Georgia plumbers still have nationwide PPO choices, including areas where Georgia Access offers only HMOs. Here's how plumbing and pipefitting business owners can lower their family's insurance costs.
Hi, I'm Sam Jaber. I'm licensed to broker health insurance in Georgia, and everything happens by phone. You can reach me from your truck between replacing a water heater and fixing a sewer line.
There's no shortage of plumbing work in Georgia. Older Atlanta neighborhoods need aging pipes replaced, suburban construction keeps expanding, and Savannah's coastal growth brings more jobs. Summer storms also expose plumbing problems in crawl spaces. Plumbers who build their own businesses leave employer group insurance behind, and Georgia's replacement options vary significantly by county.
Georgia Access might not offer a PPO where you live, but nationwide PPO insurance is still available through me in Georgia.
Georgia's 2026 marketplace includes 211 individual medical plans, with 203 HMOs and only 8 PPOs. One company supplies those PPOs across 71 counties, excluding Fulton, DeKalb, Cobb, Gwinnett, Clayton and Chatham, where Savannah is located. Marketplace shoppers in those counties have HMO choices only, generally without nonemergency out-of-network benefits. PPO coverage, by contrast, contributes toward outside-network care at greater personal expense and doesn't require referrals.
Private nationwide PPO coverage uses medical underwriting, meaning premiums depend on your health. For plumbers in good health, these plans can provide better value.
Georgia Access is where you apply for marketplace coverage. Eligibility depends on projected annual household income. Plumbing shop owners use net profit after paying for trucks, piping, fittings, fixtures, licenses, insurance and helper wages.
Georgia hasn't adopted full Medicaid expansion. Its Georgia Pathways program covers eligible adults earning up to 100% of the federal poverty level who satisfy work, education or volunteer-hour requirements. Marketplace tax credits generally begin at the poverty threshold and reduce premiums until household income exceeds the upper limit.
Once your employer's group coverage ends, Georgia Access will generally offer a special enrollment period. Georgia also has a state continuation provision that can temporarily extend the company's group insurance. It lasts through the remainder of the month when your coverage would otherwise stop, followed by three additional months. That gives you some breathing room to arrange replacement insurance, but it isn't designed to carry you indefinitely. I'd use that temporary extension to prevent a lapse while choosing the coverage you'll keep longer term.
You'll still need replacement coverage. Consider Georgia Access plans and, if you're healthy, a medically underwritten PPO. A newly opened shop might have very low earnings, creating a Georgia eligibility problem: marketplace credits generally don't apply below the poverty line, while Pathways requires qualifying hours. Estimate income with care.
Next step: Call before your final day at the plumbing company. We'll plan your temporary coverage and the insurance that follows.
If your household falls between the poverty threshold and the upper credit limit, subsidized Georgia Access coverage will almost always cost less monthly than private insurance.
Families around metro Atlanta and Savannah will have HMO marketplace choices. That can work well when your doctors are local. I'll confirm they're in the network.
Extra summer jobs repairing burst pipes and flooded crawl spaces can raise your annual earnings beyond the amount reported. Revise your estimate so you don't face a tax credit repayment.
Next step: Bring me your previous tax return. We'll calculate an income estimate and select Georgia Access coverage that makes sense.
Owning a busy plumbing shop with multiple trucks can put your family above subsidy eligibility. In Chatham and Atlanta's central counties, even full-price marketplace coverage is limited to HMOs.
If everyone in your family is healthy, I'd compare a medically underwritten nationwide PPO. The insurer evaluates your medical answers and can approve coverage, deny the application, or issue a policy excluding one previous condition. That health screening can result in premiums below the marketplace's full price. Since benefits vary, we'll examine each plan together before making a decision.
Workers' compensation, when you have it, addresses injuries suffered while working. It doesn't cover your family's illnesses the way health insurance does.
Next step: Share your county and the ages of everyone needing insurance. I'll quote nationwide PPO coverage against the Georgia Access plans available locally.
Straight answers, no sales pitch.
Availability depends on the county. Georgia's 8 marketplace PPOs for 2026 exclude Fulton, DeKalb, Cobb, Gwinnett, Clayton and Chatham. Healthy plumbers throughout Georgia can still consider private nationwide PPO coverage.
Under O.C.G.A. 33-24-21.1, Georgia continuation coverage extends through the remainder of the ending month and three additional months. Larger employers may instead fall under federal COBRA.
Georgia Pathways is the route for eligible adults earning no more than 100% of the federal poverty level and satisfying its hours requirement. The state hasn't implemented full Medicaid expansion.
No. Starting with plan year 2025, Georgia residents use Georgia Access, their state-operated marketplace, rather than HealthCare.gov.
Tell me your Georgia county, everyone needing coverage and approximately what your shop profited last year. I'll show you the costs for the route that fits, and I'll say so if your existing coverage is the better value.
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