Contract and per diem travelers

Coverage that moves with the contract

You take care of everyone else for a living and the benefits paperwork is somehow the least reliable part of the job. Agency plans start late, end early, and change with every contract. The gap between assignments is where travelers get hurt financially, and it is completely avoidable.

Mind the gap between contracts

Agency coverage frequently ends the day the contract ends and the next one may not begin until the first of the following month. Losing that coverage is a qualifying life event. Private medically underwritten plans can generally start faster and are not tied to any assignment.

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What happens next

Four steps. No runaround.

This is the exact sequence we run. No portal maze, no call-center roulette, no quote and vanish.

01

Read when agency coverage actually starts and stops

Not the recruiter's summary, the plan documents. Many agency plans begin on the first of the month after your start date and terminate the day the contract ends. Two of those in a year is two coverage gaps.

02

Decide whether to take the stipend instead

Some travelers do better declining agency benefits, taking the higher stipend, and carrying their own portable plan that never changes between assignments. That comparison is arithmetic and it is worth running once rather than assuming.

03

Check the network in the states you actually work

A plan tied to one regional network is a poor fit for someone who works thirteen weeks in three different states a year. Ask specifically about national network access and how the plan pays away from home.

04

Keep your tax home straight

Your tax home determines your state for a lot of purposes including where you can buy marketplace coverage. Travelers with a genuine tax home have cleaner answers here than travelers who have effectively become nomadic.

Coverage that survives the gap between contracts

A travel contract has a defined end date, and agency coverage frequently ends with it. The result is a predictable, repeating gap that most plan choices handle badly. Here is what to plan for.

The situationWhat usually goes wrongWhat to check before you buy
A 13-week contract endsAgency coverage can terminate on the last day worked rather than the end of the month, leaving a gap that starts sooner than expected.Get the termination date in writing from the agency, not from an assumption. It decides everything that follows.
Losing agency coverageLosing employer coverage is a qualifying life event, but the window to act is limited and it starts running immediately.You generally have 60 days from the loss to enroll in marketplace coverage. Diarise it the day the contract is signed, not the day it ends.
Working in a state you do not live inA plan built around your tax-home state may treat every provider at your assignment as out-of-network.Ask specifically how the plan behaves where you will be working, not just where you are domiciled.
Several states in one tax yearCoverage, licensure and tax residence are three different questions and they do not move together.Sort residence first. It determines which plans you can even be offered.
A deliberate break between assignmentsGoing uninsured for a month to save a premium is the cheapest decision available right up until it is the most expensive one.Price the gap honestly. Short coverage gaps are where genuinely catastrophic bills tend to land.

This table describes how coverage generally works. It is not a quote, it is not specific to any one insurer, and benefits vary by policy and by state. Confirm the details against the actual plan documents before you enroll.

What the 2026 market did to everyone

The enhanced premium tax credits expired going into 2026. These are the four numbers that describe what followed, and they apply whatever line of work you are in.

  • $113 → $178Average monthly premium actually paid after tax credits, up 58% in a year.[1]
  • $2,759 → $3,786Average marketplace deductible, up 37%.[1]
  • 7% vs 48%Households above the subsidy cliff were 7% of 2025 enrollment and nearly half the drop.[1]
  • 4,538,772Floridians who selected a marketplace plan for 2026, down 196,643.[2]

The 60-day window is the whole game

Losing job-based coverage opens a special enrollment period, which means you are not locked out until the next open enrollment. The practical failure is not eligibility, it is timing: the window is short, it runs from the date coverage ends, and it does not care that you were working nights. The nurses who get caught out are almost never the ones who did not qualify. They are the ones who qualified and ran out of days.

Why year-round availability matters in this job specifically

Private medically underwritten policies are not tied to the open enrollment calendar and can be applied for at any point in the year, which fits a contract-driven career better than a fixed annual window does. The trade is real and worth stating plainly: those policies are underwritten, so your health history determines whether you are approved and at what price, and pre-existing conditions are commonly excluded or limited. If you have a condition that needs ongoing care, the marketplace is very likely the better answer, and we will say so.

Open enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027, with December 15 the practical deadline for a January 1 start.

