Health insurance for travel nurses: agency plan or your own?

• 3.47Mregistered nurse jobs in the U.S. in 2025, according to the Bureau of Labor Statistics
• 1 dayof qualifying coverage you need in the 60 days before a permanent move to get a moving special enrollment period
• $619average monthly marketplace premium before tax credits for 2026, per CMS

Option 1: The agency plan

Most large staffing agencies offer group health insurance, and many start it within your first days or weeks on contract. The agency pays part of the premium, the plan usually has a national network, and it is simple to accept. For a nurse who stacks contracts back to back with one agency, it is often the easiest answer.

The trouble is what happens between contracts. Agency coverage is tied to being on assignment, so a two month break, a canceled contract or a move to a new agency can end it. Each new agency plan also resets your deductible and out of pocket maximum. When the coverage ends you may be offered COBRA, which the Department of Labor says applies to employers with 20 or more employees and can cost up to 102 percent of the full premium.

Option 2: Your own marketplace plan

Buying your own plan means one policy, one deductible and one set of doctors all year, no matter how many agencies you work for. You pick it during open enrollment or after a qualifying event, and it does not end when a contract does.

The rule that makes this work is residency. Federal marketplace rules (45 CFR 155.305) say you enroll where you live and intend to reside, and the marketplace may not end your eligibility because of a temporary absence from that area if you intend to return. For a travel nurse who keeps a real home base and comes back to it, that home base is where you buy.

The honest catch is the network. Most marketplace plans are HMOs or EPOs built around local doctors. While you are on assignment in another state, your plan must still cover true emergencies. HealthCare.gov states that insurers cannot require prior approval for out of network emergency room care and cannot charge you higher copays or coinsurance for it. Routine visits, specialists and planned care away from home are usually not covered, so many nurses lean on telehealth on the road and save checkups for time at home.

A PPO fixes much of that, but availability varies. In every Florida county I track, all marketplace PPOs for 2026 come from a single carrier. In the large Texas counties I track, there is no marketplace PPO at all for 2026. You can see what is sold where you live on my county by county plan data, and if you are in Florida, my page on Florida PPO plans goes deeper.

Side by side

Question	Agency plan	Your own plan
Survives gaps between contracts?	Usually not	Yes
Deductible resets when you switch agencies?	Yes	No
Routine care in other states?	Often, if the network is national	Usually emergencies only, unless it is a PPO
Who pays the premium?	Shared with the agency	You, minus any tax credit

How tax home and stipends affect your subsidy

Your tax home is an IRS idea, not an insurance one, but the two travel together. IRS Publication 463 says your tax home is generally your regular place of business, and if you have no regular place of business and no place where you regularly live, you are an itinerant whose tax home is wherever you work. That matters because tax free housing and meal stipends generally depend on having a tax home you are traveling away from.

It also matters for insurance. The marketplace measures income starting from adjusted gross income on your tax return. Many travel contracts pay a modest taxable hourly rate plus stipends, so if your stipends are legitimately tax free, the income the marketplace looks at may be well below your take home pay. For 2027 coverage, tax credits stop at 400 percent of the poverty line, which is $63,840 for a single person. Plug your taxable number into my subsidy calculator to see where you land.

Be careful with the estimate. Starting with 2026 coverage there is no longer a cap on paying back excess tax credits, so if you guess low and then take a high paying crisis contract, you repay the difference at tax time. Update your marketplace application when your income changes.

One more rule: if you are offered agency coverage that counts as affordable, you generally cannot get a tax credit for a marketplace plan during those months. For 2026 the IRS affordability line is 9.96 percent of household income for employee only coverage. If you keep your own plan while on a contract that offers affordable coverage, report the offer so you do not owe credits back.

Changing states between assignments

Taking a 13 week contract in another state is not a move. Marketplace rules treat a stay for a transitory purpose as not establishing residency, so an assignment by itself does not let you switch plans or buy in the new state. If you truly move your home, that is a permanent move, which opens a special enrollment period, but HealthCare.gov generally requires that you had qualifying coverage for at least one day in the 60 days before the move.

Nurses with no permanent home at all face a harder path. The rules let you qualify where you are living if you arrived with a job commitment, but that can mean a new plan and a new deductible in each state. If you are in that spot, it is worth a conversation before open enrollment. My page on special enrollment periods covers which events reopen the door.

Coverage between contracts

When an agency plan ends, that loss of coverage is a qualifying event that gives you 60 days to pick a marketplace plan. Many nurses use that window to switch to their own plan for good instead of bouncing on and off agency plans. My guide to health insurance between jobs compares COBRA and the marketplace in detail. If you choose a bronze plan, it is HSA eligible starting in 2026, which is useful for a nurse with irregular income. Here is how an HSA plan works.

My honest take

If you work steady contracts with one agency, like its plan, and rarely take time off, keep the agency plan. You do not need me for that. If you take real breaks, change agencies, or want one set of doctors at home, your own plan in your home state is usually the better base. I'm Carson Hornish, a broker licensed in 31 states (see which), and my help is free because carriers pay brokers, not you. Here is how that works.

Common questions