2027 Retirement Contribution Limits for Physicians: 401(k), 403(b), 457(b), IRA and HSA

As of October 1, 2026, the IRS has published one set of 2027 limits: health savings accounts, at $4,500 for self-only coverage and $9,000 for family coverage (Rev. Proc. 2026-24). The 2027 limits for workplace plans and IRAs come in the IRS's annual cost-of-living release, which for 2026 came out on November 13, 2025 (IR-2025-111). Until the 2027 release, the latest official limits are the 2026 figures below.

Physicians tend to have more account types than most savers: a 403(b) and a 457(b) at a hospital, a solo 401(k) for locums or consulting income, an HSA, and a backdoor Roth IRA. This guide lists every limit in one place, then explains which limits are shared and which stack, with three worked examples. We publish only IRS figures. Some sites post their own estimates of the 2027 limits; those are calculations until the IRS confirms them.

These are the dollar limits that matter most to physicians. The 2026 column comes from Notice 2025-67. The 2027 column will be filled in when the IRS publishes the 2027 notice.

Reading the table. The employee deferral is what you choose to have withheld from your pay, pre-tax or Roth. The $72,000 total per employer adds employer matching and nonelective contributions and any after-tax contributions to your deferrals; age-based catch-ups sit on top of it. The compensation limit caps the salary a plan can count when it calculates employer contributions, so a physician earning $500,000 with a 5% employer contribution gets 5% of $360,000 in 2026.

The IRS sets HSA limits earlier in the year than retirement plan limits, so the 2027 numbers are already final. You can contribute to an HSA only if you are covered by a high-deductible health plan (HDHP) that meets the minimum deductible and stays under the out-of-pocket maximum.

Three HSA changes from the 2025 tax law. The One Big Beautiful Bill Act (P.L. 119-21) changed who can use an HSA starting January 1, 2026, according to IRS guidance from December 9, 2025 and Notice 2026-5:

• Bronze and catastrophic plans count as HSA-compatible, whether or not you bought them through an Exchange.
• Direct primary care no longer blocks HSA contributions, and HSA money can pay periodic DPC fees tax-free, as long as the fee is no more than $150 a month for one person or $300 for an arrangement covering more than one. Rev. Proc. 2026-24 keeps those caps for 2027. If you run or are weighing a DPC practice, this matters to your patients too; see our guide to DPC and concierge medicine economics.
• The telehealth safe harbor is permanent, so an HDHP can cover telehealth before you meet the deductible without costing you HSA eligibility.

The dependent care FSA limit rose from $5,000 to $7,500 in 2026 under section 70404 of the same law. For how to invest an HSA and use it as a retirement account, see our HSA strategy guide.

Most mistakes with these limits come from assuming every plan has its own. Four rules from the IRS decide how much a physician with several plans can put away.

1. Your employee deferral limit is per person. The $24,500 (2026) covers all of your 401(k), 403(b), and SIMPLE deferrals combined, even when the plans belong to unrelated employers. The IRS calls it "your individual limit each calendar year no matter how many plans you're in" (IRS). If you change jobs mid-year, your new employer does not know what you deferred at the old one, so tracking it is your job. If you go over, ask the plan to return the excess by April 15 of the next year; otherwise the excess can be taxed twice.

2. A 457(b) has a separate limit. The IRS says the 457(b) limit "is not combined with your deferrals made to a 403(b) or other plans." An employer that offers both doubles your deferral room to $49,000 in 2026. If your employer is a private nonprofit, such as a 501(c)(3) hospital, its 457(b) is a non-governmental plan, and those must stay unfunded: the assets remain the employer's property and are available to its general creditors (IRS). Before you put money in, check that risk and how the plan pays out when you leave. Our UC retirement guide walks through one employer that offers both plans.

3. The $72,000 total limit is per employer. It covers all your accounts "in plans maintained by one employer (and any related employer)" (IRS). A plan at an unrelated employer, including a solo 401(k) for your own side business, has its own $72,000. One exception for 403(b) participants: a 403(b) is combined for this limit with the plans of any business in which you have more than 50% control, such as your own practice or consulting company (IRS Publication 571).

4. Self-employment income has its own math. In a solo 401(k) or SEP, the business can contribute up to 25% of compensation (IRS). If you are self-employed, that works out to 20% of your net earnings from self-employment after the deduction for half of self-employment tax (IRS Publication 560). Any employee deferral you make to the solo 401(k) comes out of the same per-person limit as your day job's 401(k) or 403(b), though not your 457(b).

