With over 70 million Americans now freelancing and the gig economy representing 36% of the U.S. workforce, finding affordable health insurance is a top concern for independent workers. This guide covers all your coverage options in North Carolina.
The American workforce is undergoing a fundamental shift. In 2025, more than 70 million Americans identify as gig workers—representing approximately 36% of the total workforce. By 2027, freelancers are projected to make up over half of all U.S. workers. While freelancing offers flexibility and independence, it also means taking on responsibilities that traditional employees often take for granted—including finding your own health insurance.
If you're self-employed in North Carolina, our locally based health insurance agents can help you find the right coverage for your needs.
Only 40% of American gig economy workers have access to medical insurance—compared to the vast majority of traditional employees who receive employer-sponsored coverage. This lack of a safety net creates significant financial vulnerability, as freelancers are responsible for covering their own healthcare costs.
Research indicates some of the areas freelancers worry most about include:
Unable to afford health care: Finding affordable health insurance is consistently one of the top concerns for freelancers, who no longer have an employer subsidizing the cost of their coverage.
Not enough savings: Because freelance work means selling yourself repeatedly, there's always a risk of not earning enough to cover monthly expenses and save for the future. About 80% of freelancers report struggling with unexpected $1,000 costs.
Income instability: Because freelancers often engage in short-term work with clients, they can worry about generating consistent income. This feast-or-famine cycle makes budgeting for healthcare costs particularly challenging.
Retirement planning: Without employer-sponsored retirement plans, freelancers worry about having enough savings when they retire.
Tax burden: Gig workers pay both the employer and employee portions of Social Security and Medicare taxes (15.3% of net income), making the overall tax burden significantly higher than that of traditional employees.
Luckily, freelancers have more options than ever. Healthcare coverage options differ from state to state, so talking to a local North Carolina health insurance agent can help you find the best coverage for your situation.
The Affordable Care Act (ACA) Marketplace is the primary source of health insurance for most freelancers. Through HealthCare.gov, you can compare and purchase individual health insurance plans. Approximately 5 million small business owners and self-employed workers are enrolled in ACA Marketplace plans.
Open Enrollment Dates (2025-2026):
Open enrollment for 2026 coverage: November 1, 2025 – January 15, 2026 (in most states)
December 15, 2025: Deadline for coverage starting January 1, 2026
January 15, 2026: Final deadline for coverage beginning February 1, 2026
Special Enrollment Periods: If you experience a "qualifying event," you can enroll outside of open enrollment. Qualifying events include loss of health coverage through an employer, Medicaid, CHIP, or a spouse's plan; changes in household (marriage, divorce, birth, adoption); change in residence; obtaining U.S. citizenship; being released from incarceration; or changes in income that impact your insurance coverage.
Important 2026 Update: Enhanced premium tax credits are set to expire December 31, 2025, unless Congress extends them. If these subsidies expire, KFF estimates that out-of-pocket premium payments will increase by an average of 114% for the 22 million people who currently receive tax credits. Freelancers with income above 400% of the federal poverty level ($62,600 for an individual) would no longer qualify for any premium subsidies. Contact a health insurance agent for the latest information on subsidy availability.
If you're leaving a traditional job where your employer provides group insurance, you have limited time to opt into COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage. This allows you to continue your former employer's health plan for yourself and your family.
Key COBRA Details:
Eligibility: You must have participated in your company's group health plan. Applies to voluntary resignation, involuntary termination, or reduction in work hours.
Election period: You have 60 days to decide whether to continue your COBRA coverage.
Duration: 18-36 months, depending on the qualifying event.
Cost: Expect to pay 100% of the premium plus a 2% administrative fee (102% total). Average COBRA costs in 2025 range from $400 to $700/month for individual coverage and $1,800 to $2,200/month for family coverage.
Exemptions: Religious organizations and small businesses with fewer than 20 employees are generally exempt from COBRA requirements.
When COBRA ends: If your previous employer goes out of business, you can't make premium payments, you become eligible for Medicare, or you enroll in a new group health plan, your COBRA coverage will cease. Remember, COBRA is intended as a short-term bridge—many freelancers find better value in Marketplace plans with premium tax credits.
Good news for North Carolina freelancers: North Carolina expanded Medicaid on December 1, 2023. As of May 2025, more than 481,000 adults have enrolled in the expansion. This means many freelancers who previously didn't qualify may now be eligible.
Eligibility:
Adults ages 19-64 with income up to 138% of the federal poverty level
For 2025: Up to approximately $20,782/year for a single adult, or $35,631/year for a family of three
You must be a North Carolina resident
Benefits:
No monthly premiums
Copays of $4 maximum (and only for some services)
Comprehensive coverage including doctor visits, hospital care, prescriptions, dental services, mental health, and preventive care
You can apply year-round (no open enrollment period)
If you're a freelancer with variable income, Medicaid may be an excellent option during lower-earning periods. Apply at Medicaid.nc.gov or through HealthCare.gov.
Getting advice from a health insurance agent can ensure you get the right level of coverage for your needs. Here are the main types of plans available:
HMO (Health Maintenance Organization): Requires choosing a primary care provider (PCP) who refers you to specialists. No out-of-network coverage except for emergencies. Best for freelancers who don't travel frequently and prefer a consistent healthcare experience with lower premiums.
