As the gig economy grows, more North Carolinians are working as Selfemployed—and finding health coverage on their own. Here's what you need to know about your options, costs, and how to get covered.
In recent years, many workers have shifted from traditional employment to freelance and gig work. Without employer-sponsored coverage, finding affordable health insurance becomes a top priority. If you're freelancing in North Carolina, our locally-based health insurance agents can help you find the right coverage for your needs.
Freelance work offers flexibility and independence, but it also comes with unique stresses. Research shows that the self-employed worry most about:
Saving enough money: 76% of Selfemployed surveyed said this was their top concern. Without a steady paycheck, covering monthly costs and saving for the future is challenging.
Affording health care: 72% of Selfemployed said finding affordable healthcare was a major worry—especially without an employer covering part of the premium.
Retirement savings: With no employer 401(k) match, many Selfemployed worry they won't have enough saved when they retire.
Inconsistent income: Short-term projects and gaps between clients can make budgeting difficult.
Pricing services fairly: Many Selfemployed struggle to set rates that cover all their costs—including health insurance and self-employment taxes.
Tax burden: Self-employed pay both the employee and employer portions of Social Security and Medicare taxes (self-employment tax), which can be a significant hit.
The good news: several options can help the self-employed find affordable health coverage. While rules vary by state, here are the main paths to coverage in North Carolina.
COBRA Coverage
If you're leaving a job where you had employer-sponsored health insurance, COBRA (Consolidated Omnibus Budget Reconciliation Act) allows you to continue that coverage temporarily.
How COBRA works:
You can continue your employer's group health plan for yourself and covered family members
Coverage typically lasts 18-36 months, depending on the qualifying event
You must have been enrolled in the employer's group plan while employed
Applies whether you quit, were laid off, or had your hours reduced
You'll receive an election notice—you have 60 days to decide
Important: COBRA only applies to employers with 20 or more employees. If you worked for a small business, religious organization, or certain other employers, you may not have COBRA rights.
The cost of COBRA:
Be prepared for sticker shock. When you were employed, your employer likely paid 70-80% of your health insurance premium. With COBRA, you pay the entire premium—plus up to 2% for administrative costs.
COBRA can end early if your former employer goes out of business, you miss premium payments, you become eligible for Medicare, or you enroll in a new group health plan.
Pro tip: Compare COBRA costs to ACA Marketplace plans. Depending on your income, you may qualify for premium subsidies that make a Marketplace plan significantly more affordable than COBRA.
ACA Marketplace Plans
The Affordable Care Act (ACA) created a health insurance Marketplace where individuals can compare and purchase coverage. For many Selfemployed, this is the best option.
2025-2026 Open Enrollment:
Open enrollment dates: November 1, 2025 – January 15, 2026 (for 2026 coverage)
December 15, 2025: Deadline for coverage starting January 1, 2026
January 15, 2026: Final deadline for coverage beginning February 1, 2026
Note: Starting with the fall 2026 open enrollment period (for 2027 coverage), the enrollment window will be shorter, ending December 15 in most states.
Special Enrollment Periods (SEP):
Outside of open enrollment, you can enroll in a Marketplace plan if you experience a qualifying life event, such as:
Losing health coverage (from an employer, Medicaid, CHIP, Medicare, or a spouse's plan)
Getting married or divorced
Having a baby or adopting a child
Moving to a new area with different plan options
Gaining U.S. citizenship
Being released from incarceration
Specific income changes that affect your coverage
Important 2026 Change: The "low-income SEP" that allowed people with incomes at or below 150% of the federal poverty level to enroll year-round has been eliminated. Starting in 2026, most people will only be able to enroll during open enrollment or with a qualifying life event.
When shopping for coverage, you'll encounter several plan types. Understanding the differences helps you choose the right fit for your healthcare needs and lifestyle.
HMO (Health Maintenance Organization):
Requires a primary care provider (PCP) who coordinates your care
Need referrals from your PCP to see specialists (except for OB/GYN and emergencies)
No coverage for out-of-network care (except emergencies)
Best for: Self-employed who stay in one location and don't mind using a specific network of doctors
PPO (Preferred Provider Organization):
No PCP required
No referrals needed to see specialists
Out-of-network coverage available (at higher cost)
Best for: Self-employed who travel, work remotely from different locations, or want flexibility in choosing providers
HSA-Eligible Plans (High Deductible Health Plans):
Lower monthly premiums with higher deductibles
Allows you to open a Health Savings Account (HSA) with tax-advantaged savings
HSA funds can be used for deductibles, copays, coinsurance, and many other medical expenses
2026 Update: All Bronze and Catastrophic Marketplace plans now automatically qualify for HSA eligibility, making it easier to pair low-premium coverage with tax-advantaged savings
Note: You cannot use HSA funds to pay insurance premiums (except COBRA premiums and certain other situations)
Marketplace plans are organized into four "metal" tiers based on how costs are shared between you and the insurance company. The tier names have nothing to do with the quality of care—all plans cover the same essential health benefits.
