Georgia's marketplace may offer only HMOs where you live, but a nationwide PPO is still available. Here's how self-employed AC and heating contractors across Georgia are finding coverage that fits their budgets.
Hi, I'm Sam Jaber. Health insurance is the focus of my business, and I'm licensed to help clients in Georgia. We handle everything over the phone, so you don't have to leave a rooftop job in July to deal with insurance.
Summer keeps Georgia HVAC technicians busy. The heat and humidity arrive early, stick around late, and when an air conditioner breaks during an Atlanta August, the people living in that house need help quickly. Winter doesn't last long, but furnaces and heat pumps still need attention. With that much demand, experienced technicians often decide to open their own businesses. The challenge is that their former employer's health coverage doesn't come with them. And in Georgia, the marketplace options they'll find can change considerably from one county to another.
A nationwide PPO is still within reach in Georgia, including its largest metro area. I can help you get that coverage.
For 2026, Georgia Access, Georgia's state marketplace, lists 211 individual medical plans. Just 8 are PPOs, all offered by one insurer across 71 counties. Fulton, DeKalb, Cobb, Gwinnett, Clayton and Chatham aren't included. That leaves HVAC owners in central Atlanta and Savannah with HMO coverage as their only marketplace choice. With an HMO, care outside the network generally isn't covered unless it's an emergency. A PPO gives you coverage for out-of-network doctors at a higher cost to you, and you can see specialists without getting referrals.
If you're in good health, it's worth looking at private nationwide PPO coverage. These plans use medical underwriting to determine your price and provide access to PPO networks across the country.
Georgia Access bases your eligibility on annual household income rather than whichever month brought in the most work. If you own an HVAC business, that means the profit remaining after paying for your van, condensers, parts, refrigerant, tools, licenses, insurance and technician wages.
Georgia's income rules create a few different situations. Federal premium tax credits generally become available at the poverty level and help most qualifying small business households reduce marketplace premiums. Once income exceeds the eligible range, those discounts disappear. Georgia also chose not to expand Medicaid, so most adults below the poverty level must look to Georgia Pathways. That program requires qualifying hours spent working, studying or volunteering.
If you're running a single-truck AC operation, this is probably where you'll find yourself. When you qualify for the federal premium tax credit, Georgia Access coverage is almost always more affordable than a private policy because that financial help is available only through the marketplace.
For families around Atlanta and Savannah, your marketplace choice will be an HMO. That can work well when your doctors are local, and I'll help confirm they're included in the network.
When the summer workload stretches into October, your actual earnings might exceed what you originally projected. Let Georgia Access know as soon as that becomes clear so you don't face repayment of excess premium credits at tax time.
Next step: Let's review your previous tax return and maintenance contracts over the phone. From there, we can work out a reasonable income projection and choose a Georgia Access plan.
Once an AC business expands to several trucks, the owner's family often earns too much for premium credits. That means paying the entire marketplace premium, and in metro Atlanta or Savannah, the available coverage is limited to HMOs.
For households in good health, I'd also get a quote for a nationwide PPO that uses medical underwriting. You'll answer questions about your health, and the insurer can accept the application, reject it, or offer coverage excluding one condition. A favorable health history may bring the premium below what you'd pay at full marketplace rates. Since benefits aren't identical across policies, I'll review the details with you before you decide.
Next step: Give me your Georgia county and the ages of everyone needing coverage. I'll compare nationwide PPO pricing with the Georgia Access plans offered where you live.
Maybe your first year brought few maintenance accounts, or a cooler summer left you with less work than expected. When household earnings are very low, Georgia's rules can make coverage difficult. The state didn't expand Medicaid, leaving Pathways and its required participation hours as the main low-income route. Marketplace tax credits generally start at the poverty level. If you don't meet either program's requirements, assistance may not be available.
If your income may be that low, be careful with your estimate and when you enroll.
One important distinction: workers' compensation, when you have it, addresses injuries that happen at work, including ladder accidents and burns. It doesn't replace medical insurance for illnesses or your family's healthcare.
Next step: Before signing up during a slow business year, give me a call. We'll review what you're eligible for and choose the strongest available fit.
Straight answers, no sales pitch.
Georgia Access doesn't offer marketplace PPO coverage in Fulton, DeKalb, Cobb, Gwinnett or Clayton in 2026. But if you're a healthy HVAC contractor, I can help you obtain a nationwide PPO outside the marketplace anywhere in Georgia.
You may still qualify. Premium credits are calculated using your household's annual business profit after expenses, not simply the amount your company brings in.
This needs a closer look. Because Georgia didn't expand Medicaid, Pathways is the primary low-income option for adults earning up to 100% of the poverty level, provided they meet the required work, education or volunteer hours. Call me before choosing coverage.
No. Beginning with the 2025 plan year, Georgia residents have used Georgia Access, their state-operated marketplace, to enroll.
Tell me which county you're in, who needs insurance, and roughly how much profit your business brought in last year after expenses. I'll walk you through actual prices, help you find a good fit, and be upfront if you're better off staying with your current coverage.
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