Coverage Options Compared
ACA Marketplace (Healthcare.gov)
$500-$2,500/monthBest for: Most 1099 CRNAs
Pros
- Guaranteed issue — no medical underwriting
- Subsidies available if you manage your MAGI
- Comprehensive coverage (ACA-compliant)
- Family plans available
- No network restrictions on some plans
Cons
- Expensive at full price for high earners
- Requires MAGI management for subsidies
- Open enrollment period (Nov-Jan) or qualifying event
- Narrow networks on cheaper plans
- Deductibles can be high ($3K-$8K)
Pro tip: The secret: as a 1099 CRNA, your MAGI is your AGI minus business deductions and retirement contributions. Max out your Solo 401(k), contribute to an HSA, and take every legitimate deduction — this can drop your MAGI enough to qualify for significant subsidies even on a $300K gross income.
Spousal Employer Plan
$200-$800/month (employee + spouse rate)Best for: CRNAs with a spouse who has employer coverage
Pros
- Usually the cheapest option
- Employer subsidizes part of the premium
- Broader networks than individual plans
- No MAGI management needed
Cons
- Dependent on spouse's employment
- You have no control over plan changes
- Spousal surcharge at some employers ($50-$150/month extra)
- May not be the best plan for your specific needs
Pro tip: If your spouse's employer offers good coverage, this is often the most cost-effective path. The math changes if the spousal surcharge is high or the plan has a narrow network that doesn't include your preferred providers.
COBRA
$1,500-$2,500/monthBest for: Bridge coverage when transitioning from W2 to 1099
Pros
- Same plan you had as an employee
- No coverage gap
- No medical underwriting
- Can elect retroactively (within 60 days)
Cons
- Extremely expensive (full premium + 2% admin fee)
- Maximum 18 months
- No employer subsidy
- Temporary solution only
Pro tip: COBRA is a bridge, not a destination. Use it for 1-3 months while you set up marketplace coverage or find an alternative. The retroactive election window (60 days) means you can wait and only elect COBRA if you actually need to use it during that period.
Health Sharing Ministries
$200-$600/monthBest for: Healthy CRNAs comfortable with non-insurance alternatives
Pros
- Much cheaper than insurance
- No network restrictions
- Not subject to ACA rules (can exclude pre-existing)
- Faith-based community aspect
Cons
- NOT insurance — no legal guarantee of payment
- Pre-existing conditions often excluded
- Not ACA-compliant (no longer a tax penalty but still risk)
- Sharing limits and annual caps
- Can deny sharing for lifestyle reasons
Pro tip: Health sharing is NOT insurance. It's a cost-sharing arrangement between members. If you're healthy with no pre-existing conditions and understand the risk, it can save $15-20K/year vs marketplace. But if something catastrophic happens, you may be underprotected.
Short-Term Health Plans
$200-$500/monthBest for: Very short gaps between coverage (not recommended long-term)
Pros
- Cheap
- Fast enrollment (can start next day)
- No open enrollment restrictions
Cons
- NOT ACA-compliant
- Pre-existing conditions excluded
- Limited benefits
- Maximum 36 months (varies by state)
- Doesn't count as minimum essential coverage
Pro tip: Use only as a gap filler — never as your primary long-term coverage. These plans exist to prevent catastrophic exposure during transitions. They don't cover what you think they cover.
The HSA Advantage
If you choose a high-deductible health plan (HDHP), you qualify for a Health Savings Account (HSA). The HSA is the only triple tax-advantaged account in the tax code: deductible going in, tax-free growth, tax-free withdrawals for medical expenses. After 65, withdrawals for any purpose are taxed like a traditional 401(k).
$4,300
2026 single limit
$8,550
2026 family limit
Strategy: max out the HSA, pay medical expenses out of pocket, let the HSA grow invested for decades. At retirement, you have a tax-free pool for medical costs.