Bronze: Lowest premiums, highest out-of-pocket costs. Plan pays ~60% of costs on average. Best for healthy people who rarely need care and want protection against major expenses.
Silver: Moderate premiums and out-of-pocket costs. Plan pays ~70% of costs. Required if you want Cost-Sharing Reductions (extra savings on deductibles and copays).
Gold: Higher premiums, lower costs when you need care. Plan pays ~80% of costs. Good for people who use healthcare regularly.
Platinum: Highest premiums, lowest out-of-pocket costs. Plan pays ~90% of costs. Not available in all states, including North Carolina.
In North Carolina, only Bronze, Silver, and Gold tiers are available.
Catastrophic Plans:
These very low-premium, high-deductible plans are designed for worst-case scenarios. They cover three primary care visits before you meet the deductible, plus preventive services at no cost.
2026 Eligibility Update: Catastrophic plans are now available to anyone who doesn't qualify for premium tax credits or cost-sharing reductions—not just people under 30 or those with hardship exemptions. This expands access for some self-employed with higher incomes.
Don't just look at the monthly premium. Your total healthcare costs include several components:
Premium: The amount you pay each month for coverage, whether you use care or not
Deductible: The amount you pay out-of-pocket before your plan starts paying for most covered services. Lower-tier plans have higher deductibles.
Copay: A fixed amount you pay for a specific service (e.g., $30 for a doctor visit)
Coinsurance: A percentage of costs you pay after meeting your deductible (e.g., 20% of the cost of a procedure)
Out-of-pocket maximum: The most you'll pay for covered services in a year. Once you reach this amount, your plan pays 100%.
2025-2026 Out-of-Pocket Maximums:
2025: $9,200 individual / $18,400 family
2026: $10,600 individual / $21,200 family
Important for Self-employed: A low-tier Bronze plan with a deductible of $8,000+ may seem affordable, but if you need care beyond preventive services, you'll pay most costs out-of-pocket until you hit that high deductible. Consider how much care you typically need when choosing a tier.
Many self-employed individuals qualify for financial assistance that significantly reduces their health insurance costs.
Premium Tax Credits (Subsidies)
Premium tax credits lower your monthly premium based on your household income. These credits are available to people who:
Buy coverage through the Marketplace (not directly from an insurer)
Have income between 100-400% of the federal poverty level (and above 400% FPL through 2025, if enhanced credits are extended)
Aren't eligible for affordable employer coverage or government programs like Medicaid or Medicare
2026 Subsidy Update: The enhanced premium tax credits created by the American Rescue Plan (which made subsidies more generous and available to more people) are scheduled to expire at the end of 2025 unless Congress extends them. If they expire, subsidies will be smaller, and people earning over 400% FPL will lose eligibility entirely. Watch for news on this—it will significantly affect your 2026 costs.
Important for self-employed with variable income: Premium tax credits are based on your estimated annual income. If your actual income differs from your estimate, you'll reconcile it when you file taxes. Starting in 2026, there is no cap on repayment—if you received too much in advance credits, you'll owe the full difference back to the IRS. Update your income estimate with the Marketplace if your earnings change during the year.
Cost-Sharing Reductions (CSR)
Also called "extra savings," CSRs reduce your deductible, copays, and coinsurance. To qualify:
You must have income at or below 250% of the federal poverty level
You must enroll in a Silver plan (CSRs are only available with Silver)
With CSR, a Silver plan can cover 73% to 94% of your costs (instead of the standard 70%)
If you qualify for CSR, a Silver plan may be more cost-effective than a Bronze plan, even if the Bronze plan has a lower premium.
Medicaid: If your income is low, you may qualify for Medicaid. North Carolina expanded Medicaid in December 2023, extending eligibility to adults with incomes up to 138% of the federal poverty level. If you qualify, coverage is free or very low-cost.
Family member's plan: If you're under 26, you can stay on a parent's health plan. If your spouse has employer coverage, you may be able to join their plan.
Professional or freelancer associations: Some industry groups or freelancer unions offer group health insurance options to members.
International coverage: If you're a digital nomad or spend significant time abroad, consider international health insurance or travel medical insurance. Keep in mind that these may not meet ACA requirements for U.S. coverage.
Be careful of non-ACA-compliant plans: Short-term health insurance and health care sharing ministries may seem affordable, but they:
Often excludes pre-existing conditions
May have lifetime or annual limits
Are not required to cover essential health benefits
Can deny claims or cancel coverage
Don't qualify you for premium subsidies
These products are not true health insurance and can leave you with massive bills if you get sick or injured.
Navigating health insurance as a freelancer can be complicated, but you don't have to do it alone. Our licensed NC health insurance agents can help you:
Compare Marketplace plans and estimate your total costs
Determine if you qualify for premium tax credits or cost-sharing reductions
Understand your options during open enrollment or a special enrollment period
Choose the right plan type and metal tier for your needs
Enroll in coverage that fits your budget and healthcare needs