Health Insurance for Orthopedic Surgeons

Your own plan: why private comes first

For you and your family, I start with a private, medically underwritten plan. Here is what makes it different:

• Priced on health, not income. Your rate reflects age, zip code and health answers. Partner distributions, surgery center income and a strong year in the operating room do not move it.
• Any month start. Coverage can begin on the first of any month if approved, so a partnership date, a practice change or a move does not have to wait for open enrollment.
• National reach. Many private plans use national PPO networks, which matter when you travel with a team, teach courses or have children at college out of state.

Approval is not automatic. You answer health questions, and private plans are not ACA Marketplace plans, so benefits and pre-existing condition rules vary by plan. If your health history includes a significant condition, the Marketplace is the guaranteed option, and that is what I will recommend.

Where the Marketplace falls short for you

The Marketplace was built around income-based credits, and an orthopedic surgeon's household is well past them. In 2027 the credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two, $109,280 for three and $132,000 for four. Above that line you face:

1. Full price after another round of increases. KFF found a 15 percent median proposed rate increase for 2027 in its August 2026 review of insurer filings.
2. Repayment risk. An advance credit taken on an estimate that proves too small has to be repaid in full on your tax return.
3. HMO and EPO networks. Many Marketplace plans limit you to one network with no out-of-network benefits except emergencies.
4. A $12,000 out-of-pocket maximum for one person, or $24,000 for a family, on 2027 plans.
5. One enrollment window, November 1, 2026 to January 15, 2027, with a December 15 deadline for coverage on January 1.

Orthopedic surgeons by the numbers

The AMA's 2024 Physician Practice Benchmark Survey found 54.0 percent of orthopedic surgeons in private practice, second only to ophthalmology among the specialties it measured. The Bureau of Labor Statistics counted 14,100 orthopedic surgeons in wage and salary jobs in May 2025, with a mean annual wage of $373,570 (BLS wage data). Roughly 10,290 of them worked in offices of physicians, and only about 2,800 were hospital employees. Practice owners who pay themselves as self-employed are not counted in that survey at all, so the true picture leans even further toward independent practice.

Covering your team

An orthopedic practice often employs physician assistants, athletic trainers, imaging technologists, therapists, surgery schedulers and front desk staff. You have three main ways to cover them:

• A small-group plan puts everyone, including you, on one contract and one network. It is familiar to employees and simple to explain, but costs move with the group as a whole.
• An ICHRA works for an employer of any size. You set a monthly allowance by employee class, such as full-time clinical staff or part-time front desk, and each person buys an individual plan. It keeps your cost fixed and lets you buy your own private plan separately. The ICHRA guide covers the rules.
• A QSEHRA is a simpler allowance for employers with fewer than 50 full-time employees, with annual limits set by the IRS.

If you own the practice through an LLC or another entity, the LLC owner guide explains how owner coverage differs from employee coverage. Owners who buy their own plan may be able to claim the self-employed health insurance deduction on IRS Form 7206, depending on how the business is taxed and whether an employer-subsidized plan was available to you. General information, not tax advice — confirm with your CPA based on your specific entity structure.

Partnership track and the years in between

Orthopedic surgery residency lasts five years, and many surgeons add a fellowship year in sports, spine, hand, joints or trauma. Training coverage usually ends June 30, and the first job may not start for weeks. A private plan with a July 1 start covers that stretch, and it can stay in place if your new employer has a waiting period of up to 90 days.

The next transition is partnership. Associates are often covered by the practice plan as employees. When you buy in, you may become an owner who buys your own coverage instead. Ask the practice how partner benefits work before your partnership date, and line up a private plan application for the first of that month if the answer is that you are on your own.

Traveling with a team or a tournament

Orthopedic surgeons who serve as team physicians, cover tournaments or teach at courses spend a lot of time away from home. If you are injured or sick on the road, an HMO generally covers only emergencies outside its service area. A national PPO lets you see a doctor in the city you are in, and it does the same for a spouse or children who travel with you.

Your hands, your back and your income

Orthopedics is physical work: heavy instruments, long joint cases, positioning patients, and fluoroscopy that keeps you in a lead apron for hours. Over a career, that shows up as shoulder, spine and hand problems for many surgeons. If you have had treatment for any of them, report it fully on a private application so the plan you buy will not be questioned later.

Health insurance covers treatment. It does not replace your income if you can no longer operate. Own-occupation disability coverage does, and it is worth reviewing whenever your income or practice ownership changes.

Getting it done

I am licensed in 31 states, including Florida, Georgia and Texas, and everything happens by phone or video. Tell me about your household and your practice, and I will price a private PPO for you beside the best Marketplace plan, then lay out the staff options. Get a quote or call or text (786) 218-2384.