Michigan still offers nationwide PPO insurance, and the Upper Peninsula's marketplace PPO is reasonably priced compared with its HMOs. Here's how UP plumbing contractors can decide between the two.
Hi, I'm Sam Jaber. I focus solely on health insurance, I'm licensed in Michigan, and we can do everything by phone. That's a lot easier than traveling to an office during a UP snowstorm.
Imagine operating a plumbing business from Marquette, with calls taking you through Ishpeming and into the Keweenaw. Winter brings plenty of work: service lines freeze, pipes burst inside camps that weren't drained, and boilers break down during February's worst cold. Once summer arrives, the schedule shifts toward renovations, new construction and cottages along Lake Superior. It's a business that can earn well, but the weather has a big say in how the year turns out. That makes it important to choose health insurance based on your family's needs and the shop's changing income.
Let me make this clear from the start: nationwide PPO coverage is available in Michigan, and I can arrange it for families in the UP.
Unlike some areas, the UP marketplace offers a reasonably priced PPO choice. Marquette, Houghton, Keweenaw, Baraga and Alger each have 8 HMOs and 8 PPOs listed on HealthCare.gov for 2026 through 2 insurers. Comparing unsubsidized silver plans for a 40-year-old within each county, the least expensive PPO costs 19% more than the least expensive HMO. Michigan's statewide median difference is 35%, making the UP comparison more favorable. HMOs generally cover outside-network treatment only for emergencies, whereas PPOs contribute toward those visits without requiring referrals, although your costs are higher.
Your premium tax credit depends on the plumbing shop's net self-employment earnings for the coverage year. That's what remains after expenses including the truck, pipes, fittings, thawing equipment, tools, licensing and insurance. Provide an income projection when enrolling and revise it as the year develops.
You can't know in November exactly what a UP winter will bring. If January turns bitterly cold for weeks, frozen-pipe work might push your income well above the original projection. Increase your estimate once that becomes apparent, allowing your remaining monthly credit to decrease instead of facing the adjustment at tax time.
When you qualify for a credit, begin with HealthCare.gov because that assistance generally makes marketplace coverage the more affordable choice. In the UP, you're deciding among 8 HMOs and 8 PPOs. If your household needs physicians both locally and downstate, or wants greater flexibility, consider whether paying 19% more before credits for a PPO is worthwhile. If all your doctors participate in an HMO, choosing it may save money.
Next step: Share your previous year's return and the doctors your family uses. I'll calculate UP HMO and PPO premiums after applying your credit.
Several profitable winters can move a two-truck plumbing business beyond the income range for tax credits. Marketplace premiums then become full price. For healthy households, I'd also quote a medically underwritten nationwide PPO. The insurer reviews your medical questionnaire and may approve coverage, reject the application, or accept you while excluding one past condition. Good health can bring the price below unsubsidized marketplace premiums. Its network also extends to Green Bay when you're buying parts and to lower Michigan when visiting relatives. Plan benefits aren't identical, so I'll explain each one before you choose.
Next step: Call me with your county and everyone's birth year. I'll compare a nationwide PPO quote with the marketplace coverage offered in the UP.
A mild winter may leave your plumbing business with unusually low earnings. If household income falls to 138% of the federal poverty level or less, Michigan's Medicaid expansion, the Healthy Michigan Plan, may be available. Workers' comp covers injuries that happen at work, but not ordinary illnesses.
Next step: If you're facing a year like that, phone me and we'll work through your coverage choices.
Straight answers, no sales pitch.
Yes. Marquette County lists 8 HMOs and 8 PPOs through its marketplace for 2026.
For an unsubsidized 40-year-old buying silver in Marquette, Houghton, Keweenaw, Baraga or Alger, the least expensive PPO is 19% above the least expensive HMO.
Yes. When a surge of frozen-pipe calls shows your annual earnings will exceed the projection, revise your income estimate.
A financially slow year may make you eligible. Michigan's Medicaid expansion, the Healthy Michigan Plan, covers qualifying adults up to 138% of the federal poverty level.
Tell me your county, everyone needing coverage and the shop's profit last year. I'll compare UP marketplace premiums with a nationwide PPO so we can make a decision before winter work takes over.
The guide for every state, and other work I help with