Although Tennessee's marketplace carries only EPO medical insurance, you can still get nationwide PPO coverage. Here's how contractors working throughout growing Middle Tennessee can compare plans and potentially spend less on family insurance.
Hi, I'm Sam Jaber. I broker health insurance exclusively, I'm licensed in Tennessee, and I work with clients over the phone.
Contractors across Middle Tennessee have watched Nashville's growth spread into Williamson, Rutherford, Wilson, Sumner and Maury counties. New subdivisions, townhouses, custom homes and renovations in established neighborhoods have kept construction moving. That demand also encouraged many lead carpenters and superintendents to open their own businesses. But becoming a business owner means handling your own health coverage, and Tennessee's marketplace offers fewer network choices than many builders realize. That's what I'll explain here.
I can help you arrange nationwide PPO coverage in Tennessee, regardless of which part of the state you call home.
HealthCare.gov doesn't offer medical PPOs in Tennessee. For 2026, the marketplace lists 158 individual medical plans from 6 insurance companies across all 95 counties, and they're exclusively EPOs. These plans cover out-of-network care only for emergencies. PPOs, on the other hand, contribute toward treatment outside the network, although you pay more, and don't require referrals. You may see PPO dental policies listed, but there are no marketplace medical PPOs.
Medically underwritten private coverage uses nationwide PPO networks, with premiums calculated according to your health.
For contractors with established businesses in Middle Tennessee, the real question is often whether paying the marketplace's full premium makes sense for coverage they seldom use.
Eligibility for federal premium tax credits depends on your household's annual profit. For construction businesses, that means income remaining after lumber, subcontractors, vehicles, machinery, permits and insurance expenses. Contractors managing several home builds simultaneously often earn too much for the credit. Without that assistance, Tennessee's marketplace limitation to EPOs becomes more frustrating.
Think of a successful builder in Williamson or Rutherford County with a healthy spouse and two children involved in sports. The family pays a substantial marketplace premium but receives EPO coverage restricted to one network. That's the situation we're examining.
I'd have that family compare a medically underwritten nationwide PPO. The insurance company reviews your health questionnaire and can approve coverage, decline the application or approve a policy excluding one previous condition. Healthy applicants may receive premiums below full marketplace rates. The nationwide network can serve your family while visiting a Kentucky lake house, attending a sports tournament in Alabama or going to college outside Tennessee. I'll review the specific benefits in each policy with you before you make a decision.
Next step: Call me with your county and everyone's ages. I'll show you nationwide PPO pricing alongside the Tennessee marketplace EPO options available to your household.
New construction businesses and smaller remodeling operations often qualify for this route. When you're eligible for premium credits, HealthCare.gov coverage almost always costs less than private insurance because those credits apply only to marketplace plans. We'll check that your chosen EPO includes your regular doctors. If a major property closing increases your annual income beyond your estimate, report the change to avoid having excess credits reconciled on your tax return.
Next step: Let's review your previous tax return and the contracts you've signed this year. We'll work out a realistic income projection and choose an appropriate EPO.
A new contracting business may produce very little profit initially, which creates a challenge in Tennessee. The state hasn't expanded Medicaid. TennCare generally doesn't cover adults without children and limits parent eligibility to 105% of the poverty level. Since marketplace credits usually begin at the poverty line, some low-income households qualify for neither. Let's discuss your situation before you submit an application.
Remember, workers' compensation is limited to injuries that happen while working. Ordinary medical appointments and illnesses such as the flu aren't covered.
Next step: If your business income is unusually low this year, call me before enrolling. We'll review which coverage programs you're eligible to use.
Straight answers, no sales pitch.
No. Tennessee's 158 marketplace individual medical plans for 2026 are all EPOs. Healthy contractors can still obtain nationwide PPO insurance through private coverage.
EPOs generally pay for out-of-network treatment only during emergencies. PPOs also cover other out-of-network services, though your costs are higher, and referrals aren't necessary.
Generally, no. Tennessee hasn't expanded Medicaid. TennCare limits parents to 105% of the poverty level and usually excludes adults who don't have children.
No. Workers' compensation only applies to injuries related to your job. You'll need separate health insurance for illnesses, preventive appointments and family medical care.
Give me your county, the people needing coverage and approximately how much profit your company made last year. I'll compare prices for the plans that suit your situation and tell you if keeping your existing coverage is the better move.
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