsidies disappear completely in 2026? No. The original ACA premium tax credit program is still active for people between roughly 100% and 400% of the federal poverty level. What expired was the temporary enhancement that had increased credit amounts and removed the income cap entirely [5].
How do I know if I am above or below the 400% threshold? For 2026, 400% of the federal poverty level is roughly $62,600 for a single person, $84,600 for a couple, and $128,600 for a family of four [3]. If your household income is close to this line, it is worth talking to an advisor about legitimate ways to manage your Modified Adjusted Gross Income before year-end.
Is DPC plus health sharing a good replacement for marketplace coverage? For healthy individuals who mostly need primary care and rarely need specialist or hospital-level care, it can meaningfully lower monthly costs. It is not regulated as insurance, so it is worth understanding a specific program’s terms, especially around pre-existing conditions, before switching.
Can I set up a CHOICE Arrangement just for myself if I am self-employed with no employees? Not on its own. CHOICE Arrangements are an employer benefit, so you generally need at least one W-2 employee (which can include a spouse in certain structures) to establish one through your business. Talk with an advisor about whether your specific business structure qualifies.
Will enhanced subsidies come back for 2027? As of mid-2026, no legislation has been enacted to restore the enhanced credits, and the outlook remains uncertain. The safest planning approach is to assume the standard, non-enhanced subsidy rules stay in place for 2027 until something changes [3].
Next Steps
The individual health insurance landscape shifted in 2026 in a way that genuinely changes the math for a lot of self-employed people and freelancers. The right answer depends on your income relative to the 400% threshold, your health history, and how much flexibility you want outside the traditional marketplace.
At Journey Health Advisors, we help self-employed professionals and 1099 workers compare marketplace coverage, DPC, health sharing, and HDHP strategies side by side, without pressure and without carrier bias.
Speak with an independent advisor at Journey Health Advisors: 1 (844) 580-6055 | journeyhealthadvisors.com/schedule
Related Reading:
- Health Coverage for the Self-Employed: Affordable Options for 1099 Workers
- Health Sharing Plans Explained: How They Work, What They Cost, and Who They Fit
- Leaving a Corporate Job to Go Freelance: Your Health Coverage Options
- Health coverage options for individuals and families
REFERENCES
[1] KFF. “What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles.” Kaiser Family Foundation, July 2026. https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/
[2] KFF. “How Much More Would People Pay in Premiums if the ACA’s Enhanced Premium Tax Credits Expire?” Kaiser Family Foundation, January 2026. https://www.kff.org/interactive/calculator-aca-enhanced-premium-tax-credit/
[3] Kitces.com. “Reducing ACA Health Insurance Premiums After ‘Enhanced’ Premium Tax Credit Expiration.” Kitces.com, February 2026. https://www.kitces.com/blog/reducing-aca-health-insurance-premiums-after-the-expiration-of-the-enhanced-premium-tax-credit-expiration-affordable-care-act-ptc/
[4] healthinsurance.org. “ACA Open Enrollment Guide.” healthinsurance.org, April 2026. https://www.healthinsurance.org/open-enrollment/
[5] Congressional Research Service. “Enhanced Premium Tax Credit and 2026 Exchange Premiums: Frequently Asked Questions.” Congress.gov, 2026. https://www.congress.gov/crs-product/R48290
[6] HSA for America. “How to Combine a DPC Membership with a Health Sharing Plan.” HSA for America, October 2025. https://hsaforamerica.com/blog/dpc-membership-with-a-health-sharing-plan/
[7] HSA for America. “DPC Direct: A Health Sharing Plan Designed to Work with Your DPC Membership.” HSA for America, February 2026. https://hsaforamerica.com/healthshare-direct-primary-care/
[8] Internal Revenue Service. “Notice 2026-05: Expanded Availability of Health Savings Accounts under the One, Big, Beautiful Bill Act (OBBBA).” IRS, December 2025. https://www.irs.gov/pub/irs-drop/n-26-05.pdf
[9] HealthCare.gov. “Dates and Deadlines for 2027 Health Insurance.” U.S. Centers for Medicare & Medicaid Services, 2026. https://www.healthcare.gov/quick-guide/dates-and-deadlines/
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