Locum Tenens Health Insurance: The Complete Guide

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Some docs who work locum tenens have health insurance through a main job, or through their spouse.

If that’s not you, you can exhaust yourself researching your options, and end up more confused than you started. Not to worry: we’ve done the work for you and compiled it here.

This guide gives you the confidence to enjoy the flexibility and independence of locum tenens work.

As a result, you’ll direct your career from a position of strength. You’ll ask first: “What role can locums play for me?” Not: “What will I do for health insurance?”

Then, when you want to work locums, go do it!

Introduction

You’re On Your Own

Most people get health insurance through their employer. As an employee, you get a W-2 at tax time.

In locum tenens, you’re NOT an employee of the hospital, the locums agency, or anyone else. Instead, you’re a self-employed independent contractor. You’re on your own for benefits, including health insurance, and you get a 1099 at tax time.

You Can Do It

Some docs shy away from locums work because they’re worried about health insurance. They may ask:

  • How much will it cost? (It varies.)
  • Can I rely on it? (Yes.)
  • Where do I start? (Right here!)

Bottom Line

If you want to skip the details, here’s the bottom line.

Most locum tenens docs who don’t have health insurance through a W-2 job (or COBRA) buy a policy through the Affordable Care Act (ACA), aka Obamacare. So, this guide spends a lot of time on ACA policies. If you’d like, jump to the Affordable Care Act section, or how to research your ACA policy options.

A Word About Cost

Locum tenens health insurance usually isn’t cheap, but don’t let that stop you. Read on.

It (Usually) Ain’t Cheap

Most of this guide focuses on comprehensive health insurance with no pre-existing condition exclusions. In the United States, a W-2 job is the only way to reliably get this type of coverage at a moderate cost. And employer-provided coverage still costs a lot; your employer just subsidizes much of it.

Don’t Let That Stop You

Hopefully you feel like locum tenens health insurance is affordable. Younger people, and people without kids, are more likely to feel this way.

Many locums docs will have sticker shock at first. Simply put, the right mindset is critical. Stay positive; it’s cheaper than you think; you can afford it.

Stay Positive

It can be easy to get frustrated about the lack of affordable health insurance options in the United States. But this isn’t the forum to solve that. Right now, you’re making career decisions based on the actual options in front of you.

Feel free to channel your frustration elsewhere. Just don’t let it stop you from working locums!

It’s Cheaper Than You Think

When you work locums and don’t have access to employer-sponsored health insurance yourself or through your spouse, your health insurance premiums are tax-deductible.

For quick math, assume the tax deduction saves you 35%. Example: A $20K annual premium really costs you $13K after taxes. $20K * (1 – 0.35) = $13K.

OK, 65% of a lot is still a lot! But use your true after-tax cost when you make decisions. Take the sticker price x 0.65 to get your true cost.

You Can Afford It

If your household has a full-time physician income, you most likely can afford locum tenens health insurance. Otherwise, you may not be living within your means.

If your household doesn’t have this level of income, you’re more likely to get a subsidy to buy health insurance through the Affordable Care Act. (This will still depend on your circumstances, especially your family size.)

Also consider: most W-2 employers want you to work 50% time or more to qualify for health insurance. So, if you want to work less than 50% time, you wouldn’t get coverage through a W-2 employer anyway.

Affordable Care Act Policies

As stated above, most locum tenens docs without insurance through a W-2 job or COBRA buy a policy through the Affordable Care Act (ACA), aka Obamacare. We’ll refer to these policies as “ACA policies.”

This section walks you through ACA policies, and shows you how to find and buy your best option quickly.

Introduction

Buying an ACA policy is also referred to as buying an individual policy. “Individual” just means you’re buying a policy on your own, not through an employer. An ACA policy can cover just you, or you and your family.

ACA Policy Basics

ACA policy basics:

  • No pre-existing condition exclusions. You get it, no matter what.
  • Premiums not based on medical history. You don’t pay more, no matter what.
  • Comprehensive coverage, with no cap on benefits (annual or lifetime).
  • Preventive care at no cost.
  • Must cover ten essential health benefits, including hospitalization, maternity, and prescription drugs.

You can buy an ACA policy, or change from one ACA policy to another, in two cases:

  • During open enrollment, which runs from November 1 to January 15.
  • Anytime you have a qualifying event. For locum tenens docs, losing employer-sponsored coverage (to go work locums) is the most common qualifying event. Other common ones include getting married and having a child. Here’s the full list of qualifying events.