The gap between contracts is the real risk

Most travelers do not get hurt by the cost of coverage. They get hurt by the two or three weeks between assignments where nobody is covering them. Agency plans are built around the contract, so they tend to end when it ends, and the next agency's plan tends to start on a schedule that has nothing to do with when you actually need care. If you extend, cancel, or take three weeks off between assignments, you can very easily end up uninsured during exactly the stretch where you are driving across the country. A plan you own yourself does not care whose badge you are wearing this quarter.

There is a second version of this that catches people at renewal. Because agency coverage restarts with each contract, deductibles and out of pocket accumulations frequently reset too. A traveler can pay toward a deductible three separate times in one calendar year and never actually reach any of them. Continuous personal coverage means one deductible, one accumulator, and one set of plan rules for the whole year.

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Stipend versus benefits is arithmetic, not philosophy

Agencies typically offer you a choice, explicitly or implicitly, between taking their plan or taking a higher stipend. The honest way to evaluate that is to price your own portable coverage first, then compare that real number against the stipend difference. Many travelers find their own plan costs less than the value of what they gave up to get the agency plan, and it comes with the significant advantage of never lapsing. Some travelers find the opposite, particularly if they have a significant health history. Either answer is fine. Guessing is what costs money.

Network access when you work in three states a year

This is the question that eliminates a lot of otherwise attractive plans. If a plan is built around one health system in one metro area, it is a bad fit for someone whose worksite changes every thirteen weeks. What you want is either a genuine national network or a clear, favorable answer about how the plan pays when you are outside its footprint. That has to be confirmed against the actual plan rather than assumed from the brochure, and it is one of the first things we check for travelers.

What actually happens when you call

Tell us where your tax home is, where you tend to take assignments, what your agency is offering, and what your health history looks like. We price portable coverage that does not reset every contract, we compare it honestly against the agency plan plus stipend math, and we tell you if the agency plan is genuinely the better deal. Licensed producer the whole way, and your information does not get sold.

Sources

Figures on this page last verified against the primary sources on August 13, 2026

  1. KFF, “What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles.” Published May 19, 2026; updated July 15, 2026. kff.org
  2. KFF State Health Facts, “Marketplace Enrollment Snapshot for Open Enrollment 2026,” from the CMS Marketplace 2026 Open Enrollment Period Report: National Snapshot, January 28, 2026. kff.org
  3. Peterson-KFF Health System Tracker, “How much and why ACA Marketplace premiums are going up in 2026.” Updated January 15, 2026. healthsystemtracker.org
  4. U.S. Department of Health and Human Services, annual update of the HHS poverty guidelines. Eligibility for a coverage year is measured against the prior year’s guidelines. aspe.hhs.gov
  5. Internal Revenue Service, Instructions for Form 7206, Self-Employed Health Insurance Deduction. irs.gov

Scotty Jaymes Insurance is a private, independent insurance agency. We are not affiliated with, endorsed by, or connected to any government agency, the federal Medicare or Medicaid programs, or any state or federal health insurance marketplace including Healthcare.gov. The market data above is published by the organisations cited and is provided for context only. It does not describe the pricing, benefits or availability of any policy we offer. Plan availability, benefits and pricing vary by state and by applicant. Nothing here is tax advice.

Straight answers

The questions people actually ask.

Should I take my agency's health plan or the stipend?

It depends on the real numbers. Price a portable plan you own first, then compare it to the stipend you give up by taking agency benefits. Factor in that agency coverage typically ends with the contract and that deductibles may restart with each new plan. For many travelers the portable plan wins on both cost and continuity.

What happens to my coverage between assignments?

With most agency plans, it ends. That is the gap travelers get caught in. Losing that coverage is a qualifying life event that can open a special enrollment period, and privately underwritten plans are generally available year round, but the cleaner solution is coverage that never depended on the contract in the first place.

Which state do I buy coverage in?

Generally the state of your tax home, which is also the state your permanent address and licensing tend to point to. Travelers who have let their tax home get murky create complications well beyond insurance, so it is worth keeping clean.

Will my plan work in the state where I am on assignment?

Only if it is built to. Plans vary enormously here. A national network is what you want, and if a plan is regional you need a specific answer about how it pays outside its area before you enroll.

Does my deductible reset every time I switch agencies?

With agency plans, usually yes, because it is a new plan. That is one of the strongest arguments for carrying your own continuous coverage, especially if you have any ongoing care.

Other situations

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