By The Locum Tenens Guy, Guest Writer
Many physicians interested in locum tenens work full-time are concerned about health insurance – how to get it, how much it will cost, and what kind to get. It’s a little ridiculous that we as physicians have to stress about these things, but considering the state of healthcare in the United States, it’s not surprising. This post will help walk you through your options and things to consider, but before you get started, start thinking about what your budget is and how much coverage you need.
What Are The Health Insurance Options for Locum Tenens Physicians?
First, let’s discuss your options for coverage and how to find them. This might be daunting if you’ve never had to secure your own health insurance, for example, if you’ve only held employed positions or you’re fresh out of residency. Having employer-provided health insurance definitely makes life easier, but if you don’t have that, where do you even begin? Let’s look at the options:
#1 Health Insurance Exchange/Marketplace
Perhaps the easiest place to start is to search for available policies through the Affordable Care Act health insurance exchange or marketplace (Healthcare.gov). Here you can search for coverage options by state and apply online during open enrollment.
#2 Individual Healthcare Broker
Another option is to seek out an individual broker. This person may represent several different companies and can help you decide on the best option, based on what you need and what your budget is.
#3 Your State Medical Society
If you’re a member of your state medical society, you can also inquire there. Some state medical societies offer sponsored health plans for individuals and families but may also have limited enrollment windows.
#4 National Association for the Self-Employed
Members of the National Association for the Self-Employed (NASE) can get access to a number of plans for individuals and small businesses.
#5 COBRA
If you’ve recently been employed, you could consider obtaining coverage via COBRA from your previous employer. It’s definitely expensive, but at least you’d know what you’re getting.
It’s important to note that you will need a ‘home base’ so to speak, and a physical mailing address before securing coverage.
Cost of Self-Employed Medical Insurance for Locums Physicians
The biggest concern these days when it comes to health insurance is the cost. Your overall cost depends upon multiple factors, including:
- Number of dependents (if any)
- Monthly premiums
- Deductibles
- Coverage of care, in- and out-of-network
According to an eHealth analysis of ACA plans, the average monthly premium was $393 for individuals and $1021 for families in 2017. Generally speaking, the more you spend on your premium, the better your coverage will be, and the less you’ll have to pay out-of-pocket for healthcare expenses. On the other hand, high-deductible plans have lower premiums but a higher maximum for how much you have to spend before your care is fully covered (the threshold for a high-deductible plan according to the IRS is $1350 for an individual and $2700 for a family ($1400 and $2800, respectively, for 2020)). I personally have a high-deductible plan, and my premium is $1500 per month for a family of four. If you’re younger and have no known medical conditions, you may be able to get by with a high-deductible plan. But there’s a risk that you’ll incur a ton of expenses if something unexpected occurs.
Also, consider whether benefits are in- or out-of-network. As a locums physician, you may be moving around frequently or working in more than one state at once. If your home base is in one state, but you’re working in another, will your services be considered out-of-network, and therefore, more expensive? The answer is most likely yes.
Health Insurance Tax Considerations for Locum Tenens Physicians
You might be paying out the nose for insurance premiums or out-of-pocket expenses, but you can still try to recoup some of that at tax time. Medical and dental expenses, including health insurance premiums, are tax-deductible IF they exceed 7.5% of your adjusted gross income. Examples of expenses that qualify are listed here.
Additionally, self-employed individuals are eligible for the self-employed health insurance deduction which can reduce the tax burden.
Last, if you have a high-deductible plan, you can pay for medical expenses with a pre-tax Health Savings Account (HSA). You won’t be eligible for an HSA if you do not have a high-deductible plan.
Of course, it’s always best to consult your tax advisor or accountant. Any material here should not be considered tax advice.
Health Sharing Plans for Locum Physicians
If you haven’t heard of healthcare share plans yet, it may be time to look into them. Healthcare sharing ministries are faith-based communities (not insurance plans) where medical expenses are shared. There is no monthly premium but a set monthly contribution amount, and after you’ve paid your predetermined maximum amount for the year, your remaining bills will be covered by the shared network. There are various options in terms of monthly contributions and yearly maximums, which you opt into when you sign up. Although there do not appear to be limited time windows for enrollment, these plans may not cover expenses related to pre-existing conditions. Searching ‘health share plans’ will return at least a handful of options, if you’re interested.
Should Locum Tenens Physicians Use Separate Health Insurance Plans?
If you’d rather go the traditional route, and you need coverage for yourself and your family, you could consider getting separate plans based on your needs. For example, if you have a dependent with pre-existing conditions and/or are expecting more costly procedures or prescriptions, you could get ‘better’ or more traditional coverage for your dependents and a ‘catastrophic’ plan for yourself (assuming you don’t have the same expectations). This would save money by paying a lower premium for your own plan.
In the end, how to proceed is ultimately up to you, but at least now you know you have some options.
