Setting Up Health Insurance for Your Company Drivers

Updated October 2026

Key takeaways

• Under the Affordable Care Act (ACA), employers with 50 or more full-time equivalent employees can owe a penalty if they do not offer affordable coverage to full-time employees. Smaller carriers are not subject to that penalty.
• Small carriers have several options: a small group plan, an Individual Coverage Health Reimbursement Arrangement (ICHRA), or a Qualified Small Employer HRA (QSEHRA).
• Drivers often travel across many states, so check that the plan’s network works where your drivers live and run.
• Owner-operators who are independent contractors buy their own coverage. Offering them your employee plan can create classification risk.
• A licensed benefits broker can compare plans at no direct cost to you in most cases, because brokers are usually paid by insurers.

Step 1: Know which rules apply to you

Count your employees. The ACA employer rules apply to “applicable large employers,” which have 50 or more full-time employees, including full-time equivalents. An applicable large employer that does not offer affordable minimum coverage to at least 95% of full-time employees can owe a penalty if an employee receives a premium tax credit on the marketplace.

Smaller employers do not face that penalty, but offering coverage still helps with hiring and retention. Experienced drivers often ask about health insurance early in the recruiting call.

State rules. Some states have their own requirements, such as continuation coverage rules for small employers. Your broker or benefits lawyer can confirm the rules for your state.

Contractors. Independent contractor owner-operators are not your employees and buy their own coverage. Including them in an employee health plan can be used as evidence that they are employees. See W-2 company drivers vs 1099 owner-operators.

Step 2: Choose a type of plan

Small group health plan. A traditional plan purchased from an insurer, usually through a broker or your state’s SHOP marketplace. You choose the plans and pay part of the premium. Plans include HMOs, PPOs and high-deductible plans that work with a Health Savings Account (HSA).

ICHRA. You give employees a set monthly, tax-free allowance to buy their own individual health insurance. Employers of any size can use an ICHRA, and you can set different allowances for different classes of employees, such as full-time drivers and office staff. This can work well for drivers who live in different states, because each driver buys a plan where they live.

QSEHRA. Available to employers with fewer than 50 full-time equivalent employees that do not offer a group plan. You reimburse employees tax-free for individual coverage and medical costs, up to an annual limit set by the IRS.

Level-funded or self-funded plans. Some mid-size carriers use these to control costs. They carry more financial risk and require careful setup.

Health care sharing ministries are sometimes marketed as a low-cost alternative. They are not insurance, do not have to cover pre-existing conditions or essential health benefits, and do not count as an employer offer of coverage under the ACA.

Step 3: Check networks for drivers on the road

Over-the-road drivers may need care far from home. When comparing plans, check:

• Whether the plan has a national network or out-of-area coverage
• Telemedicine options for minor illness while on the road
• Urgent care coverage in other states
• Prescription coverage at national pharmacy chains

Step 4: Add dental, vision and other coverage

Dental and vision plans are usually inexpensive and often requested. Group life and short-term disability insurance are also valued by drivers with families. Decide whether you will contribute to family coverage, because this is a common question from experienced drivers.

Step 5: Work with a broker and compare quotes

A licensed benefits broker can collect quotes from several insurers, explain the differences and help with enrollment. Ask for quotes based on your actual employee census (ages and locations), and compare total cost to the company and to the driver, not only the premium.

Step 6: Explain the benefits to drivers

• Put a short summary in your job ads: what is offered, when coverage starts and the driver’s cost.
• Train recruiters to answer basic questions and know who to send detailed questions to.
• Give new drivers a one-page summary during orientation, and a contact for questions.
• Hold open enrollment at times drivers can attend, or offer online enrollment.

See also how to offer competitive benefits to truck drivers.

Frequently asked questions

Do trucking companies have to offer health insurance?

Only applicable large employers, with 50 or more full-time equivalent employees, can owe a federal penalty for not offering affordable coverage. Smaller carriers are not subject to that penalty, but many offer coverage to compete for drivers.

What is the best health insurance option for a small trucking company?

It depends on your size, budget and where your drivers live. Small group plans, ICHRAs and QSEHRAs are the most common options. An ICHRA can work well when drivers live in several states.

Should owner-operators be on the company health plan?

Generally no. Independent contractors buy their own coverage, and including them in an employee plan can increase the risk that they are treated as employees.

Sources: 26 U.S.C. 4980H (ACA employer shared responsibility); IRS and Department of Labor guidance on ICHRAs and QSEHRAs. This article is general information, not legal or tax advice.