Health Insurance for 1099 Physicians, CRNAs and Locum Tenens

Short answer: a locum tenens agency, or a group that pays you on a 1099, is not your employer, so it does not owe you health insurance. You buy your own: a marketplace plan, a private plan or an HSA-eligible plan, and you deduct the premiums on your personal return. At physician and CRNA incomes there is no marketplace tax credit for 2027. It stops at $63,840 of household income for one person and $132,000 for a family of four.

Why the Tax Credit Does Not Reach You

The enhanced tax credits expired after 2025, so the old cliff is back. For 2027 coverage the credit is available only up to 400% of the poverty line: $63,840 for one person, $86,560 for two and $132,000 for a family of four. Below that line it caps what you pay for the benchmark Silver plan at 10.22% of income. Above it you pay the full price, and a dollar over the line loses the whole credit.

The income that counts is your net self-employment income after business expenses, plus any W-2 wages and your spouse’s income. Even after expenses, most full-time 1099 physicians and CRNAs are well over the line, so the sensible plan is to budget at full price and use the deductions below.

What a Plan Costs at Full Price

Every adult is priced on their own age and on the county where they live, so a couple at 50 pays about twice the single figure below, plus anything for children.

Monthly premium for one adult before any tax credit: the median, across the state’s counties, of the cheapest Silver plan sold there. 2026 plans, from the CMS Qualified Health Plan Landscape file. 2027 prices post in late October; increases approved so far include Indiana 17.5%, Michigan 14.5% and Tennessee about 15.6%.

The Network Problem for Locums

Locums work in different hospitals, often in different states, so the network matters more than it does for most people. Marketplace plans are sold where you live, and many are HMOs or EPOs that cover routine care only inside their own network. Emergency care is covered anywhere, at in-network cost sharing, under federal law.

In 2026, seven of the 17 HealthCare.gov states this site covers had no marketplace PPO in any county: Indiana, Kansas, Mississippi, Ohio, Tennessee, Texas and Utah. Nebraska and Wisconsin had them in some counties only (PPO availability by state). If your home state has a marketplace PPO, check that it includes providers where you actually work before you sign a long contract.

Private plans sold outside the marketplace can come with access to a national PPO network such as UnitedHealthcare or PHCS. They pay set cash amounts for covered care rather than working like an ACA plan, they are medically underwritten, and they are not major medical coverage, so they suit healthy people who don’t need maternity, mental health or rehab benefits. For someone in that position above the tax-credit line, they often cost about half the full marketplace price.

The 100% Deduction, and the Month Rule

• Self-employed health insurance deduction. Premiums for you, your spouse and your dependents come off your income on Form 7206, up to your net self-employment profit. It lowers income tax, not self-employment tax.
• The month rule. You cannot take the deduction for any month you were eligible for a subsidized plan through an employer, yours or your spouse’s. A W-2 hospital job with benefits counts, even if you turned the plan down.
• HSA-eligible plans. For 2027 an HSA-eligible plan needs a deductible of at least $1,750 for one person ($3,500 for a family), and you can put up to $4,500 ($9,000 for a family) into the HSA, all of it deductible.
• Practising through an S corporation or PLLC taxed as one? The company can pay the premium and put it on your W-2. See health insurance for S corp owners.

W-2 Job Plus 1099 Shifts

Many physicians and CRNAs keep a W-2 job and take locum or 1099 shifts on the side. If the W-2 job offers a plan, staying on it is usually the cheapest route, and the extra 1099 income does not change that. If your spouse has a job-based plan, compare the family price on it with separate plans before you decide; the spouse comparison is here.

Common Questions

Do locum tenens agencies provide health insurance?

Not when you work for them as a 1099 independent contractor: the agency is not your employer, so you buy your own plan. Some agencies offer W-2 locum positions that come with benefits, so ask which arrangement a contract is before you compare pay.

Can a 1099 physician get a marketplace tax credit in 2027?

Only if household income is at or under 400% of the poverty line: $63,840 for one person or $132,000 for a family of four for 2027 coverage. Above that there is no credit at all.

Is health insurance tax-deductible for a 1099 CRNA?

Yes. Premiums for you, your spouse and your dependents are deductible as self-employed health insurance, up to your net self-employment profit, except for months you were eligible for a subsidized employer plan through your own job or your spouse’s.

Will a marketplace plan cover me when I work in another state?

Emergency care, yes. Routine care depends on the network: HMO and EPO plans usually cover it only in their own area, while some PPO plans include providers in other states. Check the network where you will be working before you choose.

Sources

• CMS, Qualified Health Plan Landscape file, individual market medical, plan year 2026 (data.healthcare.gov): premiums and plan types.
• HHS 2026 poverty guidelines, 91 FR 1797 (15 January 2026): the 2027 tax-credit income limits.
• IRS Rev. Proc. 2026-26: the 2027 applicable percentage (10.22% at 300–400% of the poverty line).
• IRS Rev. Proc. 2026-24: 2027 HSA contribution limits and HSA-eligible plan deductibles.
• IRS, Instructions for Form 7206, Self-Employed Health Insurance Deduction.
• 45 CFR § 147.138: emergency services without prior authorization at in-network cost sharing.