Premiums

Only five factors affect your premiums with an ACA policy:

  • Age.
  • Family size.
  • Location.
  • Tobacco use.
  • Plan category.

Health, medical history, and gender do NOT affect your premiums.

The plan categories are Catastrophic, Bronze, Silver, Gold, and Platinum.

  • You can only get a Catastrophic plan if you’re under 30, or you qualify for an exemption based on affordability or hardship (most docs won’t qualify).
  • So, locum tenens docs age 30+ will choose from Bronze, Silver, Gold, and Platinum.

Bronze plans have the lowest premiums, but the highest out-of-pocket costs when you need care. Platinum has the highest premiums and the lowest out-of-pocket costs.

How To Research Your Options

This section shows how to research your ACA policy options. You can use a professional or do it yourself.

Use A Professional

A health insurance agent can sort through your options, recommend the best one, and help you make the purchase. To find an agent, ask for referrals, or use this tool.

Here’s a list of questions to ask when shopping for locum tenens health insurance. Work with an agent who can sell policies from multiple companies, not a captive agent who works for a single company.

A health insurance agent usually costs you nothing. This surprises some people. The insurance company pays the agent a commission, but your cost stays the same.

If you work with a good financial advisor who specializes in locums docs, your advisor can (and should) research your ACA policy options and make a recommendation based on your personal situation. If they can’t, find a new advisor!

Do It Yourself

Every state makes ACA policies available on a marketplace, also referred to as an exchange. Many states uses the federal Health Insurance Marketplace located at healthcare.gov. At this writing, 17 states plus D.C., including New York and California, have their own exchanges. Here’s a list of state exchanges.

You can find your options and costs in 5-10 minutes, by getting a quote on healthcare.gov or your state’s exchange. You can buy there too, but you don’t have to. (More on that later.)

You can get a quote to help you plan, even if you’re not actually getting coverage now. For example, say it’s midyear and you’re thinking about working locums next year. Next year’s premiums won’t be available yet, but get a quote for this year. This gets you in the ballpark.

How To Get A Quote Quickly

Here’s how to get a quote quickly on healthcare.gov, without creating an account or submitting an application. The process should be similar if you live in a state with its own exchange.

  • Go here and enter your ZIP code. You can get a quote anytime, even if you aren’t eligible to buy right now.
    • The link is to view 2023 plans. In the future, if this link doesn’t give you current information, go to healthcare.gov and find where you can browse current plans and prices anytime, without an account or application.
  • “Tell us about you and your household”:
    • Skip the Plan ID.
    • Complete the brief questions about your household members. No names or SSNs required.
    • Now it asks what your household income will be this year. This question determines if you’ll get a subsidy on your premiums.
      • You don’t need to be too exact, so don’t spend much time on this!
      • Just make your best guess and err on the high side. For more help if needed, see here.
    • It tells you how much subsidy you qualify for, if any.
  • Then view your options. It shows the actual premium you’ll pay, after deducting any subsidy. You can filter by premium range, max deductible, metal type, and other factors.

Cost isn’t the only factor. Access to desired providers and coverage for your medications matter too.

Where To Buy

Above, we showed how to research ACA policies. Now let’s talk about where to buy.

Where to buy depends on whether you qualify for a premium subsidy.

Most locum tenens docs who make full-time equivalent income won’t qualify for a subsidy. But if you work part-time or have a family, you might.

If You Qualify For A Subsidy

If you qualify for a subsidy on your premium, you must buy through healthcare.gov or your state exchange to get the subsidy. The subsidy is also called a “premium tax credit.”

Healthcare.gov or your state exchange will tell you if you qualify for a subsidy based on the income you entered.

A health insurance agent, if you’re using one, should tell you if you qualify for a subsidy, and help you buy through the exchange to get it.

If You Don’t Qualify For A Subsidy

If you don’t qualify for a subsidy, you can still buy through healthcare.gov or your state exchange, but don’t do that.

Instead, buy directly from the insurance company you want to use. You can do this on your own, or through an agent.

Why buy direct? Because buying and renewing are simpler this way:

  • No need to create and maintain an account on an exchange.
  • At renewal time, if you don’t want to switch, simply do nothing. In that case, the insurance company will keep you on the same plan or the closest version that’s available next year.

