The Health Insurance Gauntlet For Locum Tenens Doctors
/The Health Insurance Gauntlet For Locum Tenens Doctors
I find it ironic that a doctor looking to start locum tenens work might think that acquiring health insurance would be an obstacle on their journey. It’s like the insurance companies are giving us one last gut punch as we walk into the sunset, as if to say, we still own you! Well, those constant prior authorizations and rejections haven’t faded from my memory, and I am here to break down all the options to maintain high quality, reasonably priced health insurance while practicing locum tenens. We are on our home playing field, let’s not let the health insurance companies come into our house and push us around!
As a locum tenens doctor, you are a self-employed, independent contractor. This means you pick where you want to work, how much you want to be payed and how you structure your days. However, it also means you are running the business called YOU and as CEO, you need to provide benefits to your one employee. Health insurance can be one of the most important decisions you make as a locum tenens doctor, and these days it can be the most complicated. There are multiple aspects to the discussion of health insurance and we are going to take our time with one main issue, where you get your coverage. We understand that how much coverage you want is also a big factor in this decision but think that depends on individual concerns and health. We will leave it to you to pick the best coverage but want to provide a framework for where you can find it. Our goal is clear, allow you to find health insurance, take advantage of some tricks and wrap it all together so you, the doctor, come out on top!
Where Can I Find Coverage?
Short term health policies are available from most major insurance carries but come with a lot of red tape and downside. These are mostly used by locum tenens doctors who are transitioning between permanent jobs or are suddenly in need of healthcare. COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985, is a law passed by congress to support employees in the event that they were temporarily out of a job. In theory, if you lost or were transitioning to a new job, you should be able to continue your current employer sponsored health plan for a maximum of 18 months. Sounds simple enough, but wait, we forgot to mention the most important thing, cost. COBRA plans can be incredible expensive, and for most doctors considering long term locum tenens positions, it isn’t the best options. COBRA plans will feel like a huge price increase for the same coverage for two reasons. First, you will be responsible for the full cost of the health plan, and any prior employer contributions will be added cost. In a 2016 Kaiser Foundation study, it was determined that 82% of all employee health care costs were covered by the employers and only 18% fell on the employee. That 82% of the cost will now be solely on you. Second, COBRA adds a 2% service charge. Together, this is definitely going to hurt the wallet. We recommend using COBRA only for short spans and when it’s your only option, otherwise you are paying too much and can find better options elsewhere.
Are you married? Often times a physician who is transitioning into locums can take advantage of the health insurance plan of their significant other. This is commonly used by locum tenens doctors who take long term assignments close to their home, where their spouse continues with their current job, or with doctors who have spouses with jobs that are mobile and can take their plan on the road. Another group who can take advantage of spousal plans are those doctors who travel periodically for short term assignments but spend the majority of their time in a central location. Keep in mind, if you plan on utilizing your spouse’s plan, it is important to check the policy’s options and costs. Just because your significant other has coverage with their employer does not mean it will be the best available option or even the cheapest. One other catch, if you have access to a health insurance plan through your spouse, but choose to purchase your own individual plan, your premiums may not be tax deductible.
Your next option may not be one you would think of, but it’s right in front of your eyes. Often times if you are a member of a large organization, you are entitled to utilize their negotiating power in your favor. The American Medical Association, American Association of Retired Persons, The Freelancers Union, National Association for the Self Employed, and many specialty specific societies have reduced rates for members. As an independent contractor, locum tenens doctors fall into many groupings not utilized by doctors practicing in private practice or for a health system. Lastly, there has been huge growth in religious based health insurance organizations. These Christian Health Sharing organizations operate to provide health insurance to its members in a slightly different model. These plans do not cover preventative care, typically will have a deductible for every visit or issue, and often require you to pay up front and get reimbursed. They tend to be dramatically cheaper but have an upper limit of coverage that may scare any practicing physician who knows how high medical bills can run. When asked why one would switch to one of these, the most commonly cited reasons we found were the decreased costs and the ability to utilize “other physician friends” for basic issues. When pressed, we found that locum tenens doctors who are using Christian Health Ministries were doing so with the idea that they can ask their colleagues basic questions and avoid visits non-physicians might require. This was something we never quantified before. Regardless, utilizing the leverage of others who are similar to you can get you access to different plans or at lower rates. Maybe it’s time to actually pay that AMA bill you get in the mail every year!
