How can farmers get health insurance?

How did the ACA improve access to coverage for farmers?

Thanks to the ACA, comprehensive health insurance for farmers is available nationwide, regardless of medical history or pre-existing conditions. While many farmers get coverage from a spouse’s employer-sponsored plan,¹ a recent KFF analysis found that more than a quarter of farmers and ranchers rely on the ACA Marketplace (Obamacare) for their coverage, placing them among the occupations with the largest share of workers using the Marketplace.²

What kinds of benefits can farmers expect from Marketplace coverage?

The Marketplace provides a wide range of plan options, all of which cover various preventive care with no cost-sharing, and provide coverage for essential health benefits.³ And most Marketplace enrollees are eligible for income-based subsidies that make coverage more affordable. (This is still true in 2026, despite the expiration of subsidy enhancements at the end of 2025.)⁴

Learn more about health insurance for self-employed people.

Do farmers qualify for ACA subsidies?

Farmers’ eligibility for Marketplace subsidies depends on the same factors that apply to all Marketplace enrollees, including their household income (an ACA-specific version of MAGI) and whether they’re eligible for any other coverage.

ACA subsidies are income-based, and are not available to people who are eligible for Medicaid, premium-free Medicare Part A, or an employer-sponsored plan that’s considered comprehensive and affordable.⁵

A few points for farmers to keep in mind when determining subsidy eligibility:

• You’ll be projecting your modified adjusted gross income (MAGI) for the year ahead, and then reconciling your Marketplace subsidies when you file your taxes for that year.⁶
• If your household size or income changes during the year, you can report the change to the Marketplace and it will update your subsidy in real time.⁷ This is particularly important if your income is trending higher than you projected, since you’ll have to repay all excess subsidies when you file your taxes.
• If you’re eligible for coverage under your spouse’s employer’s plan, your Marketplace subsidy eligibility will depend on your household income as well as whether your spouse’s coverage would be considered affordable (here’s a calculator for that). If it’s not, you might be subsidy-eligible, but that would depend on how your cost for Marketplace coverage compares with your household income (here’s a calculator for that).

How is income used to calculate Marketplace subsidy eligibility for farmers?

ACA-specific MAGI for farmers is calculated based on the same rules that apply to all Marketplace enrollees:

• It’s household income, regardless of how many household members are applying for Marketplace coverage.⁸ And as noted above, Marketplace subsidies are based on the income you project for the coming year – which may or may not be the same as the income you reported on your last tax return. (You also have the option to pay full price for your Marketplace coverage throughout the year and then claim the premium tax credit when you file your tax return.)
• Farm income (or loss) is reported on Schedule F (Form 1040).⁹ The amount is then included on Schedule 1,¹⁰ along with any other income and adjustments that the household might have.
• MAGI for determining subsidies is adjusted gross income (AGI), plus – if applicable – non-taxable Social Security benefits, tax-exempt interest, and foreign-earned income and housing expenses for people living abroad. If you don’t have any of those three add-backs, your ACA-specific MAGI will be the same as the AGI reported on line 11a of your Form 1040.¹¹
• If you’re facing the “subsidy cliff” and the prospect of paying full price for your Marketplace coverage, learn about how contributions to a health savings account or pre-tax retirement plan can reduce your MAGI.

You should consult a tax advisor if you have questions about your own tax forms or circumstances.

What other health insurance options are available for farmers?

In addition to Marketplace coverage, there are some other health insurance options for farmers, with varying eligibility rules. They include:

Government-run coverage such as Medicare or Medicaid

In most states, due to Medicaid expansion under the ACA, Medicaid is available to adults under age 65 with household income up to 138% of the federal poverty level. ($45,540 for a family of four in the continental United States, under income limits that will be applied as of early 2026).¹²

So depending on the farm household’s location and total income, the household may be eligible for Medicaid. And Medicaid/CHIP is available at higher income levels for children, so they may qualify even if the household income is too high for the adults to be Medicaid-eligible.¹³

Medicare is typically available to those who are 65 or older, and to some people under 65 who are disabled.¹⁴ Medicare is always individual coverage; there’s no such thing as family Medicare.¹⁵ So if the farm household has other members who aren’t eligible for Medicare, they will need to obtain other coverage. Learn more about health insurance options for the rest of the family.

