Health insurance for doctors and dentists starting a private practice

• 42.2%of U.S. physicians worked in private practice in 2024, down from 60.1 percent in 2012, per the AMA
• $26,993average total yearly premium for employer family coverage in 2025, the price COBRA passes to you
• $6,450most a QSEHRA can reimburse for self only coverage in 2026, or $13,100 for family coverage

Step 1: Replace the hospital plan

Fewer doctors take this path every year. The AMA reports that 42.2 percent of physicians worked in private practice in 2024, and that 34.5 percent now work in hospital owned practices. So if you are leaving, you are probably the first in your circle to buy your own insurance in years.

You have three realistic choices for yourself and your family:

• COBRA. Same plan, same doctors, full price. The Department of Labor allows up to 102 percent of the plan's cost, and KFF puts the average total premium for employer family coverage at $26,993 a year in 2025. COBRA makes sense if someone in the family is mid treatment or you have already met this year's deductible.
• A spouse's employer plan. Often the cheapest route if your spouse has good benefits. Losing your coverage is a qualifying event for their plan too.
• An individual marketplace plan. The usual long term answer for a practice owner with no staff yet. Every plan covers pre existing conditions and the essential benefits.

For the full COBRA versus marketplace math, see my guide to coverage between jobs.

Why subsidies rarely apply, with one exception

Marketplace tax credits for 2027 coverage stop at 400 percent of the federal poverty line: $63,840 for a single person and $132,000 for a family of four. An established physician or dentist is almost always above that, so plan on paying the full premium. The enhanced credits that used to soften that cliff expired at the end of 2025.

The exception is your launch year. HealthCare.gov says self employed people report income after business expenses, and a new practice carrying buildout, equipment, hiring and credentialing delays can show a much smaller net profit than your old salary. If your honest projection is under the line, you may qualify. Be conservative, though. Starting with 2026 coverage there is no cap on paying back excess credits, so an optimistic loss that turns into a profit gets repaid in full at tax time. My subsidy calculator shows where the line falls for your household.

Choosing the plan when you know the system

You understand networks better than any client I have. Use that. Before you choose, check which plans include the hospital where you admit or refer, the specialists you would send your own family to, and the children's hospital if you have kids. Many marketplace plans are narrow HMOs or EPOs, and PPOs are scarce in some markets. In every Florida county I track, all marketplace PPOs for 2026 come from a single carrier, and the large Texas counties I track have none. You can compare counties on my plan data pages.

If your family is healthy and you have cash reserves, a bronze plan paired with a health savings account is worth a look, because bronze plans are HSA eligible starting in 2026. Here is how an HSA plan works.

Step 2: Deduct the premiums

As a self employed owner showing a profit, you can generally deduct your family's premiums on IRS Form 7206. The IRS instructions say you cannot take it for any month you were eligible for a subsidized employer plan, including your spouse's, even if you declined it, and the deduction cannot exceed your net earnings from the practice. If your practice is an S corporation and you own more than 2 percent, the IRS has a specific route: the premiums are reported in your wages and then deducted. Your CPA will set that up.

Step 3: Covering staff

Once you hire, you have more options, and the right one depends on headcount and budget.

Option	Who can use it	How it works
Small group plan	At least one employee who is not an owner or spouse	One plan for everyone, often a broader network, employer pays a share
QSEHRA	Fewer than 50 full time employees and no group plan	Tax free reimbursement of individual premiums, capped at $6,450 self only or $13,100 family for 2026
ICHRA	Employers of any size	You set the allowance with no federal cap, employees buy individual plans

Two things trip up practice owners. First, HealthCare.gov is clear that a business with no employees other than owners and their spouses cannot use the small business SHOP program, so a solo practice buys individual coverage. Second, in most setups a sole proprietor, partner or more than 2 percent S corporation owner is not treated as an employee for an HRA, so a QSEHRA or ICHRA covers your staff while you keep using the self employed deduction. I explain the details in ICHRA explained, and if you are in the Tampa area, my page on small business health insurance in Tampa covers group plans.

A timeline that works

• 60 days beforePrice COBRA, your spouse's plan and individual plans. Apply for the new plan so it starts the day after your old coverage ends.
• Launch yearCarry an individual family plan. Project income conservatively if you apply for a tax credit.
• First hireDecide between a group plan, a QSEHRA or an ICHRA before you make the offer, since benefits help you recruit.
• November 1, 2026Open enrollment for 2027 coverage begins. Choose by December 15 for a January 1 start on HealthCare.gov.

My honest take

If your spouse has a strong employer plan, add the family there and skip the rest. You will not need me. If you are covering the family yourself, the premium will be real, so spend it on the network you actually want. I'm Carson Hornish, an independent broker licensed in 31 states, and I work with self employed professionals every day. My help costs you nothing, and here is why that is.

Common questions