Ohio's marketplace offers nothing but HMO medical plans, yet nationwide PPO coverage is still available. Here's how builders, remodelers and general contractors can compare options and potentially lower their family's insurance costs.
Hi, I'm Sam Jaber. Health insurance is my specialty, and I hold licenses in 36 states, including Ohio. Everything I do with clients is over the phone, so we can talk between your construction jobs.
Ohio contractors know how much the seasons affect their workload. Foundations, roofing, framing and additions fill the warmer months from spring into fall. Once winter arrives, outdoor projects slow down, leaving kitchens, basements and interior renovations to keep business moving. Your earnings rise and fall with that schedule, so your insurance needs to make financial sense throughout the year. There's also an important limitation in Ohio's marketplace that becomes obvious when you search for PPO coverage.
Although Ohio's marketplace doesn't offer a PPO, I can help you get nationwide PPO health insurance outside of it.
HealthCare.gov shows 189 individual medical plans for Ohio in 2026, offered by 11 insurers across all 88 counties. They're all HMOs. With an HMO, non-emergency treatment outside the network generally isn't covered. A PPO, by comparison, contributes toward out-of-network care, although your costs are higher, and you don't need referrals. You might find PPO dental coverage listed on the marketplace, but none of Ohio's marketplace medical plans are PPOs.
You can look beyond the marketplace for medically underwritten private PPO plans. These offer networks of doctors across the country, with premiums based on your health. For contractors in good health, that can mean a more attractive price.
One important advantage Ohio has over many other states is expanded Medicaid. That creates three different coverage routes for contractors, determined by their household's annual income.
Medicaid is available to qualifying adults whose household income doesn't exceed 138% of the federal poverty level, and applications are accepted year-round. Above that threshold, HealthCare.gov offers premium tax credits toward HMO coverage until income becomes too high for the credit. After that, you pay the entire premium. For contractors, the relevant income is net profit after paying for concrete, lumber, subcontractors, vehicles, machinery, permits and insurance.
HealthCare.gov enrollment opens November 1 and closes January 15. To begin coverage January 1, enroll no later than December 15. Here's how I'd approach the different income situations.
Maybe you're launching your business, dealing with a slow construction season or recovering from a major contract that didn't happen. Your household earnings could be unusually low. That creates a coverage problem in some states, but Ohio's Medicaid expansion offers another route. At or below 138% of the federal poverty level, qualifying households can receive Medicaid without waiting for the annual enrollment period.
Keep an eye on earnings when business improves. Once spring projects start and your income goes up, report the change. You may then need to transition from Medicaid to marketplace insurance.
Next step: Call me if business has been slow this year. We'll review whether you should be looking at Medicaid or a marketplace health plan.
If your earnings exceed Medicaid eligibility but still qualify for premium tax credits, HealthCare.gov will generally offer Ohio's lowest-cost coverage. Those credits aren't available for plans purchased outside the marketplace.
Every marketplace option is an HMO, which can work well when your family receives most of its healthcare locally. Before enrolling, we'll verify that your regular doctors and preferred hospital participate in the plan's network.
Construction income can be unpredictable because of payment draws and retainage. When a large project finishes ahead of schedule, your earnings may exceed your original projection. Report that change to HealthCare.gov so you don't end up repaying part of your tax credit when filing taxes.
Next step: Let's review last year's financials and the contracts you've already signed for this season over the phone. We'll estimate your income and find an Ohio HMO that fits.
Contractors with established businesses often make too much to receive premium credits. That means paying the full HealthCare.gov price for an HMO, which may seem expensive when your family is healthy and wants more freedom to select doctors.
That's when I'd compare a medically underwritten nationwide PPO. The application includes questions about your health. The insurance company can accept you, reject the application or offer coverage excluding a previous condition. Healthy families can often get lower premiums through this process than they'd pay at full marketplace rates. Nationwide access is useful when you work in Kentucky, Indiana or Pennsylvania, or when your children attend college outside Ohio.
Benefits differ from policy to policy, so I'll review what each one covers with you before you decide.
Next step: Give me a call. I'll compare nationwide PPO pricing for your household with the Ohio marketplace HMOs available in your county.
Straight answers, no sales pitch.
No medical PPOs are available there. Ohio's 189 marketplace individual medical plans for 2026 are all HMOs. Healthy applicants can still obtain nationwide PPO coverage privately.
You could qualify. Ohio expanded Medicaid to adults with household earnings up to 138% of the federal poverty level, and enrollment is available throughout the year.
HealthCare.gov enrollment is November 1 through January 15. Enroll by December 15 to start January 1. Losing existing insurance generally gives you another enrollment opportunity.
Take your net earnings from last year, factor in confirmed projects and make a reasonable projection. Revise it on HealthCare.gov if major work finishes sooner than expected or moves into the following year.
Tell me your county, which family members need insurance and approximately what your business earned after expenses last year. I'll compare prices and recommend a direction. If staying on your existing coverage makes more sense, I'll tell you that too.
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