Are you self-employed? What health insurance hacks or tips to you have? Comment below!
[Editor's Note: The Locum Tenens Guy, a Seattle-based hospitalist and physician blogger, has successfully practiced locum tenens across many states and says he's “obsessed with career freedom and flexibility.” This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]
I’ve been with Medi Share after it was recommended by a friend who is also self employed. It’s not for everyone, and they do have restrictions, etc., but so far so good for me, and I like it that my contributions go to pay others medical expenses and not to insurance executives making millions.
When I’ve shopped for health plans in the past, I’ve noted that if you add the yearly premium amount and the max out-of-pocket amounts for a plan’s various levels (bronze, silver, gold), the total for each level is usually within a few dollars of the other levels. Knowing that, I always choose the high deductible/HSA option. If you end up maxing out your out-of pocket expenses, you’re exactly where you would be if you’d simply paid higher premiums. If you don’t, you’re ahead. Granted, if you pay the lower premiums, you need to make sure you save for the eventuality that you may end paying your deductible and co-insurance. May not be the same in every state, but it’s been consistent in my comparisons of Oregon health plans for the last 3 years.
I agree. It’s expensive stuff no matter how you pay it.
If I wanted to work lcoums for a group where I knew the lead partner, small group, can I be paid for consulting fees by their corporation and not be assessed local taxes? This wouldn’t be a huge deal, but I live out of state in a zero income tax state — why not save 5% if possible? The job might entail several weeks during the year, at around, or up to, 10k a week. Thoughts?
As a general rule, no, you have to pay the taxes in the state the work was done in.
I also agree Burke. Most plans we’ve shopped when adding up the “max” you could be spending are almost the same. I choose the lower premium, high deductible,
HSA plans and hope for the best, but prepare for the worst. I also enjoy the perks of the HSA account’s triple tax advantage (Tax free in, growth and out for med expenses).
My concern is where to find a policy that allows one to travel without fear of huge medical expenses. I read that a majority of the country now has only ACA policies with limited in state networks. Even if you have out of network coverage, you might have a 20%, 30% or 40% co pay but with the insurance companies responsibility and the OOP maximum calculated using some UCR or in-network value. I am even concerned about having a significant health problem while visiting family let alone while on a lengthy locum tenens assignment.
I can verify that ACA Marketplace plans in OH and WI offer few or no plans with out-of-network coverage. And those with OON coverage have steep co-pays (upwards of 50-75%). Also, in my experience, the Marketplace has offered the same plans at the same cost that I could get outside of the Marketplace. When I’ve moved it has been a big hassle to change plans through the Marketplace. The people I’ve talk to on the phone have not been helpful. If you don’t qualify for a subsidy (and most practicing physicians don’t) I would skip going through the Marketplace for insurance. Go through an insurance broker or get insurance directly from the insurance company.
I agree there is little reason for a doc to use the ACA marketplace. We just go to a health insurance broker.
After the forum thread (now closed) on health-sharing ministries, I’m surprised these are listed here in a discussion on health insurance without making stronger note of the caveats. As even proponents of these plans noted, these are NOT health insurance: they are not subject to industry regulations and standards, they are not legally obligated to pay for anything, and they have limitations on who they will cover (faith-based) and what they will cover (conditions resulting from non-Biblical living).
HSM may be used to defray healthcare expenses but they are NOT insurance. Many people use them as such but you have to read the fine print.
Yes, very important to understand what you are buying, how it works, what it covers, what it does not cover, what it guarantees (and who stands behind the guarantee) etc.
Your assumption that a discussion on the forum would influence something that later runs on the blog doesn’t account for the fact that this post was written (by someone not participating in that discussion), submitted (by someone not participating in that discussion), edited (by someone not participating in that discussion), and scheduled (by someone not participating in that discussion) months before that discussion.
I’m in NJ.
It’s been my experience that the plans offered on the exchange are the same plans that a broker can offer. Maybe called something else, maybe listed as “off exchange only”, but literally line by line the same plan.
If you reach out to NASE, they connect you with a broker. The broker then offers the same plans that are on the exchange.
So in essence, if you’re in NJ, self employed, and not eligible for a subsidy, then #1, 2, 3, & 4 lead to the same subpar outcome unfortunately.
Well, part of the ACA was making things uniform. So we shouldn’t be surprised when things are uniform. It’s uniformly expensive, but it is uniform.
Other health insurance option: Join Guard or Reserves get Tricare Reserve Select. Pay $228 family premium, $313 family deductible, $1044 catastrophic cap. Ofcourse, there’s joining that military part and all that comes with it ( weekend guard drill, annual 2 weeks, deployments, etc). Or you could just work an extra weekend a month to pay for private insurance premium/deductible and then some.
Not sure joining the military just for health insurance is a great idea, but it is a nice benefit.