When you drive for a company with your CDL, health insurance often comes with the job. When you become an owner-operator, it's up to you.
The Bureau of Labor Statistics (BLS) says owner-operators buy or lease trucks and run their own business. BLS counted about 2.2 million heavy and tractor-trailer truck driver jobs in 2025. About 7% of those jobs were held by self-employed workers.
This guide covers where to get coverage, how networks work when you drive in many states, and how to deduct your premiums.
Own authority or leased on: why it matters
Owner-operators usually work one of two ways. Federal leasing rules (49 CFR 376) describe the setup:
- Own authority: you are the authorized carrier. You haul loads under your own authority.
- Leased on: you lease your truck to an authorized carrier, with or without you as the driver. You haul under that carrier's authority.
Either way, your health coverage depends mostly on one question: are you self-employed, or does someone treat you as an employee?
HealthCare.gov says you're self-employed if you have a business that takes in income but has no employees. Contractors are on its list. If that's you, you can buy a plan on the individual Marketplace for yourself and your family.
Your options with your own authority
With your own authority and no employees, you shop like any other self-employed person. You can apply on the Marketplace and find out if you qualify for a tax credit, Medicaid, or CHIP. That depends on your income and household size.
If you hire drivers, the rules change. Say your business has even one employee who isn't you, a spouse, a family member, or an owner. HealthCare.gov says you may be able to use the SHOP Marketplace. That lets you offer coverage to yourself and your workers. SHOP plans aren't sold in every state. In Florida, CMS 2026 plan data list no SHOP medical plans.
Hiring contractors alone doesn't make you an employer. HealthCare.gov says employees are usually the workers who get a W-2 from you.
Your options when you're leased on
If you're leased on as an independent contractor, the same self-employed rules apply. You can buy a Marketplace plan for yourself and your family.
Read your lease and ask the carrier if it offers any health coverage. Say a carrier offers you job-based coverage. HealthCare.gov says you usually can't get a Marketplace tax credit then, even if you don't take it. In rare cases, the job plan costs too much or covers too little. Then you may still get the credit.
Covering your family
A Marketplace plan can cover your spouse and children. The tax credit is based on your whole household's income for the year you are covered.
Check your spouse's job first. Say your spouse's job offers coverage to spouses and children. Then your family usually can't get the tax credit, HealthCare.gov says. If it covers only your spouse, you can buy a Marketplace plan for you and your kids.
In most cases, married couples must file a joint tax return to get the tax credit.
Networks when you drive in many states
Your network matters more when you're away from home for days or weeks at a time. Marketplace plans come in a few types, and HealthCare.gov explains how they handle care outside the network:
- HMO: usually covers only doctors in its network, except in an emergency. It may require you to live or work in its service area.
- EPO: covers only in-network care, except in an emergency.
- PPO: you can see doctors outside the network without a referral, but you pay more.
In a true emergency, go to the closest hospital that can help. HealthCare.gov says your plan can't charge you a higher copay or coinsurance at an out-of-network ER. It can't make you get approval first. But a deductible may still apply.
Routine care is different. Before you pick a plan, check the network. Look for the doctors, urgent care clinics, and drug stores you use on your routes. Our guide to PPO vs HMO plans explains the trade-offs.
Some owner-operators also look at a private PPO plan sold outside HealthCare.gov. Some plans use PPO networks in many states. It is not a Marketplace plan and can't get a tax credit. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled. See our pages on nationwide private PPO health insurance and nationwide PPO plans for self-employed people.
What it may cost
There's no single price. Your cost depends on your age, where you live, and the plan you pick. If you get a tax credit, your household income matters too.
For a Marketplace plan, you'll estimate your net self-employment income for the year you are covered. That's your profit after business costs, the number you report on Schedule C. As of October 14, 2026, under current law, if your income turns out higher, you may have to pay back some or all of the credit, with no cap. A tax pro can help. Report changes during the year as soon as you can.
Deducting your premiums
As of October 14, 2026, under current law, many self-employed people can deduct what they pay for health insurance, the IRS says. This can include a spouse, dependents, and a child under 27. You figure it on Form 7206.
There are limits. You can't count any month you could join a subsidized health plan through an employer, including your spouse's. The deduction also can't be more than your business's net profit. If you also get a Marketplace tax credit, the math is more complex.
Our guide to the self-employed health insurance deduction walks through the steps. If your trucking business is set up as an S corp, different rules apply. Talk to a tax pro before you file.
Getting help
Daniels Health Advisors is licensed in 30+ U.S. states. We work with self-employed people in many fields. See the industries we serve.