Navigating health insurance options as a locums dermatologist

I’ll start by saying what is probably obvious to a lot of you: there is no "one-size-fits-all" health insurance plan for a locums physician. Your optimal choice likely depends on your budget, your health status, your family’s needs, and your travel schedule. Understanding the nuances of each option is a good way to avoid overpaying for coverage you don’t need or, conversely, finding yourself underinsured while on assignment.

1. Get on Your Spouse’s Plan: If you have a spouse, and that spouse has access to an employer-sponsored plan, congratulations! This is almost always your best starting point. Employer-sponsored plans are usually subsidized, meaning the total premium is lower than what you will find on the private market. If you are eligible for a subsidized plan through your spouse but choose a private plan instead, you generally cannot deduct your health insurance premiums from your 1099 income. You must join during their company's Open Enrollment or within 60 days of your "Qualifying Life Event" (leaving your job).

2. The ACA Marketplace (Healthcare.gov) Leaving your job allows you to shop the Marketplace mid-year during a Special Enrollment Period.

• High Deductible Health Plans (HDHP): To save on premiums and gain significant tax advantages, look for plans labeled as HDHP-eligible. Enrollment in an HDHP is a legal requirement to open a Health Savings Account (HSA). For 2026, the contribution limits are $4,400 for individuals and $8,750 for families (plus a $1,000 catch-up if you are 55 or older).

• Triple Tax Advantage: An HSA allows you to deduct contributions, grow funds tax-free, and withdraw them tax-free for medical expenses. These are awesome benefits.

• A note on HMO/EPO Marketplace plans: If you are a traveling locum, verify that the plan offers "out-of-area" coverage, or you may be forced to pay out-of-pocket while on assignment.

3. Private PPO Plans These are underwritten plans purchased outside the government exchange. They often utilize massive national networks. For a locum working in multiple states, this can provide the most consistent coverage across state lines. Because these are underwritten, the company can review your medical history. If you have significant pre-existing conditions, you may be denied or charged a higher premium.

4. COBRA: The Safety Net COBRA allows you to stay on your former employer’s plan for up to 18 months. You pay 100% of the premium. Federal law also allows employers to add a 2% administrative fee to the total cost. This fee is commonly applied. Check with your HR personnel to get specific quotes on cost. I think that this is an expensive option with niche uses cases (i.e. if you’ve already met your deductible for the year or are in the middle of a high-cost treatment with a specific specialist who is out-of-network on all other plans).

A note on tax deductions: As a self-employed physician, you can generally deduct 100% of your health insurance premiums. However, this only applies for months where you were not eligible for a subsidized plan through your spouse. Always verify your specific eligibility with a tax professional to ensure you are maximizing your "above-the-line" deductions.

I personally chose an HSA-eligible HDHP from the ACA Marketplace because I’m relatively healthy, highly value the tax advantages of an HSA, don’t have a spouse, and found COBRA cost-prohibitive. Before you take the leap to locums, make sure you review your health insurance options so that you can make an educated decision.

Disclaimer:The information provided in this post is for informational purposes only and does not constitute formal tax, legal, or insurance advice. Health insurance rules are state-dependent and subject to change. Please consult with a qualified insurance broker or tax professional regarding your specific situation.