Coverage Away From Home

You’ll get your planned care at home from in-network providers and facilities. In network, services are covered and your out-of-pocket cost is reasonable.

That’s great, but if you travel far from home, for locums shifts and/or pleasure, the question is: What if you need emergency care away from home?

Short answer: you’ll still be covered as in network.

This is not easy to figure out on your own. We’ve done the legwork for you and summed it up below. The answer lies in these four key factors:

  • Geographic area of your plan’s network.
  • What is covered out of network?
  • Emergency services always covered as in-network.
  • Definition of “emergency services.”

Geographic Area Of Network

The geographic area of your network depends on the type of plan you have.

  • HMOs and EPOs have only a local network of providers and facilities. “Local” may include several nearby counties, but that’s usually it.
  • PPOs and POS plans have a regional or nationwide network.

On healthcare.gov, you can filter search results by plan type, and see if a specific plan has a nationwide provider network or not. If your state has its own exchange, you may be able to filter this way too.

Important: Most ACA plans are HMOs or EPOs, which means they have only a local network. Bigger cities usually have a wider range of ACA plans to choose from, but at this writing, at least three of the ten largest U.S. cities have only HMOs or EPOs available.

What Is Covered Out Of Network?

Out-of-network coverage depends on plan type.

  • With PPOs and POS plans:
    • You’re out of network less often, because the network is regional or nationwide.
    • When you are out of network, you often still have coverage, but with a higher deductible, coinsurance, and maximum out-of-pocket cost.
  • With HMOs and EPOs;
    • You’re usually out of network when traveling, because the network is local only.
    • Typically, only emergency services are covered out of network.

So what if you have an HMO or EPO, and you need emergency care away from home?

Emergency Services Always Covered As In Network

ACA plans, including HMOs and EPOs, are required to cover emergency services out of network the same as in network. They can’t charge you more than you would have paid in network.

OK, it’s obvious that an ED visit will be covered anywhere, but let’s take it to the next level.

What if you have an HMO or EPO, and you have a skiing accident in a remote area far from home where you receive the following services:

  • Air ambulance to ED;
  • Stabilization in ED;
  • OR for surgery; and
  • Inpatient stay after surgery.

Definition of “Emergency Services”

In the skiing accident case, you want two things for the entire course of care, not just the ED visit:

  • Covered.
  • At a cost that doesn’t bankrupt you.

Good news: The entire course of care above will be covered as in-network, even with an HMO or EPO. This is because the entire course of care, not just the ED part, meets the definition of “emergency services.”

Under the No Surprises Act and related regulations, “emergency services” include stabilization and post-stabilization services related to the incident in question, even if provided in other departments of the hospital.

  • Your insurer must cover stabilization and post-stabilization services as in-network, and providers can’t bill you the difference. (You still pay whatever you would have paid in network.)
  • “Providers” refers to providers, facilities, and air ambulances (but not ground ambulances, which can still bill you the difference).
  • “Emergency services” don’t end until you can travel using non-medical or non-emergency medical transportation to an available in-network provider located within a reasonable travel distance, taking into account your medical condition.
  • At that point, out-of-network providers and facilities can seek written consent to continue to provide services, and bill you the difference between their charges and what your insurance company pays (most likely $0 with an HMO or EPO since emergency services have ended). But at that point, you should go home and get in-network treatment.

Other Avenues

Again, most locums docs will use an ACA plan. This section covers other avenues you’ll see if you Google locum tenens health insurance long enough:

  • Membership organizations.
  • Short-term health insurance.
  • Health sharing organizations.

Membership Organizations

You’ll see advice to contact a plethora of membership-based organizations about locum tenens health insurance. Save your energy and skip it.

We’ve reviewed the organizations below. Some have no insurance offering. Others have their own insurance agency, or refer to a third-party agent. For self-employed people with no employees (read: locums docs), the only options are ACA plans, and plans with medical questions and pre-existing condition exclusions.

  • American Academy of Emergency Medicine
  • American College of Emergency Physicians
  • American Medical Association
  • Medical Society of the State of New York
  • California Medical Association
  • National Association for the Self-Employed
  • Freelancers Union
  • American Association of Retired Persons (AARP)
  • Costco
  • Paychex and ADP (payroll companies)

We included two big state medical societies in the list. Feel free to contact your state’s medical society, but we aren’t optimistic.

