Health Insurance: Agency Plans vs Marketplace vs Private for Travel Nurses

Health insurance is one of the most confusing aspects of travel nursing. Should you use your agency’s plan, buy on the marketplace, or go private? Here’s how to decide.

Option 1: Agency Health Insurance

How It Works

Most travel nursing agencies offer health insurance:

• Often starts Day 1
• Premiums deducted from paycheck
• Coverage typically includes medical, dental, vision

Pros

• Easy enrollment
• Day 1 coverage
• No gap between contracts (usually)
• Group rates may be favorable
• Simple administration

Cons

• Coverage may lapse between agencies
• Limited plan choices
• May be expensive for family coverage
• Network limitations

Typical Costs

Option 2: ACA Marketplace

How It Works

Buy insurance through healthcare.gov:

• Open enrollment: Nov 1 - Jan 15
• Special enrollment with qualifying events
• Subsidies based on income

Pros

• Continuous coverage regardless of agency
• Potential subsidies
• More plan choices
• Portable across employers

Cons

• Enrollment periods are limited
• Subsidy calculation complex for travelers
• Must manage premium payments
• Network may not cover all states

Cost Factors

Without subsidies:

• Silver plan: $400-600/month (individual)
• Bronze plan: $300-450/month (individual)

With subsidies: Travel nurses often earn too much for significant subsidies. But income manipulation strategies exist (more retirement contributions = lower MAGI = more subsidies).

Option 3: Private Health Insurance

How It Works

Purchase directly from insurance company:

• No income requirements
• More plan flexibility
• Year-round enrollment (some plans)

Pros

• May offer better networks
• Continuous coverage
• Some have nationwide networks
• Year-round enrollment options

Cons

• Often more expensive
• No subsidies available
• Must navigate solo
• Underwriting may apply

Cost

• Comparable to ACA without subsidies
• $400-800/month for quality coverage

Option 4: Health Sharing Ministries

How It Works

Not insurance, but cost-sharing arrangements:

• Members share medical costs
• Usually religious-based
• Lower monthly costs

Examples

• Medi-Share
• Samaritan Ministries
• Christian Healthcare Ministries

Pros

• Lower monthly cost ($200-400)
• Exempt from ACA mandate
• Community aspect

Cons

• Not insurance (no guarantee)
• Pre-existing conditions may not be covered
• Religious requirements
• Limited coverage for some services

Comparison Table

Making the Decision

Choose Agency Insurance If:

• Starting travel nursing
• Single without family
• Want simplicity
• Plan to stay with one agency
• Cost is comparable

Choose Marketplace If:

• Switch agencies frequently
• Want continuous coverage
• May qualify for subsidies
• Open enrollment timing works

Choose Private Insurance If:

• Need specific network
• Premium isn’t main concern
• Want year-round enrollment
• Switching agencies frequently

Choose Health Sharing If:

• Cost is #1 priority
• Comfortable with uncertainty
• Generally healthy
• Meet membership requirements

Gap Coverage Strategies

Between Contracts

Short gap (1-2 weeks):

• Usually no action needed
• ACA grace periods may apply
• Pay out-of-pocket if needed

Longer gap:

• COBRA (expensive, temporary)
• Short-term health insurance
• Marketplace special enrollment

Between Agencies

If new agency offers insurance:

• Pre-existing coverage usually OK
• May have waiting period

If switching to marketplace:

• Loss of coverage = qualifying event
• 60-day special enrollment period

Family Coverage Considerations

Spouse’s Insurance

If your spouse has employer coverage:

• May be best option
• Add yourself as dependent
• Often most cost-effective

Kids Only

Some options for covering children only:

• CHIP (income-based)
• Add to spouse’s plan
• Separate marketplace plan

Full Family on Travel Nurse Coverage

Agency family coverage is often expensive. Consider:

• Spouse’s employer + your agency
• Marketplace for family, you on agency
• Mix-and-match strategies

HSA Strategies

Qualifying for HSA

Must have High Deductible Health Plan (HDHP):

• 2026 limits: $4,150 individual / $8,300 family
• Minimum deductible: $1,650 / $3,300

Triple Tax Advantage

1. Contributions tax-deductible
2. Growth tax-free
3. Withdrawals tax-free (medical expenses)

For Travel Nurses

• Choose HDHP to enable HSA
• Max contributions ($4,300 individual in 2026)
• Use for current or future medical expenses
• Great retirement supplement

Key Takeaways

• Agency insurance: Simplest, but least portable
• Marketplace: Best for frequent agency switches
• Private: Good networks, no subsidies
• Health sharing: Cheapest, but not insurance
• HSA eligibility valuable—consider HDHP
• Gap coverage strategies prevent lapses
• Family coverage often better through spouse