Health Insurance for New Locums: What You Actually Need to Know Before Your First Assignment

Stepping into locum life means trading a steady paycheck and predictable benefits for freedom, flexibility, and better control over your schedule. But there's one piece of the traditional employment package that doesn't just carry over: health insurance.

For many new locums, this is the first time they've had to think about coverage on their own. No HR department, no automatic enrollment, no benefits packet waiting on day one. Just you and a handful of decisions that can significantly affect your finances and your care. The good news? Once you understand the basics, this is a decision you can make confidently and even use it to your advantage. Here's what to know.

COBRA vs. Private Insurance

If you're leaving a W-2 job for locum work, COBRA is often the first option that comes up, mostly because it's automatic. COBRA lets you keep your previous employer's group plan for a limited time after you leave. The tradeoff is cost: your employer was likely covering a chunk of that premium, and once you're on COBRA, you're paying the full amount yourself. That bill can be a shock.

Private insurance is the other path. Depending on your health profile, a private plan can sometimes come in at a lower cost than COBRA, and it opens up more variety in plan design, deductibles, and coverage types. The right choice really comes down to your specific situation: your health, your budget, and how long you expect the coverage gap to last.

ACA Marketplace vs. Private Plans

Another major fork in the road is the ACA Marketplace versus private insurance. The Marketplace offers standardized "metal tier" plans (Bronze, Silver, Gold, etc.) and, depending on your income, potential subsidies that lower your monthly premium.

That subsidy piece looks different than it used to. The enhanced ACA premium tax credits that had been in place since 2021 expired on December 31, 2025. For 2026, subsidized marketplace enrollees are paying an estimated 114% more on average, from about $888/year to $1,904/year. And if your income lands above 400% of the federal poverty level, which isn't unusual for a locum clinician stacking assignments, you won't receive a premium tax credit at all. So the subsidy that makes the marketplace attractive on paper may not apply to you in practice.

Private plans don't come with income-based subsidies, but that also means your premium isn't exposed to the same swings: what you're quoted is closer to what you'll pay, income year to year notwithstanding. Private plans also open up more variety in plan design and deductibles, and usually offer nationwide coverage, which can be a very important asset for locums licensed in multiple states.

Why a PPO Often Beats an HMO for Locums Specifically

Plan type matters more for locums than for most W-2 employees, and it comes down to one word: mobility.

HMO plans tend to be cheaper, but they lock you into a specific network and usually require referrals to see specialists. That works fine if you're staying in one place. But locum work often means moving between cities, states, or even regions every few months, and the HMO network built around your last assignment won't do you much good in your next one.

PPO plans cost more, but they give you the freedom to see providers across a much broader network without needing referrals. For someone whose job location changes regularly, that flexibility often isn't a luxury; it's a necessity.

The Tax Angle: HRA 105 and Write-Off Potential

Here's something a lot of new 1099 locums don't realize: your health insurance premiums may come with real tax advantages. If you're self-employed or an independent contractor, there are ways to structure your coverage so premiums and qualifying medical expenses become deductible against your business income.

One structure worth knowing about is the Section 105 HRA (Health Reimbursement Arrangement). In plain terms, it's a mechanism that can allow you to reimburse medical expenses, including premiums, through your business in a tax-advantaged way, but not every private plan is compatible with this structure, and not every locum's situation qualifies. This is genuinely one of those areas where a quick conversation with someone who understands both insurance and self-employed tax strategies can save you real money.

Negotiating Health Insurance Into Your Contract

Here's a detail a surprising number of new locums miss entirely: health insurance costs can sometimes be part of the negotiation, giving you another opportunity to shape your overall compensation package.

Depending on the assignment and available benefits, options may include a stipend toward your premiums, partial reimbursement, or access to an agency-sponsored plan. Bringing it up before you sign gives you time to discuss the available options. Framing it as part of your overall compensation package helps make health coverage a natural part of that conversation. It may not be available as each agency is unique, but asking opens the door to support that could make a meaningful difference.

A Few Other Things Worth Knowing

1. Coverage gaps between assignments. If there's downtime between contracts, know how you'll be covered during that window; this is often where locums get caught off guard.
2. Multi-state considerations. If you're licensed and working across state lines, make sure your plan's network and coverage rules actually work where you'll be practicing.
3. Short-term vs. long-term plans. Depending on how long you expect to be doing locum work, a short-term plan might make sense as a bridge, while others will want something built for the long haul.

Where to Go From Here

Health insurance for locums isn't one-size-fits-all, and honestly, it shouldn't be. Your income, your travel schedule, your health needs, and your long-term plans all factor into what's actually the "right" choice for you.

If you want to explore your options, compare what you have against what's out there, or just start planning ahead for your next assignment, it's worth getting a free quote and consultation with a licensed health insurance advisor. There's no obligation, just clarity on what fits your specific situation.