The One Big Beautiful Bill Act (OBBBA): What It Means for CRNAs

By / 6 minutes of reading / All, Locum 1099, Retirement, Taxes /

Congress just passed a new tax law with a name straight out of a reality show: The One Big Beautiful Bill Act (OBBBA). But don’t let the branding fool you. Behind the glitz is a tax bill that actually does have some real planning opportunities, especially for high-income earners like many of you.

So let’s talk QBI, SALT, auto deductions, 529s, and more… let’s get into it 👇

🔍 TL;DR: What’s in the Bill?

Here’s the short version:

  • QBI deduction (20%) made permanent—with wider income thresholds
  • SALT deduction cap increased to $40,000 (but phases out at higher incomes)
  • New below-the-line deductions for tips, overtime, and auto loan interest
  • Bonus depreciation is back at 100%
  • 529 plans get more flexible
  • Child Tax Credit increased and fully refundable
  • New senior deduction if you’re 65+

Most of these expire in 2028. But between now and then? We’ve got moves to make.

💼 QBI Deduction: Still the MVP for 1099 CRNAs

The Qualified Business Income (QBI) deduction gives eligible business owners a 20% haircut on their net business income. That’s huge.

The catch? It phases out for CRNAs once your income climbs too high. But OBBBA expands those thresholds:

The IRL change with OBBBA isn’t that the top-end income limits moved—they’ve shifted the length of the phase-in window, giving CRNAs more leeway if you’re in that income band.

What changed:

  • Phase-in window increased:
    • Single: from $50k → $75k above the threshold
    • Married: from $100k → $150k above the threshold 

That means the QBI deduction phases out more gradually, offering more room for high-income CRNAs to claim part of the deduction.

🎯 How It Works for 1099 CRNAs

  • For a single filer, QBI fully phases out starting at $232,100, and now finishes phasing out at $307,100 (previously ended at $282,100).
  • For married filing jointly, the phase-out range goes from $464,200 to $614,200.

So your income levels may still put you in the phaseout—but you’re likely to get more QBI than before.Sin

✳️ Example: Taylor, Single 1099 CRNA

Taylor is running her 1099 income through an S-corp and pays herself:

  • $150,000 in W-2 wages
  • $200,000 in S-corp distributions
  • Total business income: $350,000

That puts her well above the QBI threshold of $232,100 for single filers—but she’s not out of the game.

Thanks to OBBBA, the QBI phaseout no longer ends at $282,100. It now stretches all the way to $307,100, giving higher earners like Taylor more room to work with.

🔧 Let’s Plan

If Taylor maxes out her Solo 401(k):

  • $23,500 employee deferral
  • $37,500 employer contribution (25% of her $150k W-2)
  • $61,000 total deduction

That drops her QBI-calculated income to $289,000—comfortably within the new extended phaseout zone.

With that move, Taylor can reclaim a significant chunk of her QBI deduction—potentially worth $20,000–$25,000.

Takeaway: The new law didn’t just raise income limits—it widened the landing strip. And if you’re flying at high income, that extra room matters. Run your S-corp intentionally. Dial in your salary, max your retirement plan, and keep more of what you earn.

👩‍❤️‍👨 Example: Morgan, Married CRNA With a Spouse Earning $100K

Morgan earns the same $150k W-2 and $200k S-corp distribution as Taylor, but she’s married filing jointly, and her spouse earns $100,000 in W-2 wages.

That puts their combined household income at $450,000.

Here’s where OBBBA helps: The QBI phaseout for married filers now starts at $464,200 and runs all the way to $614,200. Morgan and her spouse are well below the new threshold.

Result? Morgan gets to keep her full 20% QBI deduction—without needing to mess with her income, Solo 401(k), or salary splits just to qualify.

Takeaway: Married CRNAs now have a lot more runway to preserve QBI—even with a working spouse. And that deduction can mean huge tax savings with the right setup. Don’t waste it by defaulting to bad payroll decisions.

🧾 SALT Deduction: More Room to Itemize

The SALT (State and Local Tax) deduction cap is now $40,000, up from the old $10,000 limit.

But… it phases out starting at:

  • $500k MAGI (Single)
  • $600k MAGI (Married)
  • Now itemizing could make sense again

⚠️ New Deductions (Tips, Overtime, Auto Interest): Cool, But…

OBBBA introduced new below-the-line deductions:

  • Tips: Deduct up to $25,000
  • Overtime: Up to $12,500 single / $25,000 married
  • Auto loan interest: Up to $10,000 if the vehicle is U.S.-assembled

But here’s the catch…

These phase out at just $100,000 of MAGI.

Gone completely by $150k.

So unless you’re part-time or just starting out, you’re likely over the limit. That said…

Pro Tip: The auto loan deduction doesn’t apply, but bonus depreciation might. Which leads us to…

🚙 100% Bonus Depreciation Is Back

If you’re a 1099 CRNA and buy a vehicle over 6,000 lbs, used primarily for work, you can write off 100% of the cost in year one—thanks to bonus depreciation being reinstated through 2028.

Same goes for home office furniture, anesthesia carts, or business tech—if it’s used for your S-corp.

Example:

  • $75,000 SUV
  • 80% business use = $60,000 deduction
  • Add that to your other business deductions and we’re really cooking with gas.

Takeaway: W-2 employees can’t use this. But if you’re 1099, it’s one more reason to track vehicle mileage and make your home office legitimate.

🎓 529 Plans Just Got More Flexible

OBBBA expanded how you can use 529 plans:

  • Now eligible for tutoring, certifications, ed-tech
  • Rollover up to $35,000 into a Roth IRA—as long as the account has been open 5+ years

Planning Tip: Overfund your kid’s 529? No problem. Rollover the leftover into their Roth and help kickstart their retirement savings.

👶 Updated Child Tax Credit

  • Now worth $2,200–$2,500 per kid, depending on year (up to $2,800 by 2028
  • Fully refundable
  • Phases out above:
    • $200k MAGI (Single)
    • $400k MAGI (Married)

Many of you are sitting right at or above these limits.

Use retirement contributions and business deductions to dip under if it’s close—every kiddo’s worth a few thousand in tax credits, right?

📌 CRNA Action Steps

Here’s what you can do right now:

  • ✅ Run a tax projection under 2025 rules
  • ✅ Optimize your S-corp salary vs distribution
  • ✅ Max your Solo 401(k) + backdoor Roth
  • ✅ Look at bonus depreciation before year-end
  • ✅ Re-evaluate itemizing vs standard deduction
  • ✅ Consider PTET election if your income is high
  • ✅ Use 529s and time CTC eligibility for max impact

Final Thoughts

OBBBA isn’t just political fanfare—it creates some real tax opportunities for CRNAs. But most of these benefits don’t land in your lap. You have to go grab them.

And that’s where I come in.

Let’s make sure you’re not leaving five figures on the table.

Book a fall check-in and let’s get surgical with your strategy.