Securing Health Insurance as an Independent Contractor

You have mastered the art of the credentialing packet. You can pack a clinical wardrobe into a single carry-on, navigate a new electronic health record system before your first cup of coffee, and establish rapport with an entirely new team of nurses and attending physicians within hours of arrival. You chose the locum tenens life for the autonomy, the variety, the ability to shape your career around your life rather than the other way around. 

But there’s one aspect of independent practice that clinical experience can’t prepare you for: independent health insurance. Unlike your permanently employed colleagues who complete a single open enrollment form and forget about health coverage for another year, you’re constantly reevaluating as rules shift and premiums rise. 

Whether you’re new to independent practice entirely or simply exhausted by the annual ritual of comparing bronze plans against silver, the following sections will equip you with the framework necessary to make confident, informed decisions. We’ll look at the major pathways to coverage, decode the tax advantages unique to self-employment, and talk through the specific role that locum tenens agencies can and should play in your benefits strategy. 

Health insurance may never be simple, but for the independent contractor who understands the terrain, it can become manageable. Honestly? That makes all the difference.

Health insurance for independent contractors and locums staff

• What is the best way for a self-employed person to get health insurance?
• Other types of health coverage for independent contractors
• How do locum tenens agencies help with health insurance coverage?
• How much is health insurance for a self-employed person?
• Can you write off health insurance as an independent contractor?
• Learn more about career independence for APPs

What is the best way for a self-employed person to get health insurance?

Self-employed individuals actually have a surprising amount of choice and flexibility when it comes to insurance providers. Because there’s no single “best” plan for everyone, the optimal path depends entirely on your income, your health needs, your tax strategy, and your willingness to shop around. Generally, the best approach is to start with the most regulated and consumer-protective options before moving to niche solutions like we do here: 

ACA marketplace

The Affordable Care Act marketplace (also known by its domain name, Healthcare.gov) is frequently the most secure and comprehensive option for locum tenens providers. These plans are guaranteed-issue, meaning you cannot be denied coverage or charged higher premiums due to pre-existing conditions. Furthermore, they must cover ten essential health benefits, including mental health services, prescription drugs, and maternity care. 

The primary financial advantage for the self-employed lies in the premium tax credits. However, even if you earn too much for subsidies (as most locum providers do), the ACA platform provides a transparent marketplace where you can compare levels of coverage (Bronze, Silver, Gold, and Platinum) based on how much risk you want to assume regarding deductibles and out-of-pocket maximums.

Private health insurance

Purchasing health insurance directly from a private carrier outside of the ACA open enrollment period is possible, but it comes with significant trade-offs. These off-exchange plans are not required to adhere to the same strict coverage rules as ACA plans. They may utilize medical underwriting, and many of these short-term or indemnity-style plans feature annual or lifetime dollar limits on coverage, a practice banned under ACA-compliant plans. 

For a healthy locum tenens clinician who wants catastrophic coverage and does not need subsidies, a private plan might be the right choice, but it is critical to read the fine print to ensure you are not inadvertently purchasing a plan that leaves you exposed to six-figure medical debt.

Professional associations

Many independent contractors turn to professional associations to access group health coverage. These organizations leverage their large membership bases to negotiate rates that are typically better than individual private plans. If you’ve filed paperwork to become an LLC, you might also be eligible for business insurance through Healthcare insurance consortiums or membership in your local Chamber of Commerce. 

For locum tenens physicians, checking with your staffing agency or a state medical association can yield viable options, but you should always verify that the plan provides comprehensive major medical coverage rather than a limited-benefit plan that only supplements a small portion of medical costs.

Unique situations (spousal coverage, Medicaid, and COBRA)

Sometimes the best health insurance strategy does not involve purchasing a new policy at all. If your spouse or domestic partner has access to an employer-sponsored group plan, joining their coverage is almost always the most cost-effective and comprehensive solution available. This is considered a qualifying life event, allowing you to enroll outside of standard open enrollment periods. 

If you’ve recently left a role, COBRA allows you to temporarily stay on a previous employer’s health plan, typically for up to eighteen months. While COBRA is notoriously expensive (you pay the full premium plus an administrative fee) it offers the distinct advantage of zero changes to your deductible or provider network, making it an excellent bridge during the first few months of establishing your independent practice.

While the least likely to be useful to locums contractors, Medicaid remains a vital safety net for those experiencing a low-income year; in states that have expanded Medicaid, coverage is available to adults with income up to one hundred thirty-eight percent of the federal poverty level. Unlike ACA subsidies, Medicaid enrollment is open year-round.

Other types of health coverage for independent contractors

Beyond the major categories of major medical insurance, self-employed professionals have access to supplementary financial tools and temporary safety nets that can significantly influence both their healthcare costs and their tax liability. These options are not always direct replacements for a comprehensive major medical policy, but when used strategically, they can bridge gaps in coverage or amplify the value of an existing plan.

