Employment Models: 1099, W2 Hourly or Salaried, which is right for you? UPDATED for 2024

An important question during most interviews in the Health IT industry is: Do you prefer W2 Hourly, 1099 or Salaried employment? Normally the candidate will understand the distinction between Salaried employment and W2 hourly or 1099 /"C2C" (Corp to Corp), but many questions arise during this part of the interview as the candidate tries to determine which scenario is best for them, particularly if it is someone that is new to consulting.

I won't delve much into salaried employment, which is pretty self-explanatory. Salaried employment or Permanent employment is when you accept an internal position with a company where you will earn a salary, receive full benefits and any other bonuses that company may offer. You can consider it like a marriage... you go into it, hoping it will last forever.

The 2 models I would like to dig into are W2 hourly and 1099 (C2C) and what the distinctions are between them. Consultants that have been in the industry for years normally prefer one to the other, but are typically open to either depending on the company they will be contracting for. Frequently when speaking to folks that are just venturing into the consulting arena, they express confusion over which option is best for them. Below is a simple break down that covers the basics.

W2 Hourly: In layman's terms W2 hourly is like short term employment. You receive an hourly rate for your work, you will often have the opportunity to opt into partial benefits, you will fill out necessary Tax Forms and the company will take out taxes prior to paying you. Your "employment" will last for the duration of the engagement that you have accepted. At the end of the engagement you will be free to accept another engagement from another company or if you're working for a company that is on their toes... they may have a new engagement to offer you and you can extend your time with them.

1099 Contract & Corp to Corp: The difference between 1099 and Corp to Corp is simple. In the case of 1099 you will use your social security number and be paid as an outside contractor by the company, this scenario is rarely practiced anymore. 
In the case of Corp to Corp you will have created a legal business for yourself (LLC or S-Corp etc) by registering through your state and obtaining an EIN (Employment Identification Number)  You will sign a business agreement/contract between your company and the firm you are going accept the engagement through. Many firms are trending away from 1099 and Corp to Corp agreements. The reasoning behind this trend is two-fold; due to multiple recent lawsuits in the industry and to the IRS cracking down on companies that utilize independent contractors when they deem the company should have brought the consultant on as a W2 hourly employee.** Typically the lines are blurred when discussing 1099 vs Corp to Corp because the term "1099" has become a catch-all phrase for both. As your own business entity you will be required to invoice the company you are contracting for. You will be paid an hourly rate for your services.

Which is best for you? Lets break them down:
Salaried / Permanent Employment
Benefits:

• Security - the security of internal employment within a company and the opportunity to advance within that company. 
• Full Benefits, bonuses, PTO, 401K etc
• Regular pay schedule
• Necessary equipment provided
• Company covers liability insurance
• Corporate Credit Card for travel when applicable (in most cases)
• Being on a consistent team

Potential Draw backs:

• Income is often less than what you can bring home as a W2 Hourly or Corp to Corp Contractor
• If working for a consulting firm or EMR vendor you don't always have the freedom to choose your engagements and must go where the company sends you.
• May have to relocate/no freedom to live where ever you want.

W2 Hourly

Benefits:

• Company deals with the taxes and covers liability insurance
• Option for benefits / PTO / 401K (in most cases)
• Equipment provided (in most cases)
• Regular pay schedule
• Regular travel reimbursement schedule or paid travel when travel is required
• Freedom to choose your engagements
• Potential for higher income vs Salaried employment

Potential Draw backs:

• Largely responsible for finding your own engagements
• Typically benefits are partial and dont include PTO 

Corp to Corp
Benefits:

• Full control of your business endeavors
• Higher income (in most cases) than Salaried or W2 Hourly consultants
• Freedom to choose your own engagements

Potential Draw backs:

• Must pay your own taxes on a quarterly basis*
• Often must provide the company you are contracting for with invoices from your business
• Must maintain your own liability insurance
• Must provide your own benefits
• Typically must provide your own equipment
• May be paid 30 days on invoice in some cases
• Not eligible for certain perks of internal employees like rental car discounts, car insurance/coverage, etc.

*Always consult a CPA / Accountant when creating your own business to gain a full understanding of the tax laws and expectations.
** Tax Lawyers have explained that an old and somewhat obscure Federal Tax Law (#1706 from 1986) states that if the I.R.S. determines that a self-employed worker should have been an employee, it imposes substantial back taxes, penalties and interest on the hiring company AND on the contractor — even if the self-employed worker fully paid his/her taxes. For this reason many companies are shying away from using Corp to Corp (and 1099) contractors unless those contractors can prove that their business meets the federal criteria listed in the law. (employs at least 2 other people beside themselves and family members OR if they are in a partnership with someone other than family members OR they have incorporated (S Corp, C Corp etc) and file a 941 and pay yourself a salary) 
For more information on this law consult your local Tax Attorney.

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