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Locum CRNAs, NPs and PAs
1099 or W-2High incomeNationwide PPO
CRNAs, NPs and PAs

Advanced practice, independent coverage

CRNAs, nurse practitioners and PAs take locum and independent contracts in growing numbers. Some are W-2 with benefits, many are 1099 with none. Here is how to tell which you are and what to buy.

A quick test for whether your contract comes with coverage
Private plans on nationwide PPO networks for healthy clinicians working in several states
Disability and life coverage to replace what an employed role included
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By Erik Moran, licensed health insurance broker (NPN 20970092) · Updated October 14, 2026
Your contract

W-2 or 1099 changes everything

Quick answer

If your locum or contract role pays you on a W-2, the agency may offer benefits, and if the offer is affordable you generally cannot get a Marketplace credit instead. If you are paid on a 1099, you buy your own coverage. Independent CRNAs in particular tend to earn well above the 2027 subsidy line, which makes private plans on nationwide PPO networks worth pricing if you are healthy.

  • Paid on a W-2, taxes withheld: you are an employee. Ask about benefits, waiting periods and what happens between assignments.
  • Paid on a 1099, no withholding: you are self-employed. No employer plan, and premiums are generally deductible within the self-employed deduction's limits.
  • A mix: a part-time employed role plus independent locums. If the employed role offers you affordable coverage, that offer usually decides your Marketplace eligibility.
Choosing a plan

What tends to work for 1099 clinicians

Clinicians who cover shifts in several states need a network that follows them. A private plan built on a nationwide PPO network does that for healthy applicants, and it does not change when you switch agencies or facilities. If you have a condition that underwriting would exclude, a Marketplace plan is the safer choice even at full price.

The plain truth about private plans: the nationwide PPO plans we quote are private, medically underwritten plans, not Marketplace plans. A nationwide network means in-network doctors and hospitals in many states; it does not mean every service is covered. You answer health questions, and the carrier can decline you or exclude a condition. These plans are not ACA-compliant: depending on the plan, prescriptions, maternity, mental health and other benefits can be limited or left out, some benefits have dollar maximums, and out-of-network care costs more. We walk through exactly what a plan pays before you apply, and if a Marketplace plan fits you better, we tell you that too.

A 1099 contract also leaves out the group disability and life coverage most employed clinicians take for granted. If your income depends on your license, disability insurance belongs on the list.

Over or under the 2027 subsidy line?

Self-employed and 1099 income is counted after expenses. Our free calculator shows which side of the 400% line you land on in about a minute, with results right away and no sign-up.

Run the subsidy cliff calculator →
Questions

Questions we hear most

Do locum CRNAs get health insurance?

It depends on the contract. W-2 locum roles may include benefits; independent 1099 CRNAs buy their own coverage.

Can a 1099 nurse practitioner deduct health insurance?

Generally yes, through the self-employed health insurance deduction, limited to net profit and not for months you were eligible for an employer-subsidized plan.

Do PAs on locum assignments qualify for Marketplace subsidies?

Only if household income is under the 2027 line and no affordable employer coverage is offered to them. Many locum PAs earn above the line.

Sources

Checked October 14, 2026. Rules and dates change; confirm before you act.

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