Leaving a contractor's health plan in Tennessee doesn't mean giving up a nationwide PPO. Even though the marketplace carries only EPOs, electricians opening their own shops have another way to get covered. Here's how to make that transition.
Hi, I'm Sam. I broker health insurance, and I'm licensed in Tennessee. Everything is handled by phone, which means we can talk during your lunch break while you're still working for the contractor.
Consider a move electricians are making across Tennessee. After years working as a journeyman for a contractor in Knoxville, Chattanooga or the Tri-Cities, you're ready to use your master's license for your own business. Builders already know your work, and you've even chosen the van. Then comes the health insurance question. The group coverage from your contractor ends when you leave, and you need to replace it. That's the transition we're looking at here.
Working for yourself in Tennessee doesn't take nationwide PPO coverage off the table. I can help you get one in place.
The catch is where you buy it. HealthCare.gov shows 158 individual medical plans in Tennessee for 2026, offered by 6 insurers across the state's 95 counties. Every single one is an EPO. With an EPO, care outside the network is covered only for emergencies, leaving you responsible for ordinary visits to doctors outside that network. PPOs work differently: they contribute toward out-of-network care, although you pay more, and you don't need referrals. So if your employer provided a PPO, the marketplace can't give you an equivalent replacement. Private plans with medical underwriting can offer nationwide PPO networks, with premiums determined by your health.
When you lose coverage through your employer, that triggers a qualifying event. You generally get 60 days from the loss to enroll through HealthCare.gov, regardless of the season. There's no need to wait for open enrollment. Just be cautious with COBRA if your contractor offers it. Choosing to cancel COBRA before it expires doesn't create another enrollment opportunity. Reaching the end of COBRA does.
Because medically underwritten coverage requires an application review, I'd get started several weeks ahead of your final day.
Suppose your family is healthy and you're accustomed to the PPO you had at work. A medically underwritten nationwide PPO may be your best match. The application includes health questions, and the insurer can accept you, reject you, or offer coverage that excludes a previous condition. With a clean medical history, premiums may be lower than the marketplace's unsubsidized rates. The benefits aren't identical across policies, though, so we'll review the details before coverage begins. And if someone in your household has an existing condition, tell me about it. Don't assume that automatically eliminates the PPO, because eligibility depends on the particular condition.
Next step: Give me a call several weeks before you leave, and I'll quote a nationwide PPO that begins when your contractor's coverage finishes.
Your new business may bring in less profit during its first year. If your household income qualifies for a federal premium tax credit, an EPO through HealthCare.gov will probably cost the least. That's because the credit applies only to marketplace coverage. We'll need to verify that your family's physicians participate in the EPO network. As your business grows, remember to revise your income projection.
A particularly slow first year calls for caution. Tennessee did not expand Medicaid. TennCare generally covers parents only through 105% of the federal poverty level, while adults without children are usually excluded. Marketplace premium credits ordinarily start at the poverty line. If your household income falls well below that threshold, you could miss eligibility for both programs.
Next step: Tell me what you realistically expect to earn in year one. I'll help you weigh private coverage against the marketplace before you make the move.
Straight answers, no sales pitch.
Your employer's group coverage will typically finish when your employment does. Losing it generally starts a 60-day special enrollment window for HealthCare.gov, regardless of the time of year.
The marketplace won't have one. Tennessee's 158 individual medical plans for 2026 are exclusively EPOs. But if you're healthy, I can arrange a nationwide PPO privately.
Look at your alternatives before making that choice. Canceling COBRA voluntarily before it expires won't qualify you for another enrollment period.
It's unlikely. Tennessee has not expanded Medicaid, and TennCare generally excludes childless adults while limiting parent eligibility to 105% of the poverty level.
Tell me when your existing plan expires, what county you're in and which family members need coverage. I'll compare your choices and show you actual prices. If waiting a little longer makes more sense, I'll be straight with you about that too.
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