North Carolina still has nationwide PPO coverage available, even in Triangle counties without a PPO on HealthCare.gov. Here's how electricians working around Raleigh and Durham can compare their insurance choices.
Hi, I'm Sam, and I'm a licensed broker specializing in health insurance. North Carolina is one of the 36 states where I'm licensed. We handle everything by phone, even if you're calling from a crawlspace.
Imagine living in Clayton and running your own electrical business. One day you're wiring new townhomes in Wake County, the next you're handling a laboratory upfit in Durham, and later you're replacing a panel in Garner. You used to work as a journeyman for a larger contractor, but now you own the license and the van. You also have to purchase your own health insurance. You'd prefer a PPO because you want flexibility in choosing doctors. But when you search HealthCare.gov, there aren't any PPOs available to you.
You're seeing that correctly, but you still have a choice. Nationwide PPOs are available in North Carolina, and I help Triangle families enroll in them.
In 2026, medical PPOs appear on the marketplace in 90 of North Carolina's 100 counties. The ten without them include Wake, Durham, Orange, Johnston and Chatham. Wake and Johnston each offer 35 HMOs and 9 EPOs through 4 insurance companies. Durham offers 22 HMOs and 9 EPOs from 3 companies. Both HMOs and EPOs generally restrict coverage to network providers except for emergencies. PPOs also contribute toward out-of-network care, usually with higher costs to you and no specialist referral needed. For nationwide PPO access, you'd look at private coverage that uses medical underwriting.
The first thing I'd check is whether your household qualifies for a premium tax credit. That credit can make HealthCare.gov coverage the most affordable choice, even without a PPO. Once your income exceeds the eligible range, marketplace plans cost their full premium, and comparing private coverage makes more sense.
HealthCare.gov bases its calculation on estimated net self-employment income for the coverage year. That's your business revenue after paying for things like permits, breakers, wire, your van, liability insurance and hired help. When that income projection changes, you're expected to report the adjustment promptly.
When your business grows to a couple of crews, household earnings may rise beyond the tax credit range. At that point, you're paying the marketplace's full premium without out-of-network benefits. A healthy family should compare that with a medically underwritten nationwide PPO. The application includes health questions, and the company may approve it, deny it or approve coverage while excluding a specific previous condition. Healthy applicants sometimes receive premiums below the full marketplace price. The nationwide network also follows your family, whether your child attends college in another state or you're working in Virginia. Since benefits vary, I'll review the details of each plan with you.
Next step: Give me a call with your ZIP code and the ages of everyone needing coverage. I'll compare Triangle marketplace rates with a nationwide PPO quote.
If you're leaving a contractor and losing its health benefits, you may qualify for special marketplace enrollment without waiting until fall. Be careful with COBRA if your former employer offers it. Voluntarily canceling COBRA early won't create another enrollment window. Private medically underwritten coverage also takes time to review, so talk to me a few weeks before leaving. And remember, workers' compensation only covers injuries related to your work, not general medical needs.
Next step: Get in touch before you hand in your notice. We'll arrange your replacement insurance to begin when the employer plan finishes.
Straight answers, no sales pitch.
No medical PPOs are offered on Wake County's marketplace for 2026, only HMOs and EPOs. Healthy families can still pursue nationwide PPO coverage privately.
The 2026 list includes Wake, Person, Orange, Lee, Johnston, Franklin, Durham, Chatham, Caswell and Alamance.
Use the net profit you expect from self-employment during the coverage year, after business expenses. Revise that projection whenever your income changes.
Not necessarily. If the HMO includes your doctors and your credit makes the premium manageable, it can work well. Just understand that nonemergency out-of-network treatment usually isn't covered.
Start with your county, everyone who needs insurance and an approximate net profit for the business. I'll compare local marketplace prices with a nationwide PPO and explain which choice I'd make in your situation.
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