Ohio's marketplace may be entirely HMO-based, but nationwide PPO coverage is still an option. I'll show plumbers and pipefitters who own their businesses how to compare family coverage and potentially lower their costs.
Hi, I'm Sam Jaber, a health insurance broker licensed in 36 states, including Ohio. I work with every one of my clients by phone.
January keeps Ohio plumbers on their toes. Freezing temperatures burst pipes inside outside walls and crawl spaces, failed sump pumps leave basements underwater, and aging cast-iron and galvanized lines in older city homes create constant repair work. A busy shop owner has enough to manage without figuring out insurance after leaving an employer. And Ohio's marketplace coverage may look quite different from the group plan you had before.
Nationwide PPO insurance is available in Ohio, but you'll need to look beyond HealthCare.gov to find it.
Ohio's 2026 marketplace offers 189 individual medical plans through 11 insurers across all 88 counties. They're exclusively HMOs. Outside-network medical care generally isn't covered by HMOs except for emergencies. PPOs provide some out-of-network coverage at greater patient expense and allow specialist visits without referrals. If you notice PPO listings on HealthCare.gov, those are dental policies. Ohio has no marketplace PPO medical plans.
Private medically underwritten plans provide nationwide PPO networks, with premiums determined by your health. For healthy plumbing families, they can offer coverage similar to the PPO previously provided by an employer.
Because Ohio expanded Medicaid, plumbing families have an additional fallback when earnings decline. There are three income-based possibilities: Medicaid through 138% of the federal poverty level, a HealthCare.gov HMO with premium credits above that threshold, or unsubsidized coverage when income exceeds the credit limits. For a shop owner, count net income after trucks, pipe, fittings, fixtures, licensing, insurance and apprentice wages.
Let's look at what those coverage routes mean for you.
A new plumbing business might earn very little initially, especially when mild winter weather means fewer urgent repairs. If household income stays at or below 138% of the federal poverty level, Ohio's expanded Medicaid may cover you. Applications are accepted throughout the year, not only during open enrollment.
Plan ahead for the income transition. As business picks up and earnings increase, report the change. You may need to move from Medicaid to marketplace insurance.
Next step: If your earnings have fallen, call me. We'll review whether Medicaid or HealthCare.gov coverage makes more sense for your household this year.
Once income exceeds Medicaid eligibility, a HealthCare.gov HMO with premium tax credits is generally Ohio's lowest-cost option. Those credits can't be applied to coverage purchased outside the marketplace.
Because HMO networks are generally local, I'll verify that your regular doctor, your children's pediatrician and the closest hospital are included. We'll also review your income projection. A severe freeze can bring a rush of plumbing emergencies and increase your earnings. If you ultimately make more than you reported, you could have to repay part of your premium credit when you file taxes.
Next step: Let's review your previous year's business figures on a quick phone call. I'll help you choose a reasonable income projection and an HMO that fits.
Owners of plumbing businesses with several trucks often earn too much for marketplace credits. That means paying full price for an HMO on HealthCare.gov, while a healthy household might prefer coverage offering greater provider flexibility.
I'd compare a medically underwritten nationwide PPO. The insurer reviews your health questionnaire before approving coverage, declining it, or accepting you with a previous condition excluded. Healthy applicants may receive premiums lower than full-price marketplace coverage. Since benefits differ, we'll examine each plan's terms together before you commit.
Next step: Call me for a nationwide PPO quote for your family. I'll compare it directly with the HMOs offered in your Ohio county.
Straight answers, no sales pitch.
No medical PPOs are offered. Ohio's 2026 marketplace has 189 individual medical plans, all HMOs. Healthy applicants can still obtain private nationwide PPO coverage.
Yes, if earnings are low enough. Ohio's expanded Medicaid covers adults at up to 138% of the federal poverty level, with applications accepted year-round.
Ohio begins its state income tax calculation using federal adjusted gross income, which already accounts for the self-employed health insurance deduction. Ask your tax preparer how that deduction affects your particular return.
Workers' compensation only addresses work-related injuries. A separate health insurance policy is needed for sickness, routine medical care and family coverage.
Tell me your county in Ohio, who needs coverage and approximately what the business earned after expenses last year. I'll compare prices and explain what makes sense. If the insurance you already carry is doing its job, I'll recommend staying with it.
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