What changed in January
The enhanced premium tax credits expired. Marketplace subsidies reverted to the pre-enhancement structure, which reintroduces the income cliff: above the threshold, you pay full unsubsidized premium. For a locum physician with variable income, a good year can retroactively cost you the entire subsidy.
Two consequences: estimate income deliberately when you enroll, and reconcile at tax time expecting to owe back credits if you undershot.
Six options, ranked for a 1099 physician
- A spouse's employer plan. Almost always the cheapest real coverage. Check whether your locum start creates a qualifying life event.
- Marketplace bronze or silver plus an HSA-qualified plan. Predictable, portable, and the HSA deduction is meaningful at physician marginal rates.
- A professional or specialty association group plan. Worth pricing; quality varies widely by state.
- COBRA from a prior W-2 position. Expensive but seamless, and useful as a short bridge while you shop.
- Health care sharing ministries. Not insurance, no guarantee of payment, no appeals process. Understand that before choosing it.
- Short-term limited duration plans. Last resort. Pre-existing conditions are commonly excluded and they are not ACA-compliant coverage.
HSA arithmetic
If you hold an HSA-qualified plan, fund the HSA fully. The contribution reduces both income tax and, unlike a 401(k) deferral, is available tax-free for medical costs indefinitely. Keep receipts; reimbursement has no deadline.
Do not skip disability
Own-occupation, specialty-specific disability insurance is the coverage a locum physician actually cannot self-insure. Buy it while you are healthy and buy it portable — it is not tied to any agency.
Sources
No external source has been supplied for this guide. Figures are described in plain language rather than stated as numbers until a citable source is published here. Verify anything decision-critical against the primary authority named in the text.