The Affordable Care Act (ACA), in theory, was designed to require states to either set up their own government-run marketplaces, also known as exchanges, or use the federal government’s marketplace. These exchanges would provide a platform on which private insurers can sell health plans to Americans who were in need of coverage. Sounds simple enough, no? Recently lawmakers have removed several key parts of the legislation including the individual mandate and the cost-sharing reductions. Regardless of your opinion of the ACA, they are becoming less and less of a viable option for locum tenens doctors as the options are decreasing and the costs are skyrocketing despite relatively strong interest from consumers.
If the previous options aren’t in your wheelhouse, locum tenens doctors may choose to utilize private insurance carriers and select a plan to their liking. There are two ways this can be approached, utilizing a health insurance broker to shop plans for you or going through the big insurance agencies yourself. Like home or auto insurance, there are numerous health insurance brokers who can shop around for a plan that is best for you. Having a knowledge of the local markets, the laws and available plans, brokers often can produce big savings. On the other side, like any broker, they don’t work for free. The additional costs need to be weighed in relation to the benfits they provide. Where to find an agent? Start with reviewing several of the web-based brokerages that sell health insurance, including Insure Monkey, eHealthInsurance, and Health Plan One. You can get estimates based on limited anonymous information on these sites and often implementation is handled for you. If you don’t find what you need or what the human interaction, local agents can be found in your area by word of mouth or by searching for a local broker online at sites similar to HealthMarkets. Additional benefits to using a health insurance broker are their ability to handle the paperwork associated with insurance, addressing any issues you have, assisting with the renewal process, and servicing the account for billing, eligibility and claims along the way.
If you plan on shopping for insurance on your own, it is best to get a feel for what is out there before you get started. There are several websites that offer an overview of the market before you even begin to take a deep dive into each carrier’s plans. A very useful site is the Federal Governments Healthcare tool, which allows users to compare all plans in their area. Any doctor will appreciate the complexity of choosing a health insurance plan, and the goal is to find the coverage you need for the cheapest price. If you go at it on your own, it’s important to keep a file of important documents and dates. Each year review your current carrier and compare it to the marketplace as drastic changes happen in a short time frame when it comes to health insurance.
Health insurance coverage can be daunting if you don’t know where to look. On average, we found the majority of locum tenens doctors we surveyed were using brokers they were familiar with. Knowing where to get started is key, and a trusted broker is incredibly valuable. With all this information, it is important to shop around and find the plan that’s right for you.
~The Locums Life~
FAQ: Locum Tenens Health Insurance for Physicians
1) Do locum tenens physicians get health insurance through the staffing agency?
Sometimes—but not always, and it varies widely by agency. Some large locum tenens staffing agencies offer access to group health plans, while others offer limited options or none at all (especially if you’re truly 1099). The key is not assuming: locum tenens health insurance is not guaranteed the way it often is in W-2 employment.
2) Why is health insurance more complicated for locum tenens physicians?
Because locum tenens physicians are often independent contractors, meaning:
no employer is obligated to provide benefits
your income may be variable month-to-month
you may work in multiple states
you may take breaks between assignments
Health insurance hates uncertainty. Locums work can be wonderfully flexible—but that flexibility needs a plan so you never have a coverage gap.
3) What are the main health insurance options for locum tenens doctors?
Most locum tenens physicians choose from these core paths:
Spouse/partner employer plan (often simplest if available)
Agency-offered group plan (if offered and competitive)
ACA Marketplace plan (state or federal exchange)
Private individual plan (off-exchange) (availability varies by state)
COBRA from a prior employed job (short-term bridge)
Direct Primary Care (DPC) + catastrophic plan (strategy, not a full replacement)
Which is best depends on your family size, income, state, and how often you move between assignments.
4) What’s usually the best option for a locum tenens physician with a family?
If available, spouse/partner employer health insurance is often the simplest and most stable for families, because it:
stays active even if your assignments change
avoids multi-state confusion
reduces administrative burden
If that’s not available, many physicians do well with an ACA Marketplace plan, especially if you want predictable coverage independent of agencies.
