If you’re a CRNA, you know that staying ahead of financial changes is just as crucial as keeping up with patient care advancements. And with the 2025 expiration of the Tax Cuts and Jobs Act (TCJA), major tax changes could be coming your way.
So, what does this mean for you? Higher taxes? New deductions? A chance to save more? Let’s break it all down so you can stay ahead of the game and keep more of your money.
A Quick Refresher: What the TCJA Did for Your Taxes
Passed in 2017, the TCJA introduced substantial changes to the tax code. Some highlights include:
- ✅ Lower income tax rates across the board
- ✅ Doubled standard deduction (fewer people itemizing)
- ✅ $10,000 cap on SALT deductions (bad news for high-tax states)
- ✅ 20% QBI deduction for 1099 earners (huge for independent CRNAs)
- ✅ Higher estate tax exemption (more tax-free wealth transfer)
But here’s the catch: These benefits expire in 2025 unless Congress steps in.
With Republicans holding the majority, some of these breaks might stick around—but others, like SALT deductions and estate tax limits, are up for debate. Here’s what CRNAs need to prepare for.
1️⃣ Income Tax Rates: Will They Go Back Up?
Current TCJA Rates:
- Top tax rate: 37% (down from 39.6%)
- Middle brackets: 22% and 24% (lower than pre-2017 levels)
📅 What Might Happen in 2025?
- Likely: Republicans are likely to extend the current rates, avoiding the pre-TCJA increases and keeping more money in your pocket.
- Possible: Standard deduction ($15,000 single / $30,000 married for ’25) stays put.
📌 What CRNAs Should Do:
- ✔ Check your tax bracket now—adjust withholdings or estimated payments so you don’t get hit with a surprise tax bill. Here’s a guide we put together for safe harbor and estimated payments.
- ✔ While the rates are still low, consider making after-tax and/or Roth Solo 401(k) contributions instead of pre-tax contributions.
2️⃣ State and Local Tax (SALT) Deductions: A Break for High-Tax States?
The $10,000 cap on SALT deductions has been a major pain point, especially for CRNAs in high-tax states like California, New York, and New Jersey.
📅 What Might Happen in 2025?
- Possible: Congress raises or removes the SALT cap, offering relief for high-tax state residents.
- BUT: This could trigger the Alternative Minimum Tax (AMT), which might reduce or even eliminate the benefit for high earners.
📌 What CRNAs Should Do:
- ✔ If you own property or pay significant state taxes, calculate whether potential SALT cap changes could lower your overall tax bill.
- ✔ Be aware that AMT exposure could offset these benefits.
- ✔ Consider a Pass-Through Entity (PTE) Election: If you’re a 1099 CRNA or own a business, your state may allow a PTE tax election, which lets your business pay state taxes at the entity level. This bypasses the $10,000 SALT cap by turning state taxes into a deductible business expense on your federal return. Availability varies by state, so check with a tax professional. (More details here)
This strategy could mean thousands in tax savings if structured correctly—worth looking into if you’re a high-income CRNA in a high-tax state.
3️⃣ Section 199A QBI Deduction: Huge for 1099 CRNAs
Current Rule: 1099 CRNAs can deduct up to 20% of Qualified Business Income (QBI)—a game changer for independent contractors and small business owners.
📅 What Might Happen in 2025?
- Likely: While the deduction will likely continue, proposals to expand it—potentially increasing the QBI deduction to 30% or more—could provide significant savings.
- Possible: Lawmakers may also reconsider which professions qualify under the Specified Service Trade or Business (SSTB) exclusion.
📌 What CRNAs Should Do:
- ✔ Track ALL business expenses—liability insurance, equipment, CEUs—to maximize deductions.
- ✔ Talk to a tax pro about QBI eligibility. This deduction can mean thousands in tax savings.
- 👉 Check out this post to see how big of an impact the QBI deduction can have on your income.
4️⃣ Estate & Gift Taxes: Big Changes Ahead
The current gift and estate tax exemption stands at a historically high $13.61 million per individual.
📅 What Might Happen in 2025?
- Without action, the exemption will drop to ~$7 million.
- Republicans may maintain the higher exemption, reducing the urgency for high-net-worth families to transfer wealth before 2026.
📌 What CRNAs Should Do:
- ✔ If your net worth approaches the exemption threshold, work with an estate planning expert to evaluate whether gifting assets before 2026 makes sense.
- ✔ Focus on trusts or other strategies to protect your estate and achieve your financial goals.
5️⃣ Will We Get Back Miscellaneous Deductions?
The TCJA killed deductions for investment advisory fees, unreimbursed work expenses, and some legal fees.
📅 What Might Happen in 2025?
- There’s momentum among industry advocates to bring back or expand these deductions, particularly for financial planning services that aren’t directly tied to investments.
📌 What CRNAs Should Do:
- ✔ If reinstated, these deductions could reduce out-of-pocket costs for professional financial advice, making it easier to integrate long-term planning into your practice.
6️⃣ Student Loan Repayment & Forgiveness: What Could Change for CRNAs?
For many CRNAs, student loan debt is a major financial burden, and proposed changes from the Trump administration could reshape repayment options.
📅 What Might Happen in 2025?
- Income-Driven Repayment (IDR) Changes: The administration wants to consolidate IDR plans into a single plan where borrowers pay 12.5% of discretionary income (up from the current 10%). Graduate loans, which many CRNAs hold, wouldn’t be forgiven until 30 years—up from the current 20-25 years.
- Elimination of Public Service Loan Forgiveness (PSLF): If passed, this would end PSLF for new borrowers, removing a key loan forgiveness option for CRNAs working in non-profit hospitals or government agencies.
📌 What CRNAs Should Do:
- ✔ If you’re pursuing PSLF, stay the course. Changes might only impact new borrowers, so ensure you’re meeting all requirements.
- ✔ If using IDR, prepare for higher payments. If the 12.5% repayment rule is implemented, your monthly loan bill could increase.
- ✔ Consider private refinancing if PSLF is off the table. If forgiveness options shrink, a lower interest rate could save you money in the long run.
These changes could significantly impact CRNAs managing student loan debt. Keeping an eye on policy shifts is key to making the best financial moves. (More details here)
🔮 What Other Tax Breaks Could Be Coming?
The Trump administration has floated some big ideas that could impact CRNAs, including:
- Tax-free overtime and tips (if you work extra shifts, this could be big)
- Eliminating Social Security taxes on retirees (long-term perk)
While these are speculative, they suggest a trend toward more tax relief in targeted areas.
🔥 CRNAs: Here’s Your 2025 Tax Plan
- Maximize Current Opportunities: Use 2024 and 2025 to leverage existing tax strategies, from mega backdoor roth strategies to home office deductions.
- Anticipate Changes: Staying ahead of legislative shifts ensures you’re prepared for new rules.
- Work With Experts: A tax advisor familiar with CRNA-specific challenges can help you optimize deductions and reduce liabilities.
Final Thoughts: Be Proactive, Not Reactive
Tax laws change, but the best financial moves happen before the rules shift. If you’re a CRNA, taking action NOW could mean saving thousands and building long-term financial security.
👉 Want a tax strategy tailored for CRNAs? Book a free call now and get a customized tax plan before tax changes hit. [Schedule here]