An example
For a 47-year-old CRNA who contracts with two surgery centers through an S corporation, the 2026 figures work out like this:
- Cash balance plan, first year
- $109,000
- Solo 401(k) alongside
- $35,000
- Both plans
- $145,000
- A Solo 401(k) on its own
- $69,500
- Federal income tax saved
- $27,200
Federal income tax only, compared with making no retirement contributions. State tax saved depends on where you live: see savings by state. An illustration from the same calculation as the estimate, not a quote.
CRNAs are generally a specified service business for the 20% qualified business income deduction. Above the income threshold that deduction phases out, and a contribution that brings taxable income back down can restore part of it. How the deduction interacts with contributions
How you are paid decides what the plan can use
CRNAs are paid in more ways than most clinicians, and many use more than one at once.
| Arrangement | What counts for your own plan |
|---|---|
| W-2 staff position at a hospital or anesthesia group | Nothing. That employer's plans cover it. |
| 1099 contracts as a sole proprietor or single-member LLC | Net earnings from the contracts, after the deduction for half of self-employment tax. |
| Contracts through your own S corporation | Only the W-2 salary the corporation pays you. Distributions of profit do not count. |
| A staff job plus 1099 per diem or locum shifts | Only the 1099 side. The 401(k) deferral limit is shared with the staff job. |
The last row is common. If you already defer the full amount through a hospital 401(k) or 403(b), a Solo 401(k) in your side business has no deferral room left, but the cash balance plan is unaffected. See a W-2 job and a side business.
If you contract with several facilities, all of that income can run through the same business and support one plan. Separate entities for separate contracts add paperwork without adding room: two businesses you own outright are treated as one employer for retirement plan purposes.
Long-running contracts with one or two facilities tend to make CRNA income steadier than many self-employed incomes. That steadiness is what a cash balance plan needs, because it comes with a minimum contribution each year.
In an S corporation, salary sets the ceiling
Many CRNAs contract through an S corporation and take part of the profit as distributions, which carry no payroll tax. The trade-off is direct: the plan can only use W-2 salary. The benefit a cash balance plan can fund is capped at 100% of your average pay over your highest three consecutive years, so a modest salary caps the plan however large the profit.
Raising the salary raises payroll tax. Above the Social Security wage base ($184,500 in 2026), the extra cost on each additional dollar is mostly Medicare tax. Whatever salary you choose has to be paid through payroll by December 31 and has to be reasonable for the work. See S corporation owners.
One more S corporation point for CRNAs 50 and over: if your 2025 Social Security wages from the corporation were over $150,000, any 401(k) catch-up contribution for 2026 has to be Roth, so it adds nothing to this year's deduction. See Roth catch-up contributions.
Groups with other anesthetists
Some CRNAs build a practice and bring in other anesthetists. Once another CRNA is on your payroll, the business is no longer a one-person business: an employee who meets the plan's age and service conditions has to be covered. See hiring your first employee.
Owning part of an anesthesia group or staffing company that has employees raises the same issue from the other side. The controlled group and affiliated service group rules can treat that business and your own as one employer.
For the qualified business income deduction, Treasury regulations name nurses in the definition of the health field, so anesthesia services are a specified service.