COBRA Alternatives for CRNAs and Locum Physicians
Leaving a W-2 job for 1099 or locum work? COBRA lets you keep your old plan, but you pay the whole premium yourself. These are the COBRA alternatives to compare before you elect it.
Why COBRA Costs So Much
COBRA isn’t a new plan. It is your employer’s plan with the employer’s money taken out. The coverage stays the same. The bill doesn’t.
While you were on payroll
On COBRA
Your COBRA bill: up to 102% of the full premium.
- Your old payroll deduction
- The share your employer used to pay
- An administration fee of up to 2%
Illustration only, not to scale. The split between you and your employer is different at every job.
On payroll, most clinicians only ever see their own share of the premium: the deduction on the pay stub. The employer quietly pays the rest. Under the federal COBRA rules, the plan can charge you the full premium, both shares, plus an administration fee of up to 2%. That is why the first COBRA bill comes as a shock.
Your exact price is printed on the election notice the plan sends after you leave. Get that number first. Every alternative on this page should be compared against it.
Already have your COBRA notice? Bring it to a coverage review and we’ll put it side by side with the alternatives. Book a Consultation
Your 60-Day Window After Employer Coverage Ends
Three clocks matter when you leave a W-2 job. Two of them start the day your employer coverage ends, and both run out 60 days later.
COBRA
You get at least 60 days to elect COBRA. If you elect inside that window and pay the premiums back to the first day, the coverage is retroactive, so there is no gap. After that it can run for up to 18 months.
Marketplace (ACA)
Losing employer coverage opens a Special Enrollment Period, from 60 days before the coverage ends to 60 days after. Miss it and you generally wait for Open Enrollment (November to January).
Private PPO
No enrollment window. You can apply in any month and pick a start date that lines up with your last day. Approval depends on a health questionnaire, so apply early.
What this means: you don’t have to decide on COBRA the day you leave. Use the 60 days. Apply for the alternative first, and keep COBRA as the backup until the new plan is approved and in force. One catch: dropping COBRA later does not reopen the Marketplace window.
Five COBRA Alternatives for 1099 and Locum Clinicians
Each of these fits somebody. Which one fits you depends on your health, your household income, where you live, and where you take contracts.
Private PPO Coverage
A policy you own, on a nationwide PPO network. It isn’t tied to an employer, an agency, or a contract, so it stays with you from one assignment to the next.
Often fits: generally healthy clinicians who earn too much for a Marketplace subsidy and work in more than one state.
Why it works
- The policy belongs to you, not your employer
- Coverage can start right away or on a future date
- It stays in place as contracts change
- Several deductible and premium choices
Keep in mind
- A health questionnaire is required, and approval isn’t guaranteed
- Pricing depends on your age, location, and household
- Best handled with a licensed broker who knows locum work
Marketplace (ACA) Plans
Plans sold through Healthcare.gov or your state’s exchange. Nobody can be turned down.
Often fits: anyone with a health condition, or a household income that qualifies for a subsidy.
Why it works
- Guaranteed approval, no health questions
- Possible subsidies, depending on household income
- Preventive and essential care included
Keep in mind
- Enrollment timing matters: Open Enrollment, or 60 days after losing coverage
- Networks are often limited to one state or region
- Higher-income households usually pay full price
Short-Term Medical Insurance
Temporary coverage that fills the space between two longer health plans.
Often fits: a gap of a few months, for example while you wait for another plan to start.
Why it works
- Fast approval and a quick start
- Often lower monthly costs
- Many plans use nationwide networks
Keep in mind
- Medically underwritten, and pre-existing conditions are usually not covered
- Not built to be a long-term plan
- Length and availability vary by state
Group Health Plans Through Your Business
If you work through your own LLC or S-corp, a small group plan can open up strong PPO options with predictable pricing.
Often fits: clinicians who run a real business entity, especially with a spouse or staff on payroll.
Why it works
- True group coverage with rich benefits
- Pre-existing conditions are covered
- Possible extras like family add-ons
Keep in mind
- May require proof of an active business
- Availability varies by state
- May need a minimum number of employees
Joining a Spouse or Family Plan
Losing your own employer coverage usually lets you join a spouse’s employer plan in the middle of the year.
Often fits: anyone whose partner has active employer coverage.
Why it works
- Typically no underwriting
- A smooth transition with no gap
- Can be cost-effective when the employer contributes
Keep in mind
- Dependent premiums can vary a lot
- Deductibles and networks may change
- There is a deadline to join, often 30 days. Ask the spouse’s HR
Want the three main routes in one table? See nationwide PPO vs. Marketplace vs. COBRA. Going 1099 for the first time? Start with health insurance for 1099 and locum CRNAs.
Questions About COBRA When You Leave a W-2 Job
How much does COBRA insurance cost?
Up to 102% of the plan’s full premium: the share you paid through payroll, the share your employer paid, and an administration fee of up to 2%. The exact amount is on your COBRA election notice. If you don’t have the notice yet, HR or the plan administrator can tell you the number before your last day.
How long does COBRA last?
Usually up to 18 months when the reason is leaving a job or a cut in hours. Some events allow dependents a longer period. COBRA ends early if a premium isn’t paid on time, and it was never meant to be a permanent plan. Anyone going 1099 for good needs a long-term answer before it runs out.
Can I get COBRA if I quit to go 1099?
Yes. Leaving a job voluntarily counts, the same as a layoff. The only exception in the federal rules is termination for gross misconduct. Federal COBRA applies to employers with 20 or more employees. Smaller employers may fall under state continuation rules, which vary.
What is the 60-day COBRA “loophole”?
It is the election period. You have at least 60 days to elect COBRA, and if you elect within that time and pay every premium back to the day your employer coverage ended, you are covered for that whole stretch. Some people treat the window as a safety net while new coverage is being approved.
It is not free coverage. If you elect, you owe every month from day one. If you miss the deadline, the option is gone. Read your election notice for your exact dates.
Can I switch from COBRA to another plan later?
To a private PPO, yes, in any month, as long as you pass the health questionnaire. To a Marketplace plan, only during Open Enrollment or when COBRA runs out. Dropping COBRA on your own, or no longer paying for it, does not open a Special Enrollment Period. Keep COBRA until the new plan is in force.
Premiums and taxes are a separate topic: tax and HSA guidelines
More answers on the health insurance FAQ page