5) Can I use the ACA Marketplace if I’m a high-earning physician?
Yes. High income affects subsidies, but not eligibility. Many high-earning locums physicians use Marketplace plans without subsidies—basically paying full price for stability and independence. The value is not always cost—it’s control.
6) Are there subsidies for locum tenens physicians on Marketplace plans?
Possibly, but many physicians won’t qualify due to income. However, locum tenens income can be variable, and your eligibility is based on projected annual household income. If you have a year with lower income (taking time off, part-time locums), subsidies may be relevant. It’s worth checking annually.
7) Should I choose an agency’s health insurance plan if they offer it?
Maybe. Compare:
monthly premium
deductible
out-of-pocket max
network quality (this is huge)
prescription coverage
coverage across states (if you travel)
whether coverage continues between assignments
Some agency plans can be great. Others are expensive with limited networks. Don’t choose based on convenience alone.
8) What’s the biggest trap in locum tenens health insurance?
Network limitations. Many plans have narrow networks that work well in one region and poorly elsewhere. If you travel for assignments or have kids who need routine care, a narrow network can create constant friction and surprise bills.
9) If I work in multiple states, do I need health insurance in each state?
Typically no—you generally maintain one primary health insurance plan based on your state of residence. But coverage use across states depends on the plan:
PPO plans often have broader out-of-network options
HMO/EPO plans may have limited out-of-state coverage except emergencies
If you travel frequently, the plan’s national coverage footprint matters.
10) What’s the best health insurance plan type for traveling locum tenens doctors: HMO, EPO, or PPO?
For frequent travel, PPO plans often provide the most flexibility, including out-of-network care (though at higher cost). HMO/EPO plans can be cheaper but may be restrictive outside your home region. If you rarely need non-emergency care while traveling, an HMO/EPO might still work.
11) What if I only need coverage for emergencies while I’m on assignment?
If you’re healthy and rarely need care, you might prioritize:
low premium
high deductible
strong catastrophic protection
good emergency coverage nationwide
But families and physicians with chronic care needs often benefit from stronger networks and lower friction.
12) Can I stay on COBRA when I leave a W-2 job to do locums?
Yes, COBRA can be a bridge. It’s often expensive, but it offers continuity—same network, same coverage. Many physicians use COBRA for a few months while they:
ramp locums income
choose an ACA plan
coordinate spouse coverage
COBRA is rarely the best long-term strategy, but it can be a useful transition tool.
13) Can I switch health insurance plans mid-year if I start or stop locums work?
Yes, if you have a qualifying life event (QLE), such as:
loss of coverage
marriage/divorce
birth/adoption
moving to a new state (in some cases)
Otherwise, changes may require waiting for open enrollment. Plan ahead to avoid getting stuck.
14) If I move for a locums assignment, can I change my Marketplace plan?
If you change your permanent residence to a different state, you may be able to enroll in a new plan. But many locums physicians maintain a stable home base and travel—so they don’t change residency each assignment. Changing residency casually can create insurance chaos and tax complications.
15) What about short-term health insurance plans?
Short-term plans can be cheaper but often:
exclude pre-existing conditions
have coverage limitations
may not meet ACA standards
can be risky if something serious happens
For a physician supporting a family, short-term plans are usually a last resort—not a core plan.
16) Are health sharing ministries a good option for locum tenens physicians?
They are not traditional insurance and often come with limitations, exclusions, and non-guaranteed payment structures. Some people use them, but for physicians—especially with families—they can be risky. If you consider one, read every exclusion and understand you may be exposed.
17) What is Direct Primary Care (DPC), and can it replace health insurance?
DPC is a membership model where you pay a monthly fee for primary care access. It can be excellent for convenience and relationship-based care, but it typically does not replace insurance for hospitalization, surgeries, imaging, specialty care, or emergencies. Many combine DPC with a high-deductible plan.
18) Should locum tenens physicians choose a high-deductible plan (HDHP)?
Often yes—especially if you’re healthy and want to lower premiums. HDHPs also allow HSA contributions (if HSA-eligible), which can be a major advantage. But if you have frequent healthcare use (kids, chronic meds), a lower deductible plan might be worth it.