A spouse’s coverage

According to a 2015 USDA analysis (the most recent available), more than half of farm households have employer-sponsored health insurance, typically provided by a spouse’s off-farm employer. This was almost exactly the same as the percentage of non-farm households that have employer-sponsored coverage.¹

Non-ACA-compliant alternatives

Coverage alternatives that aren’t regulated by the ACA include products like short-term health insurance and fixed-indemnity insurance, as well as non-insurance products like health care sharing ministry plans.¹⁶

Farm Bureau health plans are another non-insurance option available in several states, including Alabama, Arkansas, Florida, Indiana, Iowa, Missouri, Kansas, Mississippi, Nebraska, North Dakota, Ohio, South Dakota, Tennessee, and Texas.¹⁷

The Farm Bureau in each of those states markets these plans to its members as an alternative to Marketplace insurance. The plans use medical underwriting, which means people with certain health conditions won’t be accepted, and pre-existing condition waiting periods are common. Farm Bureau can sell these plans only because those states have laws specifically clarifying that these plans are not insurance.¹⁸

That allows them to avoid state and federal insurance laws in order to offer lower-cost plans to healthy people. But it also means that if someone is enrolled in one of these plans and has trouble with it, they cannot turn to their state insurance commissioner for help, as these plans are not subject to the same rules and oversight that apply to health insurance.

And because these plans do not have to comply with insurance regulations, enrollees facing significant medical needs may find that their coverage under these plans is inadequate.¹⁹

(Legislation was under consideration in 2026 in Maine²⁰ and Wisconsin²¹ to allow Farm Bureau plans in those states.)

While non-ACA-compliant plans might be less expensive than Marketplace coverage for someone who doesn’t qualify for Marketplace subsidies, they come with various drawbacks. These kinds of plans don’t meet the minimum essential coverage requirements under the ACA, and may include pre-existing condition exclusions and lifetime and/or annual dollar limits on benefits. It’s important for consumers to read all the fine print of the policy terms and understand exactly what they’re buying, what’s covered (and what’s not), and what recourse they have if they run into difficulties with the plan.

Are ACA Marketplace plans available year round for farmers?

No, ACA Marketplace plans are not available year round for farmers, nor are individual-market plans purchased directly from insurers (off-exchange plans).

Farmers have the same enrollment access as anyone else: ACA-compliant individual-market coverage is available during the annual open enrollment period (starting in the fall of 2026, this window runs from November 1 through December 15 in most states), but outside of that window, it’s only available if individuals qualify for a special enrollment period.

(American Indians and Alaska Natives have a year-round special enrollment period, but otherwise, special enrollment periods are triggered by specific qualifying life events.) And in most cases, a special enrollment period is only available if the person already had minimum essential coverage prior to the qualifying life event.²²

Similarly, farmers who rely on a spouse’s employer-sponsored coverage can enroll in that plan, drop coverage, or change to a different plan (if offered by the employer) during the employer’s open enrollment period or a special enrollment period linked to a qualifying life event.

Can farmers deduct their health insurance premiums?

Farmers who are self-employed can claim the self-employed health insurance deduction for the after-subsidy portion of their premium, as long as they aren’t eligible for group coverage (including group coverage offered by their spouse’s employer).

The self-employed health insurance deduction will reduce MAGI, which will affect premium subsidy amounts. Learn more about how this works.

The self-employed health insurance deduction does not require the policyholder to itemize, but the deduction is only available to people who are considered self-employed.²³ Anyone who itemizes their deductions is allowed to deduct total medical costs – including health insurance premiums – that exceed 7.5% of their adjusted gross income. Learn more about how this works.