Self-employed people can get coverage through an ACA marketplace or off-exchange ACA plan, Medicaid (limited in Florida), a spouse’s employer plan, COBRA, association plans, and non-insurance options like health-sharing ministries, short-term plans, and direct primary care. For most, an ACA plan is the best choice because it covers pre-existing conditions and may qualify for income-based subsidies.
Whether you’re a solo contractor in DeLand, a freelance consultant in Orlando, or a small business owner anywhere in between, here’s a complete look at every option available to self-employed Floridians, ranked from most to least reliable.
1. ACA Marketplace Plans — The Gold Standard for Most
For the vast majority of self-employed people, an ACA marketplace plan through healthcare.gov is the best combination of comprehensive coverage, financial protections, and affordability. These plans are guaranteed issue — meaning you cannot be denied for a pre-existing condition — and they cover all ten essential health benefits including hospitalization, mental health services, prescription drugs, and preventive care.
Income-based Premium Tax Credits are available to individuals earning between roughly $15,960 and $63,840 (100%–400% FPL) for 2027 coverage, directly reducing your monthly premium; above 400% FPL there’s no credit now that the enhanced subsidies have expired. Florida has one of the largest ACA markets in the nation, and for 2027 carriers like Florida Blue, Ambetter from Sunshine Health, Oscar, UnitedHealthcare, and AvMed compete in most Central Florida counties (Cigna and Molina are leaving Florida’s individual market). Off-exchange ACA plans offer the same protections without subsidies, and some carriers offer off-exchange-only PPO networks. Open Enrollment for 2027 runs November 1, 2026 through January 15, 2027 (enroll by December 15 for a January 1 start); outside that window, qualifying life events (losing coverage, moving, getting married) trigger a Special Enrollment Period. For most self-employed Floridians, start here — see how self-employed people use the ACA marketplace.
2. Medicaid — If You Qualify (Florida’s Caveat Is Important)
Medicaid provides free or near-free coverage to qualifying low-income residents, but Florida’s eligibility rules are more restrictive than most states. Florida has not adopted the ACA’s Medicaid expansion. This means that most working-age adults without dependent children are not eligible for Medicaid in Florida, regardless of income.
If you’re a self-employed adult with no children and a low income, you may find yourself in Florida’s coverage gap — earning too little to qualify for marketplace subsidies (which begin at 100% FPL) but not meeting Medicaid’s narrow adult eligibility thresholds. For parents and caretakers of minor children, Medicaid eligibility applies only at very low income levels, while pregnant women and children (through Florida KidCare) have broader eligibility.
If you think you might be in the coverage gap, contact a licensed broker before assuming you have no options. There are still marketplace plans available, and depending on your situation, there may be workarounds worth exploring.
3. A Spouse or Domestic Partner’s Employer Plan
If your spouse or domestic partner has access to employer-sponsored coverage that includes dependents, getting added to their plan is often the simplest and most cost-effective path. Employer group plans typically offer richer benefits and lower out-of-pocket costs than individual marketplace plans, because the employer is subsidizing the premium.
There’s one important consideration: if you’re offered coverage through a spouse’s employer plan, you generally cannot claim marketplace subsidies for your own individual plan — even if the employer plan costs more than you’d like. The IRS considers you to have access to affordable coverage. That said, if the employer plan’s cost for covering the family would exceed 9.96% of household income in 2026 (10.22% in 2027), you may still qualify for marketplace assistance. This is a nuance worth reviewing with a broker if cost is a factor.
4. Professional or Trade Association Group Plans
Some professional associations — for realtors, contractors, freelancers, and other trades — offer group health plans to members. Quality varies widely: some are genuine group policies underwritten by major carriers, others are watered-down benefit packages. For self-employed Floridians who qualify for marketplace subsidies, a subsidized Silver plan usually wins on value. For higher earners above the subsidy threshold, a solid association plan can be worth comparing — but confirm whether it’s ACA-compliant, because non-compliant plans may exclude pre-existing conditions.
5. Health Sharing Ministries — Understand What You’re Getting
Health sharing ministries are not insurance. Members contribute monthly and share each other’s medical costs based on shared values. Contributions are often lower than ACA premiums, which makes them appealing — but the limitations are significant. These programs are not regulated by the Florida Office of Insurance Regulation. They are not required to cover pre-existing conditions, mental health care, prescriptions, or substance abuse treatment, and they can decline to share costs based on their own guidelines with no guarantee of payment. They may work for generally healthy people who fully understand the risks; they are not a reliable substitute for real insurance, especially given Florida’s high hospitalization costs. More here: should self-employed people use health sharing plans?