19) What is an HSA, and why do locums doctors love it?
An HSA (Health Savings Account) is a tax-advantaged account paired with an HSA-eligible HDHP. Benefits:
contributions may be tax-deductible
growth is tax-free
qualified withdrawals are tax-free
can become a powerful long-term wealth tool
For independent contractors, HSAs can be a stealth “retirement” vehicle.
20) What about dental and vision insurance for locum tenens?
Often separate. Options include:
spouse plan
Marketplace add-ons (varies)
private plans
paying cash (sometimes more efficient)
Dental/vision plans can be useful for predictable needs (braces, glasses), but compare premiums vs expected costs.
21) How should a locum tenens physician plan health insurance if hookup between assignments is uncertain?
Assume gaps will happen and build a plan that doesn’t rely on continuous employment. That means:
a plan independent of your assignment schedule (spouse plan or Marketplace)
or a clear “bridge” plan (COBRA, then Marketplace)
calendar tracking so you don’t accidentally lapse coverage
22) What’s the best strategy to avoid coverage gaps?
Use a “coverage continuity rule”:
never terminate old coverage until new coverage is confirmed active
keep documentation of effective dates
ensure premium autopay is set
confirm coverage cards and access
A single missed premium can cause a painful lapse.
23) How do I evaluate a plan quickly (without getting lost)?
Use four numbers:
Premium (monthly cost)
Deductible
Out-of-pocket max
Network quality (most important in real life)
Then add:
prescription formulary if you take meds
pediatric coverage if you have kids
24) What does “out-of-pocket max” actually mean?
It’s the most you’ll pay in a year for covered in-network services (not including premiums). For families, this number matters more than deductible, because a serious illness or injury pushes you toward the max quickly.
25) If I’m a high-income locums physician, is an expensive plan still worth it?
Sometimes yes—because you’re buying:
network access
predictable billing
less administrative friction
protection from catastrophic costs
High earners often underestimate how disruptive medical billing chaos can be to their life and work.
26) What if I’m traveling and need non-emergency care while on assignment?
This is where plan type matters:
PPO: may cover out-of-network care partially
HMO/EPO: may not cover non-emergency out-of-network care
If you travel frequently, prioritize nationwide access—or plan to do routine care at home between assignments.
27) What if I have a chronic condition or a child with ongoing medical needs?
Then network stability matters enormously. You may prioritize:
a plan that covers your existing specialists
predictable prescription coverage
lower out-of-pocket max
strong pediatric networks
In these cases, spouse coverage or a high-quality Marketplace PPO can be worth the higher premium.
28) How does being 1099 affect health insurance premiums tax-wise?
Self-employed physicians may be able to deduct health insurance premiums under certain conditions. This is powerful, but depends on business income and eligibility rules (and whether you have access to employer coverage through a spouse). This is a CPA question, but it’s one of the “pros” of locums.
29) Can I deduct premiums if I’m on my spouse’s plan?
Often no, or it’s limited. If you’re eligible for spouse employer coverage, the self-employed premium deduction may not apply in the same way. The details matter. A CPA can guide this quickly.
30) What about maternity coverage while doing locums?
Make sure your plan:
is ACA-compliant (maternity is an essential benefit)
has an OB and hospital network you trust
covers pediatric care for the newborn
Short-term plans often have weak maternity coverage. Families planning pregnancy should prioritize stability and network access.
31) What’s the bottom line for locum tenens health insurance?
Here’s a clean takeaway sentence you can paste into your blog:
“Locum tenens physicians must proactively choose health insurance because 1099 work rarely includes employer benefits. The best locum tenens health insurance strategy is usually spouse coverage, an agency group plan, or an ACA Marketplace PPO—chosen for network strength, out-of-pocket maximum, and continuity between assignments.”
32) Quick checklist: What should I ask before choosing a health plan for locums?
Will coverage remain active between assignments?
Is my home state and travel region covered in-network?
Is it PPO vs HMO/EPO?
What’s the out-of-pocket max for my family?
Are my medications covered?
Are pediatric providers and hospitals in-network?
Can I use an HSA?
Disclaimer
This FAQ is educational and not insurance or tax advice. Health plan availability and rules vary by state and can change.