A nationwide PPO is still available to you throughout Virginia, although marketplace PPOs are restricted to a small number of Northern Virginia communities. Here's how local construction business owners and remodelers are reducing what they spend on family coverage.
Hi, I'm Sam Jaber. I specialize exclusively in health insurance and hold a Virginia license. Everything happens by phone, whether you're managing construction in Chesterfield or renovating a home in Virginia Beach.
Building in Virginia means working across several very different markets. Richmond has growing subdivisions, Northern Virginia's established neighborhoods need kitchen renovations and additions, Hampton Roads sees military families coming and going, and the Shenandoah Valley supports custom construction. Wherever your company operates, you're buying your own medical coverage through Virginia's state-operated exchange. Unfortunately, its PPO choices are far more geographically restricted than many builders realize.
Whether your projects are in eastern, western, northern or southern Virginia, I can help you secure a nationwide PPO.
For 2026, Virginia's Insurance Marketplace offers 83 individual medical plans from 8 insurance companies, but only 4 are PPOs. Those PPOs are limited to Alexandria, Arlington, Fairfax City, Falls Church and certain areas of Fairfax, Loudoun and Prince William counties. In communities such as Henrico, Roanoke and Chesapeake, marketplace shoppers instead have HMOs and EPOs. HMOs typically exclude nonemergency care outside their networks, while EPOs generally cover only emergencies outside the network. Even in the areas offering PPOs, the lowest-priced PPO costs 131% more than the least expensive plan using another network type.
Private medical plans that use underwriting offer another route. They provide nationwide PPO networks and calculate premiums based on your health. That allows a healthy Lynchburg contractor to access the same type of coverage available to someone living in Arlington.
Virginia residents sign up through Virginia's Insurance Marketplace, not HealthCare.gov, because the state operates its own exchange. Your annual household income determines the available financial assistance. With Medicaid expansion, adults earning no more than 138% of the federal poverty level may qualify for Medicaid. At higher qualifying incomes, federal premium tax credits reduce marketplace costs. Once income exceeds the credit range, you pay the entire premium.
Virginia also has a reinsurance program authorized through a federal waiver, designed to lower individual-market premiums even for people paying full price. For contractors, the income calculation starts with business profit after materials, subcontractors, vehicles, equipment, permits, bonding and liability insurance.
Marketplace PPOs are available if you live in Arlington, Alexandria, Fairfax City, Falls Church or eligible sections of the three neighboring counties. But availability doesn't automatically make them worthwhile. When the PPO premium is more than twice that of the lowest-priced alternative, healthy families without credits should compare carefully.
I'd compare that marketplace PPO with a medically underwritten nationwide option. The private insurer reviews a health questionnaire and may approve your application, decline it or accept you while excluding a previous medical condition. For someone with a favorable medical history, underwriting can produce a premium below the marketplace PPO's price.
Next step: Tell me where you live and who needs coverage. I'll compare the marketplace PPO, a medically underwritten PPO and the strongest HMO choice side by side.
Many established Virginia builders live outside the limited marketplace PPO service area. If your household earns too much for credits, you're paying full price for a regional HMO or EPO, even though construction projects may regularly send you into Maryland, North Carolina or West Virginia.
If your family is healthy, let's check the cost of a medically underwritten nationwide PPO. Since coverage terms differ by policy, I'll go through the benefits with you before you commit.
Next step: Call with your Virginia county and the ages of your family members. I'll compare a nationwide PPO quote with the marketplace plans available at your address.
If household income exceeds Medicaid eligibility but remains within the premium tax credit range, marketplace coverage almost always has the lower monthly premium. That's because private plans cannot use the federal credit.
For families outside Northern Virginia, marketplace choices consist of locally focused HMOs and EPOs. Those can be practical when your family sees nearby providers. I'll verify that your doctors participate before you enroll.
Contractor earnings can change sharply depending on project closings and retainage payments. If a substantial contract pays sooner than expected, update your marketplace income. Otherwise, excess tax credits may have to be reconciled when you file your return.
Next step: Let's review your latest tax return alongside your signed projects. I'll help you choose a reasonable income estimate and coverage that matches your circumstances.
A difficult construction year can reduce household earnings almost to nothing. Since Virginia expanded Medicaid, families at or below 138% of the poverty level may qualify for coverage rather than remain uninsured.
Keep track of income as construction picks up again. If you cross the Medicaid threshold, report the change and prepare to switch to marketplace coverage. Also, workers' compensation applies to workplace injuries, not ordinary sickness or your child's routine medical visits.
Next step: If your business is having a low-income year, call me. We'll determine whether Medicaid or a marketplace policy is the better choice right now.
Straight answers, no sales pitch.
Only certain Northern Virginia locations offer the 4 marketplace PPOs. But healthy contractors anywhere in Virginia can obtain nationwide PPO coverage privately through me.
No. Enrollment happens through Virginia's Insurance Marketplace, operated by the State Corporation Commission.
Yes. Virginia expanded Medicaid, making adults with household incomes no higher than 138% of the federal poverty level potentially eligible.
No. Workers' compensation handles job-related injuries. Illnesses, preventive appointments and family healthcare require medical insurance.
I'll need your Virginia city or county, the people you're covering and an approximate figure for last year's business profit. Then I'll explain the choices and show you actual prices. If your existing coverage is the best fit, I'll recommend keeping it.
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