Ohio's marketplace may offer nothing but HMO medical coverage, but that doesn't mean a nationwide PPO is off the table. If you own an AC or heating business here, let me explain how to compare your choices and keep the cost manageable.
Hi, I'm Sam Jaber. I specialize in health insurance, and Ohio is among the 36 states where I hold a license. We handle everything over the phone, even if you're calling between a furnace repair and a condenser replacement.
Running an HVAC business in Ohio means dealing with two busy seasons. The first serious cold spell brings a flood of furnace failures, and heating calls can stay steady until spring. Once summer turns humid, air conditioning becomes the priority. Between those peaks, you're handling installations and maintenance visits. Owners learn to budget around those changes in demand. They also discover that buying health coverage gets more complicated without an employer plan, particularly when Ohio's marketplace offers just one medical plan type.
Ohio residents still have access to nationwide PPO coverage. I can get you a quote for one, even though HealthCare.gov doesn't offer it.
Look at Ohio's 2026 marketplace numbers: 189 individual medical plans, offered by 11 insurers throughout all 88 counties. Every medical plan is an HMO. These plans generally won't pay for nonemergency treatment outside their provider networks. PPOs, by comparison, contribute toward out-of-network doctor visits at a higher cost to you, without requiring referrals. Any PPO you see listed on Ohio's marketplace is dental coverage, not medical insurance.
Another route is private coverage built around nationwide PPO networks. These plans use medical underwriting, meaning your health affects the premium. That's worth putting alongside marketplace coverage if you're a healthy HVAC technician.
Ohio's marketplace doesn't judge your income by how busy January or July happens to be. It considers the entire household's earnings for the year. For a business owner, that means net income after paying for vans, equipment, refrigerant, replacement parts, licenses, insurance and employee wages.
Ohio's Medicaid expansion creates three possible coverage paths based on annual household income. At 138% of the federal poverty level or below, Medicaid may be available. Above that threshold, a marketplace premium tax credit can reduce an HMO's price. Once income exceeds the credit limit, you're responsible for the entire premium.
Maybe the winter stays unusually warm and heating calls never reach their usual volume. Or perhaps you're still building the service contracts for a new shop. If your household ends up earning no more than 138% of the poverty level, Ohio's expanded Medicaid program may cover you. Applications are accepted throughout the year.
Remember to account for business picking up again. If a stretch of freezing weather fills your schedule and pushes income above the eligibility threshold, report that change. You may need to move from Medicaid to marketplace coverage.
Next step: If business has been slow this year, call me. We'll compare your current situation against Ohio Medicaid and HealthCare.gov coverage.
Once your income is above Medicaid eligibility, a subsidized HMO through HealthCare.gov will generally cost less in Ohio. That's because the premium tax credit can't be applied to coverage purchased elsewhere.
Because these plans use local networks, we'll check that your family's hospital and doctors participate before enrolling. Also, don't forget how quickly either busy season can change your earnings. If profits are headed higher, revise your income estimate. Otherwise, you could owe back part of the tax credit when you file.
Next step: Tell me what last year's tax return showed and how many service agreements you have. I'll help estimate this year's income and choose an HMO with you.
Hiring changes which coverage arrangements your company can use. When you're working alone, the individual marketplace is your route. Add at least one employee who isn't a business owner or family member, and you may become eligible for SHOP, the marketplace program for small employers. Contractors you hire as helpers don't satisfy that employee requirement.
We should look at both your company's budget and your family's coverage needs before deciding on SHOP. Providing a plan for your technicians may make sense, but keeping your household on separate coverage may be the better move for now.
Don't confuse workers' compensation with medical insurance. It addresses workplace injuries, such as slipping off a ladder on an icy driveway, rather than providing general health coverage.
Next step: Give me a call before that first employee begins working. We'll figure out a coverage arrangement that makes sense for both your household and the company.
If your heating and cooling business has dependable contracts, your household income may exceed the tax credit limit. That leaves you paying full price for an Ohio HMO. For a healthy household, a nationwide network may be more appealing.
To apply for a medically underwritten nationwide PPO, you'll answer questions about your health. The insurer can accept you, reject the application or approve coverage that excludes a previous condition. A healthy history may qualify you for premiums below the marketplace's full price. We'll review the benefits carefully because they aren't identical across plans.
Next step: Call me and we'll put the price of a nationwide PPO beside the Ohio marketplace HMOs offered where you live.
Straight answers, no sales pitch.
Yes, but you'll need to shop outside the marketplace. Ohio's 189 individual medical marketplace plans for 2026 are all HMOs. If your health qualifies, I can help you get a nationwide PPO.
It's your total annual household income that counts. Should it fall to 138% of the federal poverty level or below, you may become eligible under Ohio's Medicaid expansion. You don't have to wait for an enrollment season to apply.
Yes, potentially. Hiring at least one employee who isn't an owner or family member can make your company eligible for SHOP through the marketplace. Workers classified as 1099 contractors don't meet that requirement.
No. Workers' compensation applies to job-related injuries, not ordinary medical needs. You and your family still need health coverage for sickness and routine appointments.
Start by telling me your county, who needs insurance and approximately how much profit the business made last year after expenses. I'll compare the costs and explain what fits. If staying with your existing plan makes more sense, I'll tell you that too.
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