Health insurance for contractors and construction workers

• 27.8%of construction and extraction workers were uninsured in 2024, the Census Bureau reports
• 25%of carpenter jobs are held by self employed workers, per the Bureau of Labor Statistics
• $178average monthly marketplace premium after tax credits for 2026, per CMS

Why contractors go uninsured

The Census Bureau found that 27.8 percent of workers in construction and extraction occupations had no health insurance in 2024, compared with 10 percent of all workers ages 19 to 64. The trades also run heavily on self employment. The Bureau of Labor Statistics says a quarter of carpenter jobs are held by self employed workers. Put those together and you get a lot of skilled people with no employer plan, uneven income, and a sense that insurance is only for people with a W-2.

It is not. The individual marketplace was built for exactly this situation.

Your realistic options

Option	Good for	Watch out for
Marketplace plan	Most 1099 contractors. Covers pre existing conditions, tax credits possible	Estimating income honestly when work is seasonal
Spouse's employer plan	Families where a spouse has good benefits	It can block your tax credit and your premium deduction
Short term medical	A healthy person bridging a short gap	Not an ACA plan, pre existing conditions generally excluded, restricted in many states and not sold in Colorado or Illinois
Group plan for your company	Contractors with W-2 employees	1099 subs do not count as employees

How the subsidy works on 1099 income

HealthCare.gov tells self employed people to report the income they expect from the business after expenses. For a contractor that means revenue minus materials, tools, fuel, truck costs, liability insurance and the other ordinary expenses of the job. A remodeler who bills $150,000 but nets $55,000 is judged on the $55,000.

For 2027 coverage, tax credits are available up to 400 percent of the federal poverty line, which is $63,840 for a single person and $132,000 for a family of four. Above that, you pay full price. Near that line, a smart retirement contribution or a well timed equipment purchase can make a real difference, which is a conversation for you and your accountant. You can test numbers on my subsidy calculator.

Seasonal and project income is the trap. Starting with 2026 coverage there is no longer a cap on paying back excess tax credits, so if you estimate $45,000 and a big commercial job pushes you to $80,000, you repay the difference when you file. Log in and update your income whenever a large job lands.

The self employed deduction

Premiums you pay for your own plan are generally deductible on IRS Form 7206 if your business shows a profit. The IRS sets two limits. The deduction cannot exceed your net earnings from the business, and you cannot take it for any month you were eligible for a subsidized employer plan, including one through your spouse, even if you turned it down. That second rule surprises a lot of married contractors.

Workers' comp is not health insurance

Workers' compensation covers employees hurt on the job. As an owner, you may not be covered by it at all. The Florida Division of Workers' Compensation lets up to three officers of a construction corporation or LLC who own at least 10 percent elect to be exempt, and it states that once exempt, the officer is not considered an employee and may not recover workers' comp benefits. Other states have their own rules.

So if you are exempt, your health plan is your safety net for a fall off a ladder as well as for a heart attack. That is a strong argument for a plan with a manageable out of pocket maximum rather than the cheapest premium you can find. It is also a reason to read the plan documents, because how a plan handles work related injuries can vary.

Picking a plan that fits trade work

• Price the out of pocket maximum, not just the premium. Injuries are a real risk in this work. Know the worst case number.
• Check the urgent care and orthopedic network. Most injuries on a job site start at urgent care and end at an orthopedist. Make sure both are in network near where you work.
• Consider gold. In many Florida and Texas counties I track, the cheapest gold plan costs less than the benchmark silver plan before subsidies. See your area on my county plan data.
• Bronze plus an HSA. Bronze and catastrophic plans are HSA eligible starting in 2026. Here is how an HSA plan works.

When you have a crew

Once you have at least one W-2 employee who is not you, your spouse or another owner, small group coverage becomes possible. HealthCare.gov is explicit that a business with no employees other than owners and their spouses cannot use the small business SHOP program. Subcontractors you pay on 1099 do not count. If you are still solo, my page on small business owners with no employees covers your setup, and if you are in the Tampa area with a crew, see small business health insurance in Tampa.

When to enroll

Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027 on HealthCare.gov, with a December 15 deadline for coverage that starts January 1. Losing other coverage, such as leaving a W-2 job to go out on your own, gives you a 60 day special enrollment period. If you think you missed your window, read how special enrollment works.

My honest take

If your spouse has strong family coverage at work, joining that plan is often the cheapest answer, and you do not need me for it. If you are on your own, a marketplace plan sized to your real net profit is almost always better than going without. I'm Carson Hornish, an independent broker licensed in 31 states, and my help is free to you. For more on working for yourself, see my self employed health insurance guide, or the Florida and Texas versions.

Common questions