Short-Term Insurance

Short-term health insurance is temporary coverage with lower premiums, but also high deductibles and significant coverage limitations.

This article is focused on comprehensive coverage for maximum peace of mind. So, we don’t recommend short-term insurance, but wanted to cover it briefly for those who may be interested.

Temporary

Short-term insurance is typically one year long, and renewable for up to three years. This depends on the state you’re in. Premiums can go up each year. Look for a rider that lets you renew even if you develop a health issue.

Coverage Limitations

Short-term insurance is not ACA-compliant. This means:

  • They don’t cover pre-existing conditions.
  • They ask medical questions and can deny you based on your health history.
  • They don’t cover some services that a more comprehensive plan would cover. Read the fine print carefully.
  • There are caps on benefits (annual and/or lifetime).
  • If your short-term insurance policy expires, you may have to wait until ACA open enrollment to get new coverage. Loss of a short-term insurance policy isn’t a qualifying event for ACA purposes.

Who Might Consider?

Again, we don’t recommend short-term insurance. With that said, who might consider it?

  • Healthy people willing to take a risk to save money on premiums.
  • People who need coverage outside ACA open enrollment (November 1 – January 15), but don’t have a qualifying event. That won’t be you because you’re reading this article! 😊

Health Sharing Organizations

Some people go another route and use what is called a health sharing organization. The longest-standing ones are Christian, and most require members to be Christian. There are some newer secular entrants.

In a health sharing organization, members make monthly contributions that are used to pay for (“share”) other members’ healthcare needs. Health sharing organizations offer the potential for materially lower costs than traditional insurance, subject to the important caveats below.

This article is focused on comprehensive coverage for maximum peace of mind. So, we don’t recommend health sharing organizations, but wanted to cover them briefly for those who may be interested.

Not Insurance

Health sharing organizations are NOT insurance.

  • They are not regulated by state insurance commissioners.
  • There is NO guarantee of payment.
  • Neither the organization nor the other members are legally obligated to share your expenses.

With that said, some of the oldest organizations have a long track record of paying covered expenses in full.

Exclusions

Each organization is different, so read each one’s materials carefully to determine what expenses they do and don’t share. With that said, health sharing organizations often don’t share in expenses like those shown below.

  • Some pre-existing conditions (at least for a period of time).
  • Annual wellness exams.
  • Vaccinations.
  • Maintenance prescription drugs.
  • Most psychological and psychiatric treatment.
  • Hazardous activities (including failing to wear a seat belt or motorcycle helmet).
  • Self-inflicted injuries.
  • Matters contrary to the organization’s values, such as:
    • Drug and alcohol abuse, including resulting injuries and illnesses.
    • Births from unwed mothers, abortions, and birth control.
  • Expenses above a cap. Often, you can (and should) pay extra to raise or remove the cap.

Logistics

With traditional insurance, you the policyholder have less hassle and risk. You don’t deal much with negotiating and paying bills, and you get your insurance company’s contracted rates instead of the far higher sticker price.

With health sharing organizations, you’re usually treated as a self-pay patient. This means you’re billed full sticker price. Then, the plan is to negotiate for discounts before the organization pays the discounted amount.

Each organization handles logistics differently, so read their materials carefully. Some key points to be aware of:

  • Do you send your monthly contributions to the organization, or directly to specific members?
  • Who negotiates for discounts? You, or the organization? If you, what support does the organization provide?
  • Must you use a provider network? If yes, who is in the network?

Also of note: Monthly contributions to a health sharing organization are not tax-deductible.

Who Might Consider?

Again, we don’t recommend health sharing organizations. With that said, who might consider them?

  • People for whom faith plays an important role.
  • Healthy people willing to take a risk to save money on monthly contributions.
  • People with a strong desire to opt out of today’s insurance landscape.
  • People who have few or no ACA plans available in their area.

For further reading, see this lengthy comparison of health sharing to traditional insurance, including significant detail on the four most popular sharing organizations. This summary chart is also helpful.

The article and chart are from 2018 but still very relevant. See the organizations’ websites, of course, for current details and pricing.

Conclusion

We hope this guide has saved you time and energy, and given you the confidence to enjoy the flexibility and independence of locums work without worrying about health insurance. When you want to work locums, go do it!

For help with your locum tenens health insurance strategy, schedule a FREE Financial Pulse Assessment™. This is a 3-step process to get clarity on your finances and “test drive” our services.

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