Health insurance has never been simple in trucking. For owner-operators and small carriers, it’s often one of the most confusing, expensive, and emotionally loaded parts of running the business. And in 2026, that pressure could increase — not because of a new law, but because a temporary one may quietly run out.
Several provisions tied to the Affordable Care Act (ACA) are scheduled to expire at the end of 2025 unless Congress acts. If that happens, the way many self-employed drivers and small fleet owners pay for health insurance could change quickly.
This isn’t about politics. It’s about understanding the mechanics of what could happen and how it may affect your operation.
What Exactly Is Expiring?
The ACA itself is not going away currently. What’s at risk are enhanced premium subsidies that were expanded in recent years and made coverage more affordable for people who buy insurance on the individual marketplace — including a number of owner-operators.
These subsidies were temporarily expanded to:
• Increase the amount of financial help available
• Extend subsidies to people with higher incomes than before
• Cap premium costs as a percentage of household income
Those changes are set to expire after 2025 unless renewed. If nothing changes, the subsidy system reverts to its older structure in 2026.
Why This Matters Specifically to Trucking
Owner-operators and small carriers often fall into a tricky income category.
You might gross a solid number on paper but still operate on tight margins. You may not qualify for employer-sponsored insurance, and group plans are often unavailable or unaffordable for very small fleets.
That’s why some in trucking rely on the individual ACA marketplace — especially those who:
• Are self-employed
• Run one to five trucks
• Don’t offer full group benefits
• Use household income to qualify for subsidies
For this group, subsidies can be the difference between a manageable monthly premium and a bill that disrupts cash flow.
What Happens If the Subsidies Expire
If the enhanced subsidies are not extended, several things are expected to happen based on current projections.
Premiums Could Increase Sharply
For many individuals, monthly premiums would rise — in some cases significantly. Analyses suggest some households could see annual premium costs increase by thousands of dollars.
For a small carrier, that’s not just a personal expense. It affects:
• Take-home pay
• Household budgeting
• Business cash reserves
• Willingness to stay independent
Health insurance is already one of the few costs that doesn’t scale smoothly as you grow.
Some Drivers May Drop Coverage
Historically, when premiums rise beyond a certain point, people opt out.
For trucking, that carries risks:
• Greater financial exposure from illness or injury
• More stress operating without coverage
• Delayed medical care
• Increased reliance on emergency treatment
None of that helps a business run better.
Hiring and Retention Get Harder for Small Fleets
Small carriers already compete with larger fleets that offer group benefits. If individual insurance becomes more expensive, it becomes harder to attract drivers who rely on marketplace coverage or family plans. Even some leased-on operators may factor this into where they choose to work. This could quietly widen the gap between large fleets and small operators.
What This Does Not Mean
It’s important to be clear about what’s not changing:
• The ACA marketplace is not disappearing immediately
• Insurance exchanges will still exist
• Coverage options will still be available
• This is not an immediate 2025 issue
The concern is about cost, not access.
Why This Deserves Attention Now
Many trucking businesses plan for fuel swings, maintenance, insurance renewals, and slow seasons. Health insurance often gets overlooked because it feels personal rather than operational.
But for owner-operators, the line between personal and business finances is thin.
A sudden increase in health insurance costs can:
• Change how much freight you need to run
• Impact breakeven calculations
• Reduce your ability to sit during weak markets
• Force decisions you didn’t plan for
This is especially true if margins are already tight.
Practical Steps Small Carriers Can Take
This isn’t a panic situation — but it is a planning one.
A few smart moves:
• Review how much of your current premium is subsidized
• Understand what your premium would be without enhancements
• Factor potential increases into 2026 budgeting
• Talk with a health insurance advisor who understands self-employment
• Build a buffer rather than assuming today’s rate holds
This is the same mindset you apply to fuel or maintenance — you plan for volatility.
The Bigger Picture
Health insurance has always been one of the structural disadvantages for small trucking businesses. Enhanced ACA subsidies temporarily softened that reality for many.
If they expire, the underlying issue doesn’t change — it simply becomes more visible again.
Whether Congress acts or not, the takeaway for small carriers is the same: health insurance is a business variable, not just a personal one.
Understanding it, planning for it, and adjusting around it is part of operating with intention — especially in a market where margins don’t forgive surprises.
