If you’re 50 or older, working as a CRNA or NP, and earning more than $150,000, a rule buried inside the Secure 2.0 Act just changed how your retirement catch-up contributions are taxed. Most people in this field haven’t adjusted their plan for it, and if you don’t either, it can cost you real money.
The Catch-Up Contribution Change
For 2026, anyone 50 or older can put $24,500 into a 401(k) or 403(b) as a normal employee deferral, plus a catch-up contribution on top of that. For most people 50 and older, the catch-up is $8,000, bringing the total to $32,500. That part hasn’t changed.
What changed is where the catch-up piece is allowed to go. If your prior-year wages from the employer sponsoring your plan were $150,000 or more, your catch-up contribution has to be Roth. Pre-tax is off the table for that piece specifically, even if your plan still offers pre-tax options for everything else. This is based on wages from that one employer, not your total income across every job you hold.
What Doing Nothing Costs You
If you’re used to putting that $8,000 catch-up in pre-tax and you don’t change anything, it no longer reduces your taxable income the way it used to. For someone in the 32% federal bracket, that’s roughly $2,500 or more in taxes due this year that wouldn’t have been due last year on that piece alone. If you’re stacking catch-up contributions across two plans, say a 403(b) and a governmental 457(b), and you default into Roth on both without checking your options, that number can roughly double to around $5,000.
Most retirement contributions run on autopilot, and that’s usually a good thing since it keeps you saving without second-guessing every paycheck. But it also means nothing forces you to notice when a rule changes underneath you. Payroll just starts routing your catch-up into Roth once your plan updates its system, and you may not even see it happen until the tax bill shows up.
The Three Accounts You Might Not Be Using Together
Most CRNAs and NPs have access to more than one type of retirement account and treat them like they all share the same limit. They don’t.
Your 403(b) and a 457(b) are separate plans with separate caps, so you can max out the employee deferral in both in the same year. If your 457(b) also happens to be within three years of your plan’s stated normal retirement age, and you have unused contribution room from earlier years, it may qualify for a special three-year catch-up instead of the standard age-50 catch-up. Under the final regulations, the portion that falls within that special limit can still go in pre-tax, even above the $150,000 wage threshold.
If you pick up 1099 income on the side, locum shifts or part-time consulting, a solo 401(k) opens up a third bucket. Since self-employment income isn’t reported as FICA wages, the $150,000 Roth mandate doesn’t apply to it the same way, and the employer-side contribution runs on its own limit, up to $72,000 in combined employee and employer contributions for 2026.
Put those three together, and you’re looking at a structure that can shelter meaningfully more than the generic “just max your 401(k)” advice most people get, using accounts that already exist and are already available to you.
Retirement Planning Case Study
Consider a hypothetical CRNA named Dana. She’s 51, earns around $230,000 between a W2 hospital job and 1099 locum work, and has just over $1 million saved. If she just maxes her 403(b) and calls it done, she’s contributing $32,500 a year, catch-up included. That’s a solid number on its own.
But if she structures all three accounts, her 403(b), her 457(b) using the special three-year catch-up, and a solo 401(k) funded by her locum income, she can reasonably contribute around $40,000 more per year than the single-account approach. At a hypothetical 7% average annual return, that extra $40,000 a year compounds to roughly $900,000 in additional growth over the 14 years between her age now and 65. Left alone with no further contributions, her current savings would grow to about $2.7 million by 65 under that same assumption. Structured properly, she’s looking at closer to $3.6 million.
If you’re over 50 and earning above $150,000, pull up your last pay stub or W2 and check your FICA wages against that number. If you’re over the line, call your plan administrator directly, not a generic call center, and ask whether your plan offers a Roth option, whether you qualify for the 457(b) special catch-up, and whether a solo 401(k) makes sense if you have 1099 income. A free Pre-Op Assessment is a good place to start if you’d like help modeling it. Schedule a meeting to get started.
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