“Health sharing is more like a credit union. You are a member of a community. The focus is on serving members rather than maximizing profits.”
CHANGES TO AFFORDABLE CARE ACT SUBSIDY ELIGIBILITY in 2026 are prompting a growing number of self-employed workers, 1099 contractors, and freelancers to explore health sharing programs as marketplace insurance becomes less affordable for middle-income earners.
Marketplace subsidies under the ACA are calculated based on household income. Individuals whose earnings exceed eligibility thresholds must pay the full cost of their health insurance premiums, often resulting in significant financial strain for independent workers with variable income.
The system creates repayment risk. Individuals who receive subsidies based on projected income may be required to repay some or all of the subsidy when filing federal taxes if their actual income exceeds the qualifying range.
“For freelancers and self-employed individuals, income can change from year to year,” said Catherine Okubo, CEO of MPowering Benefits, a longtime advocate for medical cost sharing programs. “If you receive a subsidy based on projected income and you earn more than expected, you may have to pay that subsidy back when you file taxes. That uncertainty creates financial risk.”
Because of this, many people in 2026 are taking a closer look at alternatives like health sharing.
The Alternative to Insurance
Unlike insurance companies, health sharing organizations are not structured around shareholder profit models and are not regulated as insurance.
“With a traditional insurance company, you are often just another account number and the organization answers to shareholders,” Okubo said. “Health sharing is more like a credit union. You are a member of a community. The focus is on serving members rather than maximizing profits.”
Health shares like Zion HealthShare, Medi-Share, and Christian Care Ministry operate as nonprofit communities where members agree to share eligible medical expenses and have grown in popularity over the past decade, particularly among individuals seeking alternatives to health insurance.
One key difference is enrollment flexibility. While insurance plans typically require enrollment during limited open enrollment periods, many health sharing programs allow individuals to join throughout the year, a feature that appeals to contractors whose employment status or income may change mid-year.
Health Sharing Can Make Financial Sense for 1099 Contractors
As Health sharing programs work differently, instead of deductibles, they use a structure called an Initial Unshareable Amount. This amount represents the portion a member is responsible for before eligible medical expenses can be shared.
For freelancers whose income may go up or down each year, the predictable contribution structure of health sharing can provide clearer expectations about healthcare costs.
Health sharing guidelines are often easier to understand than insurance policies, which can include complex networks, coverage tiers, and changing regulations.
Many medical cost sharing communities also provide concierge style support. This means members can receive help scheduling appointments, understanding medical bills, and navigating larger medical events.
For people moving away from insurance, this kind of support can feel reassuring.
A Strategic Opportunity for Insurance Agents
Changes in subsidy rules create new opportunities for insurance brokers and agents.
Health sharing can serve as a valuable option for clients who do not qualify for marketplace subsidies or whose self employment income makes it difficult to predict future earnings.
Many health sharing programs can support both individuals and small groups. This allows agents to serve freelancers, independent contractors, and small business owners who may need more flexible healthcare solutions.
Commission structures for health sharing programs are often competitive with insurance products. This makes it a practical option for agents who want to expand the solutions they offer to their clients.
A Growing Consideration in 2026
As healthcare subsidies continue to evolve and the freelance economy continues to grow, more Americans are asking an important question: Is insurance the only option?
Zion HealthShare remains committed to helping individuals understand their options and determine whether medical cost sharing is the right fit for their healthcare journey in 2026 and beyond.
* Zion HealthShare is not an insurance company. Neither this publication nor membership in Zion HealthShare are offered by an insurance company. Visit ZionHealthShare.org to view your state-specific notice.