How can gig workers – such as Uber, Lyft, and DoorDash drivers – get health insurance coverage?

If I earn money through ride sharing or a delivery service, do I qualify for ACA Marketplace health insurance?

You almost certainly have access to Marketplace health insurance if you are otherwise eligible. That will be the case as long as you’re lawfully present in the United States, not incarcerated, and not enrolled in Medicare.⁴

A bigger question is access to Marketplace subsidies. Most Marketplace enrollees – 93% in 2025 – qualify for premium tax credits (also referred to as “premium subsidies”  or “subsidies”).⁵ Note that subsidies have been enhanced since mid-2021, making them more widely available. In early 2021, before the subsidy enhancements were available, 86% of Marketplace enrollees were receiving premium subsidies.⁶

If Congress doesn’t extend the subsidy enhancements, they’re scheduled to expire at the end of 2025. If that happens, the subsidy structure would revert to the way it was in early 2021. The majority of enrollees still qualified for subsidies at that point, but the percentage wasn’t as high as it’s been in more recent years.

Subsidy eligibility is based on annual household income (an ACA-specific calculation of modified adjusted gross income). In addition, you’ll be eligible for subsidies only if you don’t have access to comprehensive insurance from an employer that’s considered affordable, and you aren’t eligible for Medicaid/CHIP or premium-free Medicare Part A.⁷

How do subsidies work for people with fluctuating income?

Gig workers’ income often fluctuates over time, which may make it difficult to predict exactly how much they’ll earn throughout the year.⁸ Here’s what you need to know about Marketplace subsidies if your income fluctuates:

• Premium subsidies are a tax credit paid on your behalf to your insurance company, throughout the year you are covered. Because these payments precede tax filing, this process is called advance payment of the premium tax credit (APTC.) The size of the subsidy is based on your total household income for the year that you have coverage.⁹ That means you’ll need to project your total income for the coming year (or the current year, if you’re enrolling mid-year due to a qualifying life event) when you enroll.
• The Marketplace may ask you to provide documentation to verify the income projection you provide. This proof can be in the form of a self-employment ledger, for those who don’t have pay stubs or wage documents.¹⁰
• You’ll need to reconcile your premium tax credit (PTC) on your tax return. At that point, your total income for the year will be known, rather than a projection. If your projection wasn’t accurate, the IRS might owe you additional PTC, or you may have to repay the excess APTC that was paid on your behalf during the year.¹¹
• Starting with the 2026 plan year, there is no longer a cap on how much people have to repay if they owe excess APTC to the IRS. This makes it particularly important for you to be as accurate as possible when projecting income.
• If you realize mid-year that your income isn’t lining up with what you projected when you enrolled, you can log into your Marketplace account and update your income projection.¹² This will allow the Marketplace to make a real-time change in your APTC amount so that you don’t have as much of a discrepancy to reconcile when you file your tax return.

If I have more than one gig, like driving for Uber and delivering for DoorDash, do I combine all the income when applying for coverage?

Yes. Marketplace subsidy eligibility is based on total annual household income. If you have more than one gig – or use gig work to supplement your income from another job – you’ll need to provide your total household income to the Marketplace. If you’re married, your spouse’s income will also be counted, even if they aren’t applying for Marketplace coverage.¹³

Can I change health plans mid-year if my income drops or I lose a big contract?

If your income drops mid-year, you might be eligible to change health plans at that point. It will depend on whether the income drop makes you newly eligible for premium tax credits or cost-sharing reductions (CSR).

If an income change makes you newly eligible for premium subsidies, you’ll have an opportunity to switch to a different plan at any metal level. If the income change makes you newly eligible for cost-sharing reductions and you’re not currently enrolled in a Silver plan, you’ll have an opportunity to switch to a Silver plan. (CSR benefits are only available on Silver plans.)¹⁴

On the other hand, if you experience a mid-year income increase that makes you newly ineligible for premium subsidies or CSR, you’ll also have an opportunity to switch to a different plan.

Marketplace subsidies aren’t available if your household income is below the federal poverty level. If you’re in the coverage gap in a state that hasn’t expanded Medicaid, you’ll qualify for a special enrollment period if your income increases to at least the poverty level and you become eligible for subsidies.

If I take a break from gig work, can I pause my coverage or do I have to keep paying premiums?

If you’re in a state that has expanded Medicaid under the ACA, you might find that an income drop makes you newly eligible for Medicaid. This is the case in 2025 (and through the first few months of 2026) in most states if your monthly income drops below about $1,800.¹⁵ (This applies to a single person. The amount will be higher if there are other people in your household.) The updated 2026 numbers will be published by the federal government in early 2026, and states will begin using them to determine Medicaid eligibility by March or April 2026.

If your income drop makes you eligible for Medicaid, you can enroll in Medicaid and cancel your Marketplace plan. If you pick up some additional gigs later in the year and your income increases to the point that you’re no longer eligible for Medicaid, you can report the income increase to Medicaid and be disenrolled. That loss of coverage will trigger a special enrollment period that will let you enroll in a Marketplace plan again.