IRAs and HSAs sit outside all of this. Each has its own limit, and neither depends on what you put into workplace plans. High earners who are over the Roth IRA income limits can still fund one through a backdoor Roth IRA, and some 401(k) plans allow after-tax contributions up to the $72,000 total for a mega backdoor Roth.

These show the maximum room each person has, not a recommendation to fill all of it. All three are under 50, so no catch-ups apply.

A resident at a public hospital with a 403(b) and a governmental 457(b). Deferral room is $24,500 in each plan, but deferrals cannot exceed your pay, and few residents can save anywhere near $49,000. The more useful facts for a resident: a single resident is well below the $153,000 Roth IRA phase-out, so you can contribute $7,500 directly to a Roth IRA without the backdoor steps, and if your hospital offers an HDHP, the HSA adds $4,400 (self-only). Our resident financial guide covers what to fund first.

An attending at a private nonprofit hospital with a 403(b), a non-governmental 457(b), and family HSA coverage.

• 403(b) employee deferral: $24,500, plus whatever the hospital contributes
• 457(b) deferral: $24,500
• Backdoor Roth IRA: $7,500
• HSA, family coverage: $8,750
• Total from your own pay: $65,250, before employer contributions

An employed physician with $40,000 of locums or consulting income on the side. If the day job's 401(k) already takes the full $24,500 deferral, the side business can still set up a solo 401(k) or SEP and make an employer contribution of 20% of net self-employment earnings. With $40,000 of side profit that is roughly $7,400 to $7,900, depending on how much self-employment tax you owe; it is closer to the high end when your W-2 wages already exceed the Social Security wage base. Publication 560 has the worksheet. If the day job is a 403(b) and you own more than 50% of the side business, remember that the two count toward one $72,000 limit. See our guides to physician side income and locum tenens pay.

Age 50 and over. You can defer $8,000 more in 2026 to a 401(k), 403(b), governmental 457(b), or the TSP. Between ages 60 and 63, the extra amount is $11,250 instead (IRS). IRAs allow $1,100 more and HSAs $1,000 more from age 55.

Two catch-ups specific to physician employers. If your 403(b) plan allows it and you have 15 years of service with the same hospital or other eligible employer, you may be able to defer up to $3,000 more a year, with a $15,000 lifetime cap (IRS). A 457(b) plan may allow a special catch-up in the three years before the plan's normal retirement age, up to twice the annual limit; in a governmental 457(b) that also allows the age-50 catch-up, you use whichever is larger, not both (IRS).

The Roth catch-up rule. Starting in 2026, if your FICA wages from your employer in the prior year were over $150,000, any catch-up you make to that employer's plan must be a Roth contribution (IRS). Most attending physicians are over that line, so expect catch-ups to come out of after-tax pay. The final regulations apply from 2027, with later dates for some governmental plans; for 2026, plans may follow a reasonable, good-faith reading of the law. If your plan does not offer a Roth option, ask your benefits office how it is handling catch-ups. The wage threshold for 2027 catch-ups will be in the IRS's 2027 announcement.

1. Finish 2026 first. Workplace deferrals come out of your paychecks, so check how many are left and whether your year-to-date total will reach the limit you want. IRA and HSA contributions for 2026 can be made until April 15, 2027 for most people, not counting extensions (IRS Publication 590-A; Publication 969).

2. Set your 2027 HSA contribution now. Those limits are final. If you change coverage during open enrollment, check that the new plan's deductible meets the 2027 minimum of $1,750 (self-only) or $3,500 (family).

3. Update your deferral election after the IRS announces 2027. If you elect a fixed dollar amount per paycheck, recalculate it for the new limit and your number of pay periods. If your employer matches each pay period and does not make a year-end true-up, spreading deferrals across the whole year keeps you from missing match in the months after you reach the limit. Your plan's summary plan description says which applies.

4. Note any birthday that changes your limit. Turning 50, 55 (HSA), or 60 in 2027 raises your catch-up room, and turning 64 drops you back from the $11,250 amount to the regular one.

5. If you have more than one job, keep your own running total. No employer sees the others' payroll. To see how these contributions add up over a career, try the retirement savings calculator.