Health Insurance for 1099 and Independent Physicians

Who this guide is for

This is the starting point for any physician without employer health benefits. The most common situations I see:

• Hospitalists and emergency physicians paid on a 1099 through a staffing or physician group that offers no health plan.
• Telehealth physicians who contract with one or more platforms and see patients in several states.
• Moonlighting physicians whose side shifts have become the main income. If you still have a full-time job with benefits, keep that coverage; this guide is for when the job goes away.
• Practice owners, solo or with a small staff, who need a plan for themselves and sometimes for employees.

If you travel from assignment to assignment, the locum tenens guide covers the details of short contracts and gaps between them.

Option 1: A Marketplace plan

A Marketplace plan must accept you regardless of health, covers pre-existing conditions and includes the standard essential health benefits. For 2027, the out-of-pocket maximum is $12,000 for one person.

The catch for most physicians is price. For 2027, the Marketplace subsidy stops at 400 percent of the federal poverty level, and a full-time physician's household income is usually well above that line. Above it, you pay the full premium, and full price rises with age.

Two other points matter for physicians:

• Plans are sold where you live. Many have local networks, and care outside the plan's area may be limited to emergencies.
• Timing is fixed. Open enrollment for 2027 runs November 1, 2026 to January 15, 2027 on HealthCare.gov. Choose by December 15 for a January 1 start; from December 16 to January 15, coverage starts February 1. State exchanges set their own dates. Outside that window, you need a qualifying event, such as losing other coverage, which opens a 60-day special enrollment period.

The Marketplace is often the better fit if you have a significant health condition, are planning a pregnancy, or are in a partial year of earnings, such as the year you finish training, when you may qualify for a subsidy.

Option 2: A private, medically underwritten PPO

For a healthy physician over the subsidy line, this is usually the first plan I price.

• Priced on your age, ZIP code and health, not on your income.
• A national PPO network on many plans, which helps if you live in one state and work in others.
• You answer health questions to apply, and approval depends on those answers.
• Benefits vary by plan, and plans may exclude or limit pre-existing conditions.
• These are not Marketplace plans. They do not follow every ACA rule, so read the plan documents before you buy.

You can apply any time of year. If approved, coverage can start on the first of the following month, so you are not waiting for open enrollment.

Option 3: Your spouse's employer plan

If your spouse has a job with family coverage, price it before anything else. Group plans accept everyone in the family regardless of health, and the employer usually pays part of the premium. Adding a spouse is generally allowed at your spouse's open enrollment or within a short window after a qualifying event, such as you losing your own coverage, so check the plan's deadline.

Many physician households end up here, and when the employer contribution is solid, it is often the better fit.

Option 4: A group plan through your own practice

If you own a practice with W-2 employees, a small group plan can cover you and your staff. Small group plans accept the group regardless of anyone's health, and they help with hiring and keeping good staff.

They come with rules. Insurers usually require at least one employee who is not the owner or the owner's spouse, a minimum share of eligible employees enrolling, and a minimum employer contribution. A practice with only the physician owner usually does not qualify.

Option 5: An ICHRA through the practice

An individual coverage health reimbursement arrangement, or ICHRA, lets the practice set a monthly allowance. Each employee buys their own individual plan, and the practice reimburses premiums up to that amount. It gives the practice a predictable budget and lets each person choose a plan that fits.

The plan each person buys generally has to be individual coverage that meets ACA rules, so many medically underwritten private plans do not qualify. Whether you as the owner can participate, and how reimbursements are treated for taxes, depends on how your practice is organized. General information, not tax advice — confirm with your CPA based on your specific entity structure.

Working across states

Health insurance follows where you live, not where you hold a license. A physician who lives in Florida and covers shifts or telehealth visits in other states still buys a plan based on a Florida address.

That makes the network the key question:

• A local Marketplace network may work well if you see doctors only near home.
• A national PPO network is worth more if you spend weeks working away from home or your family splits time between states.
• Moving your home usually opens a special enrollment period on the Marketplace if you had qualifying coverage before the move, and a private plan may need to be re-priced in the new state.

Disability insurance is a separate decision

Health insurance pays medical bills. It does not replace your income if an illness or injury keeps you from practicing. Employed physicians often have group disability coverage; independent physicians usually lose it along with the health plan.

Disability coverage is its own policy with its own underwriting, and the definition of disability, especially whether it protects your own specialty, matters a great deal. Get it quoted separately by someone who works in that field. This guide covers the health side only.

Specialty guides

Some specialties have their own wrinkles. See the guides for emergency physicians, family physicians and surgeons for the details specific to each.

A simple example

Dr. Ruiz is 44, works as a 1099 hospitalist for a group in Tampa and does telehealth visits in four other states. His wife runs her own business, and they have two children. Their income is well above the 2027 subsidy line, so a Marketplace plan would be full price, and the family's options there use local networks. Everyone in the family is healthy, so we price a private plan with a national PPO network next to the full-price Marketplace plans and compare deductibles, networks and total yearly cost. If anyone has a condition the private plan would exclude, the Marketplace becomes the stronger option for that person.

What to gather before you compare

1. Who needs coverage, with ages and your home ZIP code.
2. A short health summary for each person, including current prescriptions.
3. The doctors and hospitals you want to keep.
4. The states where you work or spend significant time.
5. Your spouse's employer plan cost, if one is available.
6. The date any current coverage ends.

Let's sort out your coverage

I am licensed in 31 states, including Florida, and I work by phone or video in English or Spanish. There is no fee for a consultation. Send me your household details and work setup, and I will lay out the Marketplace, private plan and group options side by side. Request a quote or call (786) 218-2384.