PPO (Preferred Provider Organization): No PCP requirement or referrals needed. Offers coverage for out-of-network providers (at a higher cost). Best for freelancers with mobile lifestyles who need flexibility to see doctors anywhere. Higher premiums but more freedom.
HSA-Eligible High Deductible Health Plan (HDHP): Allows you to pair a health savings account (HSA) with your plan to pay healthcare expenses with pre-tax dollars. HSA funds roll over year to year and can be invested for growth. These plans typically have lower premiums but higher deductibles. Starting in 2026, Marketplace enrollees in Bronze or catastrophic plans will be able to contribute to an HSA.
ACA Marketplace plans are organized into metal tiers based on how much of your healthcare costs the plan covers versus what you pay out of pocket:
Bronze: 60% coverage (plan pays) / 40% (you pay). Lowest premiums, highest deductibles. Best for healthy individuals who want protection against major medical events.
Silver: 70% / 30%. Moderate premiums and deductibles. Required to receive Cost-Sharing Reductions (CSRs) if you qualify. Best value for many freelancers.
Gold: 80% / 20%. Higher premiums, lower out-of-pocket costs. Good for those with regular healthcare needs.
Catastrophic: Very low premiums, very high deductibles. Must be under age 30 or qualify for a hardship exemption. Covers three primary care visits per year and preventive services before the deductible.
Note for North Carolina: Only Bronze, Silver, and Gold tiers are typically available for most enrollees. Catastrophic plans are limited to those under 30 or with hardship exemptions.
When comparing health insurance plans, consider all the costs involved—not just the monthly premium:
Premium: The monthly amount you pay for coverage, regardless of whether you use any healthcare services.
Deductible: The amount you pay out of pocket before your insurance starts covering costs. Lower-tier plans can have deductibles as high as $9,000+ for individuals. The maximum deductible for 2026 is $10,600 for individuals and $21,200 for families.
Copay: A fixed amount you pay for specific services (e.g., $30 for a doctor visit).
Coinsurance: The percentage you pay for covered services after meeting your deductible (e.g., 20% of the cost of a hospital stay).
Out-of-Pocket Maximum: The most you'll pay in a plan year for covered services. After reaching this limit, your plan pays 100% of covered costs.
Tip: If you anticipate significant healthcare expenses, you may be better off paying a higher premium for a plan with lower out-of-pocket costs. Calculate your expected total annual costs (premiums + likely out-of-pocket expenses) rather than just comparing premiums.
Premium Tax Credits (PTCs)
When you purchase insurance through the Marketplace, you may qualify for premium tax credits that lower your monthly premium based on your income. Currently, 93% of Marketplace enrollees receive premium tax credits—over 20 million people.
Credits are available at all income levels (with enhanced credits currently in place through 2025)
You can take the credit in advance (lowering your monthly premium) or claim it when you file taxes.
If your income changes during the year, you'll reconcile the difference when you file your tax retur.n
Important: Starting in 2026, there is no longer a cap on how much excess advance premium tax credit you must repay to the IRS—income estimation is more important than ever.
Cost-Sharing Reductions (CSRs)
If your income is between 100-250% of the federal poverty level, you may qualify for Cost-Sharing Reductions (sometimes called "extra savings"). CSRs lower your deductible, coinsurance, and copay amounts. To receive CSRs, you must:
Enroll in a Silver-tier plan specifically
Purchase through the Marketplace (not directly from an insurer)
Self-Employment Tax Deduction
Self-employed individuals can deduct 100% of health insurance premiums paid for themselves, their spouse, and dependents from their taxable income. This is an "above-the-line" deduction, meaning you don't need to itemize to claim it.
Join a Family Member's Plan: If you're under 26, you can stay on a parent's health plan. If you're married and your spouse has employer-sponsored coverage, joining their plan may be the most cost-effective option.
Professional Association Plans: Some freelancer organizations (such as Freelancers Union or the National Association for the Self-Employed) offer group health plans that can provide 5-10% savings compared to individual rates. Availability varies by location and industry.
Short-Term Health Insurance: These plans provide temporary coverage but don't meet ACA requirements. They typically don't cover pre-existing conditions and have limited benefits. It may be an option only as a gap-filler between more comprehensive coverage.
International Health Insurance: If you're a globe-trotting freelancer, consider international health insurance for an extended time abroad. Standard travel insurance may suffice for short trips, but longer stays require more comprehensive coverage.
Review plans during Open Enrollment each year: benefits, costs, and provider networks change annually. What was the best plan last year may not be the best this year.
Check if your doctors and hospitals are in-network: Out-of-network care can cost significantly more.
Verify your prescriptions are covered: Check the plan's formulary (drug list) to make sure your medications are covered at a reasonable cost.
Estimate your income conservatively: If your gig income fluctuates, estimate on the lower end. You can reconcile subsidies at tax time.
Consider your total healthcare needs: Factor in planned procedures, ongoing prescriptions, and typical doctor visits when choosing between premium and out-of-pocket costs.
Work with a licensed agent: A health insurance agent can help you navigate options, calculate subsidies, and find the best plan for your situation—typically at no additional cost to you.
If you've been searching for health insurance as a freelancer, our North Carolina-based agents can talk you through the various options available. We can help you:
Compare Marketplace plans and calculate your potential premium tax credits
Determine if you qualify for NC Medicaid under the expanded eligibility
Evaluate COBRA vs. Marketplace options
Understand how the 2026 subsidy changes may affect your coverage and costs
Find the best plan for your healthcare needs and budget