6. Short-Term Health Plans — Cheap, But Risky
Short-term plans are sold outside the ACA marketplace with lower premiums and quick issuance. A 2024 federal rule caps them at 3 months initially and 4 months total, though federal agencies announced in August 2025 that they won’t prioritize enforcing that limit. The catch: they are not ACA-compliant. They can deny coverage based on health history, exclude pre-existing conditions, cap total benefits, and omit essential services like mental health and maternity care. Use them only as a temporary bridge — for a healthy person waiting a few months for Open Enrollment — not as a long-term substitute for real insurance.
7. COBRA Continuation Coverage — Comprehensive, But Expensive
If you recently left a job with employer coverage, COBRA lets you continue that exact plan for up to 18 months — same network, same benefits. The downside is cost: you pay both your share and your former employer’s share, plus a 2% fee, which often means several hundred dollars or more a month for an individual. Most self-employed Floridians who qualify for marketplace subsidies will find a marketplace plan dramatically cheaper. COBRA makes most sense if you’re mid-treatment and need continuity with specific providers for a few months. Note: the 60-day election window is strict — miss it and the option disappears.
8. Direct Primary Care — A Supplement, Not a Standalone
Direct Primary Care (DPC) practices are growing in Florida, including in the Central Florida area. Under this model, you pay a flat monthly membership fee directly to a primary care physician, and in return get unlimited primary care visits, same-day appointments, and often direct-message access to your doctor. It’s not insurance.
DPC doesn’t cover hospitalization, specialist care, surgery, imaging, or emergencies. It works best as a complement to a high-deductible marketplace plan — you handle routine care through DPC, and the HDHP protects you against major events. Some self-employed Floridians pair a Bronze HDHP with a DPC membership and an HSA for a lean but functional coverage package. DPC alone, without insurance behind it, leaves you dangerously exposed to catastrophic costs. See whether direct primary care can replace health insurance.
| Option | Covers pre-existing conditions? | Subsidy eligible? |
|---|---|---|
| ACA marketplace plan | Yes | Yes, 100–400% FPL |
| Off-exchange ACA plan | Yes | No |
| Spouse’s employer plan | Yes | N/A |
| COBRA | Yes | No |
| Health-sharing ministry | Often no (not insurance) | No |
| Short-term plan | Often no | No |
How to Choose the Right Option
For most self-employed Floridians, the priority order looks like this: ACA marketplace plan first (especially if you qualify for subsidies), a spouse’s employer plan second if available and affordable, COBRA as a short-term bridge, association group plans if you’re above the subsidy threshold, and everything else only with full awareness of the limitations. Health sharing ministries and short-term plans should be last resorts, not first choices. For a side-by-side of on- and off-exchange options, read marketplace vs. private insurance for self-employed.
Frequently Asked Questions
What is the best health insurance option for self-employed people in Florida?
For most, an ACA-compliant plan — bought on healthcare.gov or off-exchange — is the best option because it covers pre-existing conditions and essential health benefits. If your household income is between 100% and 400% FPL, buy on the marketplace to get a premium tax credit. Above that, compare on- and off-exchange plans.
Can self-employed people get group health insurance?
A self-employed person with at least one W-2 employee who isn’t a spouse may be able to set up a small group plan. Solo self-employed people generally can’t, and instead use individual ACA coverage. Some association plans are marketed to the self-employed, but check whether they’re ACA-compliant before enrolling.
Are health-sharing ministries insurance?
No. Health-sharing ministries are not insurance and aren’t regulated by the Florida Office of Insurance Regulation. They don’t guarantee payment, can exclude pre-existing conditions, and lack ACA protections. They also don’t qualify for premium tax credits or count as HSA-eligible coverage.
I specialize in helping self-employed Floridians find the right fit and will compare every available option in your county, on and off exchange. I’m Michael McAllister, owner of Choice Health Insurance Brokers in DeLand, FL — a licensed broker appointed with 200 carriers (NPN 18229135). My help costs you nothing; I’m paid by the carriers. Call or text me at 321-230-9536 or visit choice.healthcare for a free quote and a plan comparison built around your situation.