Health Insurance for Optometrists: Owners, Associates and Leased-Space ODs

Why I start ODs with a private plan

A private, medically underwritten plan sets its price from your age, zip code and health. Income plays no part, so adding a second location or a busy contact lens season never changes your premium. If approved, these plans can start the first of any month, and many use national PPO networks, which helps if you live near a state line or travel for continuing education. You do answer health questions, and approval is not guaranteed.

Private plans are not ACA Marketplace plans, and benefits and pre-existing condition rules vary by plan. Reading the plan details together is part of how I work.

A quick income check

The Bureau of Labor Statistics reported a mean annual wage of $141,550 for optometrists in May 2025, with about 42,790 employed ODs nationwide, most of them in offices of health practitioners. Those figures leave out self-employed owners. Even so, the employee average is above the 2027 subsidy line for every household size up to four people: $63,840 for one, $86,560 for two, $109,280 for three and $132,000 for four.

What the 2027 Marketplace costs an optometrist

Above the line, the Marketplace offers no credit at all, and the full price is climbing. A KFF review of 2027 filings found that Marketplace insurers asked for a median increase of 15 percent, the second double-digit jump in a row.

The credit also has a sting for anyone near the line. It is paid in advance based on your estimate, then reconciled on your tax return. Finish above 400 percent of the poverty level and you repay every dollar of the advance. For an associate whose production bonus arrives in December, or an owner whose practice has a strong year, that is not a hypothetical.

The plans themselves are often built around tight local networks. HMO and EPO designs are common, and they generally pay nothing outside the network except in emergencies. The 2027 out-of-pocket maximum is $12,000 for one person and $24,000 for a family. And you can only sign up during open enrollment, November 1, 2026 to January 15, 2027 (December 15 for a January 1 start), unless a qualifying life event opens a special window.

Coverage by practice model

• Practice owner. You pay for your own coverage and decide whether to cover staff. A private plan is usually the first quote I run, and the practice may be able to offer staff a reimbursement arrangement instead of a group plan.
• Associate OD. If your employer offers a group plan, compare its cost and network with a private plan before you enroll your family. If you work part time or across two practices, you may not qualify for either employer's plan.
• Leased-space OD. Doctors who lease space inside an optical retailer typically run their own small business there, which means no employer health plan. You are effectively self-employed, and the private-first comparison applies directly.
• Fill-in or multi-office OD. Covering vacations and open schedules on a 1099 basis is a common bridge career. Our locum tenens guide covers the contractor side in more depth.
• Corporate OD moving to ownership. Leaving a corporate role opens a 60-day special enrollment period, and COBRA may be available if the employer has 20 or more employees.

Graduation, residency and the first contract

The window between finishing school and starting your first job is the most common coverage gap I see. If you are under 26, you can usually stay on a parent's plan, which buys time. If you are aging off that plan, losing it opens a special enrollment period. An optional one-year residency usually comes with coverage, but the move from residency to your first position often leaves a month or two uncovered while credentialing and start dates settle.

If approved, a private plan can start the first of the month after your old coverage ends, then stay with you through the first job, a move into ownership or a switch to leasing space. Coverage you choose yourself does not end when a contract does.

When you have opticians and techs on payroll

Once you employ opticians, technicians and front-desk staff, benefits become a retention question. Three common options:

1. Small-group plan, the traditional route, with participation and contribution rules set by the carrier.
2. QSEHRA, for employers with fewer than 50 full-time employees, where you set a monthly allowance toward each employee's individual coverage.
3. ICHRA, for any size employer, which lets you set different allowances for classes such as full-time and part-time staff.

The small business owner guide and the ICHRA guide explain the mechanics.

On your own plan, an owner who is a sole proprietor, partner or more-than-2-percent S corporation shareholder may be able to take the self-employed health insurance deduction, limited to the sponsoring business's earnings and not available for months you could join a subsidized employer plan, such as a spouse's. General information, not tax advice — confirm with your CPA based on your specific entity structure.

Your eyes, hands and neck are the practice

Optometry is close, precise work. A hand injury, a retinal problem of your own or a neck condition that makes the slit lamp painful can end your ability to see patients long before it ends your ability to work in general. Health insurance pays the medical bills, but an own-occupation disability policy is what protects your income as an optometrist specifically. I suggest pricing both at the same time.

When the Marketplace is the right call

If you or a family member has a significant health condition, the Marketplace is the guaranteed option, and I will tell you so. It is also worth a look if your household income will honestly fall under the line, for example in a residency year or your first months as an owner. Bronze and catastrophic plans have been HSA-eligible since 2026, with 2027 limits of $4,500 self-only and $9,000 family, plus a $1,000 catch-up at 55.

Next step

I work by phone or video in 31 states, including Florida and Tennessee. Send your zip code, the ages on the plan and a brief health summary, and I will put private plans and the Marketplace side by side. Get a quote or call (786) 218-2384.