The Texas marketplace doesn't offer PPO medical coverage, but that doesn't mean you're out of options. I can help you get a nationwide PPO. Here's how Texas builders, general contractors and remodelers are finding more affordable coverage for their families.
Hi, I'm Sam Jaber, a health insurance broker licensed in 36 states, Texas included. Everything I do is over the phone, so whether you're supervising a foundation pour in Katy or working on framing outside Austin, we can handle your coverage without you leaving the job.
There's no shortage of construction work in Texas. Cities continue expanding, renovation projects keep coming, and hailstorms and Gulf weather create plenty of repairs. Finding health insurance is another story. When you own the company, you're responsible for buying coverage yourself. And if you're looking for a PPO through the Texas marketplace, you'll discover an important missing option.
Here's what I want you to know first: Texas marketplace plans don't include PPOs, but I can still help you obtain nationwide PPO coverage.
Here's what catches many people off guard. In 2026, HealthCare.gov offers 834 individual medical plans throughout Texas's 254 counties. Exactly zero are PPOs. Instead, you'll find HMOs, POS plans and EPOs. An HMO typically limits coverage to its network except for emergencies, while an EPO generally covers outside-network care only for emergencies. PPOs are different: you can see doctors outside the network without a referral, although your share of the cost is higher. You might notice PPO dental policies listed, but those aren't the medical plans we're discussing.
You can look beyond HealthCare.gov at private, medically underwritten plans using nationwide PPO networks. Your health helps determine the premium, which means builders in good health may qualify for surprisingly affordable coverage.
In Texas, marketplace enrollment goes through HealthCare.gov. Whether you receive a premium tax credit depends on your household's annual income. If you own a contracting business, we're talking about profit after expenses such as lumber, concrete, subcontractors, vehicles, trailers, permits, insurance and bonding. Even a company bringing in substantial revenue might have a qualifying net income.
Your household's position within or outside the tax credit range is what shapes your choices. Let's look at where you fit.
When your business profit places your household within the qualifying income range, HealthCare.gov generally offers the lowest family coverage cost in Texas. That's because the premium tax credit cannot be applied to privately sold plans.
The compromise is which doctors you can use. Marketplace coverage comes through HMOs, POS plans and EPOs with networks centered on local providers. That can work well when your family receives care nearby. We'll check that your regular doctor, children's pediatrician and preferred hospital participate before you enroll.
Be careful with your income projection, too. Construction payments, deposits, draws and retainage can make annual earnings unpredictable. If a major project finishes early and raises your income, update HealthCare.gov. Otherwise, excess premium credits are reconciled when you file your taxes.
Next step: Share your latest tax return and the contracts you've secured for this year. We'll work out a sensible income projection and find a Texas health plan that fits.
Many experienced builders earn too much to receive a premium tax credit. If that's you, HealthCare.gov charges the full premium, and it still doesn't offer a PPO.
That's when I'd compare a medically underwritten nationwide PPO. The application asks about your health, and the insurance company can accept you, reject the application or offer coverage excluding a previous condition. Because eligibility depends on health, families with favorable medical histories can often pay less than full marketplace premiums. You also get access to a nationwide network, useful when your projects take you to Oklahoma or Louisiana or your children attend college in another state.
Coverage details differ between policies. Before you decide, we'll examine the benefits and exactly what the insurer agrees to pay.
Next step: Give me a call. I'll get a medically underwritten PPO quote for your family and compare it with the marketplace coverage available in your Texas county.
When you're launching a contracting business or waiting for new bids to come through, your household income can drop sharply. That's particularly difficult in Texas because the state hasn't expanded Medicaid. Under Texas Medicaid, parents generally qualify only when their income is no more than 15% of the federal poverty level. Adults without children who aren't disabled generally don't qualify regardless of income. At the same time, marketplace premium credits generally begin only once household income reaches the poverty level.
That creates a situation where a Texas family with extremely low earnings may qualify for neither program. If you're facing that possibility, both your HealthCare.gov income projection and the timing of your application are important.
One more distinction as you launch your company: workers' compensation protects against workplace injuries. It doesn't replace personal medical insurance.
Next step: If business income is looking low this year, phone me before signing up. We'll review your eligibility and make sure you understand the reporting requirements.
Straight answers, no sales pitch.
No, not for medical insurance. Texas has 834 individual marketplace medical plans in 2026, all HMOs, POS plans or EPOs. Healthy applicants can still obtain nationwide PPO coverage privately.
Generally, no. Texas hasn't expanded Medicaid. Parent eligibility ends at 15% of the poverty level, and adults without children generally aren't covered. Call me before enrolling during a low-income year.
Begin with your latest annual net profit, adjust for contracts already secured, and report that estimate to HealthCare.gov. Update the figure if a major job finishes sooner than expected or gets delayed.
No. Workers' compensation is for work-related injuries, not everyday medical treatment, illnesses or healthcare for your family.
Just tell me your county, who needs coverage and approximately how much profit your business made last year. I'll compare the available choices and their prices. If keeping your existing plan makes more sense, I'll say so.
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