But there are some points to keep in mind here:

• Medicaid eligibility is based on monthly income but the program may take annual income into account where an individual’s income varies, whereas Marketplace subsidy eligibility is only based on total annual income.¹⁶
• If you switch from Marketplace coverage to Medicaid and then switch back again later in the year (due to multiple income fluctuations), your second Marketplace plan will be a new policy, rather than a reinstatement of your previous policy. You’ll be starting over with $0 accumulated toward your deductible and out-of-pocket limit, regardless of whether you had out-of-pocket spending earlier in the year.

If you don’t become eligible for Medicaid or other coverage and simply stop paying the premiums for your Marketplace policy, your coverage will lapse. (The timing of this will depend on whether premium tax credits are being paid on your behalf.) If that happens, you’ll have to wait to re-enroll until the next open enrollment period.

(You could re-enroll before open enrollment if you experience a qualifying life event that triggers a special enrollment period, but many special enrollment periods require the applicant to have had minimum essential coverage in place prior to the qualifying life event).¹⁴

Is short-term health insurance a good option for gig workers, or should I only use ACA-compliant coverage?

Health insurance that doesn’t comply with the ACA’s requirements for comprehensive coverage – such as short-term health insurance – isn’t built to provide accessible, affordable everyday coverage. This is due to constraints such as limited benefits, medical underwriting, and restrictions on how long a policy can remain in force.

Under federal rules that took effect in 2024, a short-term health insurance policy can have a maximum coverage duration of four months. Again, because it’s intended and required to be temporary, short-term coverage won’t work as a longer-term insurance solution.

In addition, pre-existing conditions are often not covered by short-term health insurance, fixed indemnity plans, or non-insurance solutions such as health care sharing ministry plans. These types of non-ACA compliant coverage are generally medically underwritten and also tend to have gaps in their coverage, as they aren’t required to cover the ACA’s essential health benefits.¹⁷

Do gig ridesharing and delivery platforms help to pay for health coverage or provide access to group coverage?

In general, no. People who are not traditional employees – including gig workers, freelancers, independent contractors, and sole proprietors – typically do not have access to employer-sponsored group health insurance unless they have also have  traditional employment that offers health benefit, or if they have access to a spouse’s group plan. Some states require ridesharing platforms to provide certain benefits to eligible drivers, although assistance with health insurance is rarely required by a state.¹⁸

Depending on where you live, you might be able to enroll in an optional injury coverage policy offered by the ridesharing platform. In California, Minnesota, and Massachusetts, this coverage is automatic (and drivers in Washington are covered by workers’ compensation while en route to pick up a customer and while driving a customer). But drivers in most states need to opt into (and pay for) this coverage if they want it.¹⁹

Bills introduced in Congress in 2025 would allow companies to voluntarily provide health benefits to independent contractors without jeopardizing the independent contractor status, and would also allow independent contractors to join Association Health Plans (AHPs).²⁰

AHP access for independent contractors was briefly allowed under the first Trump administration, but later overturned by a judge and subsequently rescinded by the Biden administration. AHPs are regulated as large group plans, which means they do not have to follow the ACA’s requirements for individual and small group health insurance. This means, for example, they do not have to cover the ACA’s essential health benefits.²¹ Consumers advocates worry that a push to expand access to AHPs for gig workers might result in more people being enrolled in coverage that doesn’t provide the ACA’s consumer protections.²²

If I’m injured while driving or delivering, how do I know if my health insurance will cover me?

You’ll want to check with your health insurance policy carrier, but also look at your auto insurance policy, and any additional coverage you might have through your ridesharing or delivery platform.²³

It’s also important to understand how different policies cover you depending on whether an accident happens when you’re on the ridesharing app, en route to pick up a customer, or driving a customer to their destination.²⁴

When determining what medical coverage you need, your first step should be to contact your major medical health plan and ask about the details of your coverage. Find out if your plan will cover injuries sustained during an accident while you’re on the job as an independent contractor.

If so, you’ll also want to make sure you know what your plan’s out-of-pocket maximum is. If it’s an amount you wouldn’t be able to cover, you could consider enrolling in an optional occupational accident insurance policy. As noted above, this type of coverage might be offered by the gig platform you are engaged by.

Your personal car insurance likely has an exclusion related to “business use” of your vehicle.²⁵ So you’ll want to check the specifics of this with your car insurer, and make sure that you have adequate coverage while driving for business for a ridesharing platform.

Pre-ACA, individual (self-purchased) health insurance could decline applicants based on their medical history, and it was also common for insurers to decline applicants who worked in certain industries. The specifics varied by insurer, but taxi cab driver was often on the list of ineligible occupations.²⁶ (Platforms like Uber and Lyft were just getting started around the time the ACA was enacted.) Fortunately, the ACA no longer allows individual market insurers to reject applicants based on their occupation.²⁶