The Question Nobody Asks Until It's Urgent
You've been thinking about leaving your clinic job for a while. Maybe the caseload is unsustainable. Maybe the commute isn't worth it anymore. Maybe you're tired of fighting insurance companies for a salary that doesn't reflect what you actually do.
But then the practical question hits: what happens to my benefits?
Health insurance. Retirement contributions. Paid time off. Malpractice coverage. These aren't small things — and for a lot of pediatric therapists, they're the main reason people stay in jobs they've outgrown.
This post is going to walk through each of them honestly. Not to scare you, and not to minimize what changes. But because knowing the real numbers is what lets you make a real decision.
Health Insurance
This is the big one. When you leave a W-2 job, your employer-sponsored health insurance ends, usually at the end of the month in which you leave.
Your options as an independent therapist:
COBRA
You can keep your existing plan for up to 18 months through COBRA. The catch: you pay the full premium — what you paid plus what your employer was covering on your behalf. That's often $400–$700/month for an individual, more with dependents. It's expensive, but it buys you time to find something better.
ACA Marketplace Plans
When you leave a job, you have a Special Enrollment Period (60 days) to enroll in an ACA marketplace plan. Depending on your projected income, you may qualify for premium tax credits that significantly reduce your monthly cost. Many independent therapists end up paying less for comparable coverage than they did under employer plans once the credits are factored in.
Healthcare.gov is the place to start. Budget 1–2 hours to run through plan options in your state.
Spouse or Partner Plan
If your household has another earner with employer-sponsored coverage, this is often the cleanest option. Losing a job qualifies as a life event that allows you to join their plan outside of open enrollment.
What it actually costs
Plan for $300–$600/month for a solid individual plan, depending on your state and income. Build this into your earnings calculation when you're deciding whether the math works. For most pediatric therapists moving to independent practice, the flexibility and income gains more than cover the difference — but you need to know the number going in.
Retirement
Without an employer matching your 401(k), it's on you to fund your own retirement. The good news: as a 1099 independent contractor, you actually have access to retirement vehicles with higher contribution limits than most employer plans.
Solo 401(k)
If you're self-employed with no employees, a Solo 401(k) lets you contribute as both employee and employer. In 2025, that means up to $69,000/year in total contributions. You can open one through Fidelity, Vanguard, or Schwab with no annual fees.
SEP-IRA
Simpler to set up than a Solo 401(k). You can contribute up to 25% of your net self-employment income, up to $69,000. Good option if you want simplicity over maximum flexibility.
The discipline piece
The challenge isn't access to retirement accounts — it's building the habit of funding them yourself. Most independent therapists we talk to set up an automatic transfer to their retirement account on the same day as each paycheck. Automate it early and you won't feel like you're making a sacrifice each month.
Paid Time Off
This is the one that surprises people most. As an independent contractor, there's no PTO bucket — you don't get paid for days you don't see patients.
But here's the reframe: as a W-2 employee, your PTO was already priced into your total compensation. Your employer was budgeting for your vacation, sick days, and holidays as part of what it costs to keep you. As an independent therapist with higher per-session rates, that value doesn't disappear — it's just held by you. You build your own buffer.
Practically: set aside roughly 15–20% of your earnings in a separate account specifically for non-working weeks. If you're seeing 15 patients a week at strong per-session rates, a week off costs you one week's revenue. Most independent therapists find this is actually more flexible than the 10 days their employer was doling out — you choose when to take it, not a policy.
Malpractice Insurance
As a W-2 employee, your employer's malpractice policy typically covered you while you were practicing within your scope of work on the job.
As an independent therapist, you need your own policy. The good news: malpractice insurance for pediatric OTs, SLPs, and PTs is more affordable than most people expect.
- HPSO (Healthcare Providers Service Organization) is the most commonly used insurer for pediatric therapists
- Annual premiums typically run $150–$300/year for individual coverage
- Make-sure you have an occurrence-based policy (not claims-made) so you're covered for incidents that happened during the policy period even if a claim is filed later
This is a non-negotiable line item. Get covered before you see your first patient.
How Coral Care Fits Into This
When providers join Coral Care, they're independent contractors — meaning the above applies. But a few things are different from going fully solo:
- Billing is handled entirely by Coral Care. You don't manage claims, chase denials, or spend time on insurance administration. That unpaid labor disappears.
- Patients come to you. You don't spend time or money on marketing, cold outreach, or building a referral network from scratch. That cuts down on the income gap during ramp-up.
- Credentialing is handled for you. Getting paneled with insurers typically takes weeks and a significant amount of administrative work. Coral Care does this at no cost.
- Pay is bi-weekly and consistent. No waiting on slow-paying insurance companies. You know when you're getting paid.
The benefits you gave up at your clinic job are real. But they were also compensation that was already priced into your package. As an independent therapist with Coral Care, you keep more of each session's value — and you get to choose what to do with it.
The Math Exercise Worth Doing
Before you decide anything, run this calculation:
- Your current take-home salary, after taxes
- The value of your employer health contribution (ask HR — it's often $300–$600/month)
- Your 401(k) match (typically 3–6% of salary)
- The dollar value of your PTO days at your daily rate
Add those up. That's your true total compensation.
Now estimate what you'd earn as an independent therapist based on your target caseload. Factor in the cost of health insurance you'd purchase, your retirement contributions, and your built-in PTO buffer.
For most pediatric therapists who run this exercise, the independent model isn't as expensive as it looks. In many cases, it's financially better — especially once you account for the hours you're currently working off the clock.
The Bottom Line
Going independent means taking ownership of your own benefits. That's a real thing and it deserves real preparation. But it doesn't mean you're giving something up with nothing in return.
The therapists who make this transition successfully are the ones who planned for the costs, built the habits (automatic transfers, good insurance choices), and stopped letting benefits uncertainty make the decision for them.
If you're thinking about what independent practice looks like for you, Coral Care is a good place to start. No fees. No minimums. A full infrastructure team behind you from day one.
