Healthcare Costs Double for Farmers and Other Self-Employed Workers, Adding Pressure to Already Tight Budgets

Recent reporting highlights that many rural Americans are experiencing dramatic premium increases in 2026 as the enhanced Affordable Care Act premium tax credits expired at the end of 2025, leaving many Marketplace enrollees with less federal financial assistance toward their monthly premiums. This has created a growing affordability crisis for families who don’t receive employer-sponsored health insurance.

For farmers, ranchers, contractors and other self-employed workers, some annual insurance costs have doubled or more, adding another major expense to already rising business costs. Recent reports have also documented the impact on individual farm families. Many of these workers don’t have access to employer-sponsored health insurance and must purchase coverage on their own, leaving them particularly exposed to changes in Marketplace costs.

Carson Hornish, an independent health insurance broker licensed in 24 states, sits down with farm families and 1099 workers to navigate this decision every week. “What I am seeing for 2026 is that the worst of the sticker shock lands on households just over the subsidy cutoff, where a few thousand dollars of extra farm income can swing a premium by hundreds a month,” he shared.

For many of those families, the first response isn’t to drop coverage altogether, but to look for ways to bring the monthly premium down. Hornish noted that farm families and 1099 workers are asking him to price a higher deductible. “My job is usually to slow that down and check whether their income estimate is even right, because farm and self-employed income is a projection rather than a salary and people routinely overstate it and price themselves out of help they actually qualify for,” he explained.

For some, the trade-offs extend beyond a higher deductible. Farmers and other self-employed professionals are dropping their coverage altogether or delaying and rationing care, which is particularly concerning given that many farmers are already behind on bills, making minimum payments and setting up payment plans even for routine primary-care visits. Some are putting off health problems entirely or only seeking emergency care until they qualify for Medicare.

Lowering the monthly premium can also come with significant risks. Hornish pushes back most strongly on delaying care to protect the monthly premium. The trade-off Hornish pushes back on most strongly is delaying care to protect the monthly premium. “One hospital stay costs more than a year or the gap between two plans,” he said. For families already balancing unpredictable income with the rising costs of running a farm or small business, that calculation can make an already difficult decision even harder.

With health coverage becoming harder for some self-employed workers to afford, more are looking for alternatives. Farmers, contractors, freelancers and other 1099 workers are exploring health sharing as an option as Marketplace coverage becomes less affordable for some middle-income earners following changes to the Affordable Care Act. Unlike insurance companies, health sharing organizations are not structured around shareholder profit models and are not regulated as insurance.

Zion HealthShare operates as a non-profit medical cost-sharing community. We are not insurance and cannot operate in the state of Washington. Please visit https://zionhealthshare.org/disclosures/state-notices/ for state notices.