Health Savings Accounts (HSAs)

A Health Savings Account is arguably one of the most powerful yet underutilized financial tools available to the self-employed. To be clear, an HSA is not an insurance plan itself, but rather a tax-advantaged savings account that must be paired with a qualifying High Deductible Health Plan. For independent contractors who are healthy enough to assume a higher deductible in exchange for lower monthly premiums, the HSA offers a triple tax benefit that no other account can match. 

Contributions are made pre-tax, reducing your adjusted gross income and thereby your self-employment tax burden. The money grows tax-free through investments, and withdrawals are completely tax-free as long as they are used for qualified medical expenses. Unlike a Flexible Spending Account, funds in an HSA roll over year after year and remain yours even if you switch insurance carriers. 

Short-term coverage

Short-term health insurance plans exist in a very different regulatory space than ACA-compliant policies, and they serve a very specific purpose in the locum tenens lifestyle. These plans are designed to fill temporary gaps in coverage, such as the interval between a contract ending and spousal coverage beginning, or during the waiting period before association coverage takes effect. However, it is critical to view these plans as a bridge rather than a foundation, as relying on them during a serious illness or injury could result in catastrophic out-of-pocket expenses.

How do locum tenens agencies help with health insurance coverage?

The manner in which a locum tenens agency assists with health insurance depends entirely on how the clinician is classified for tax purposes. In some cases, agencies offer traditional W-2 employment model, wherein the clinician is officially an employee of the agency rather than a true independent contractor.

Under this arrangement, the agency withholds payroll taxes and, critically, provides access to group health insurance benefits. Coverage can extend to spouses and dependents, and it continues uninterrupted during gaps between assignments as long as the break does not exceed thirty-one days. 

However, not all locum tenens professionals work under this model. Many agencies place clinicians as 1099 independent contractors, and in those cases, the responsibility falls on the clinician to secure individual coverage. Recognizing this gap in the market, third-party services such as Ten99 Health have emerged specifically to cater to locum tenens providers who lack access to employer-sponsored plans. 

However, even if your agency doesn’t provide insurance directly, recruiters often have experience assisting clinicians seeking health insurance and can likely help you understand your options and make decisions. 

How much is health insurance for a self-employed person?

There is no single dollar amount that answers this question, as the cost of health insurance for a self-employed individual varies wildly based on income, subsidies available in your area, and local pricing. The primary driver of these costs for independent contractors is the premium tax credit, a subsidy that lowers monthly payments for those who purchase plans through the ACA marketplace. When these subsidies expire or are reduced, as was the case in 2026, the full weight of the premium lands on the consumer. We saw ACA benchmark premiums increase 21.7% in 2026 thanks to the loss of these subsidies. 

What can be stated with certainty is that the cost is substantial, but luckily for many locums providers, still very tenable. 

Can you write off health insurance as an independent contractor?

Yes, and this tax deduction is one of the most significant financial advantages available to the self-employed professional. The IRS permits eligible independent contractors to deduct one hundred percent of their health insurance premiums from their taxable income. This distinction is crucial: because it’s an above-the-line deduction, it reduces your adjusted gross income regardless of whether you itemize, and it lowers your income tax liability while also potentially improving your eligibility for other tax credits and deductions that phase out at higher income levels.

The deduction covers premiums paid for medical, dental, vision, and qualified long-term care insurance, as well as all Medicare parts, for the taxpayer, their spouse, their dependents, and any non-dependent child under the age of twenty-seven. 

However, the deduction is prohibited for any month during which the taxpayer or their spouse was eligible to participate in an employer-sponsored subsidized health plan, even if they declined that coverage. This rule trips up many independent contractors who have a spouse with a traditional job; if the spouse’s employer offers affordable coverage, the self-employed individual cannot deduct their own premiums, even if they prefer to remain on their own plan.

Learn more about career independence for APPs

The freedom of locum tenens work should not come at the cost of constant anxiety about what happens if you get sick, nor should the financial benefits of a 1099 income be erased by confusion over which premiums are deductible and which marketplace plan actually covers your medications. At Locumly, we believe that career independence should feel like freedom, not like being lost at sea without a compass.

Locumly is a locum tenens agency built by experts who understand that your professional autonomy must be supported, not exploited. We place nurse practitioners and physician assistants in rewarding temporary assignments across the country, but our commitment to you extends far beyond the credentialing packet and the first day of your contract.

We want you to build a career on your own terms, whether that means taking high-paying crisis response contracts in the fall and hiking the Appalachian Trail in the spring, or settling into a single facility for an extended assignment while your children finish high school. 

Let us handle the logistics so you can remember why you became a clinician in the first place.