Texas still has nationwide PPO options, even though HealthCare.gov doesn't sell any medical PPOs in the state. Here's how plumbing business owners and pipefitters compare coverage to spend less on their families.
Hi, I'm Sam Jaber. I'm a health insurance broker licensed in Texas and 36 states altogether. We handle everything by phone, whether you're between slab leak repairs or water heater installations.
Plumbing work stays busy across Texas. Shifting clay beneath slabs can crack pipes, freezing temperatures can cause widespread breaks overnight, and neighborhoods keep expanding around Houston, Dallas, Austin and San Antonio. That demand leads plenty of plumbers to start their own businesses. But leaving an employer means giving up the company health plan, and the choices on Texas's marketplace can be surprising once they start shopping.
Nationwide PPO coverage remains available in Texas, just not through HealthCare.gov.
Texas lists 834 individual medical plans on its 2026 marketplace, with not a single PPO among them. Instead, you'll see HMOs, POS plans and EPOs. HMOs usually restrict nonemergency coverage to their network, while EPOs generally cover outside-network care only for emergencies. PPOs help pay for other outside-network doctors, though you pay more, and referrals aren't needed. You may notice dental PPOs on HealthCare.gov, but those aren't medical PPO plans.
One alternative is private coverage that uses medical underwriting. These plans offer nationwide PPO networks, with premiums based on your health rather than marketplace pricing. That can make them less expensive for healthy plumbers and their families.
HealthCare.gov provides Texas marketplace assistance through premium tax credits based on annual household income. If you own a plumbing shop, the relevant figure is net self-employment income. Take your revenue and subtract expenses such as the truck, pipes, fittings, fixtures, state licensing, insurance and helper wages. Even with plenty of invoices coming in, your actual profit might still qualify for help.
Watch the enrollment dates too. HealthCare.gov opens November 1 and closes January 15. To begin coverage January 1, you must enroll by December 15. At other times, you'll generally need a qualifying event, such as losing your previous insurance.
Here's what that means in practice.
When your household qualifies for a premium tax credit, HealthCare.gov generally offers the lowest-cost coverage. Plans purchased elsewhere can't receive that credit.
Your marketplace options will be local-network HMOs, POS plans and EPOs. Those can serve a family well when most care happens nearby. Before enrolling, though, verify that your pediatrician, primary doctor and closest hospital participate in the network.
A plumber's income can change quickly, especially when a major freeze brings emergency calls across the city. If earnings rise beyond your original projection, update HealthCare.gov. Otherwise, you may have to repay some premium credits at tax time.
Next step: Bring your latest tax return and let's review the figures together. We'll estimate your income realistically and find coverage that matches.
Once a plumbing business has several trucks operating, the owner's household may earn too much for marketplace credits. That means paying full HealthCare.gov premiums without even having a PPO option there.
If everyone is healthy, I'd price a medically underwritten nationwide PPO. The application asks about your medical history, and the company may approve coverage, reject it, or approve it with a previous condition excluded. That health screening can help healthy families pay less than HealthCare.gov's full premiums. It also makes reviewing each policy's benefits with me especially important.
Next step: Give me a call. I'll compare a nationwide PPO quote for your household with the HealthCare.gov plans offered in your Texas county.
Leaving an employer and losing its health plan usually creates a 60-day special enrollment period through HealthCare.gov, regardless of the season. Be careful with COBRA, though. Voluntarily ending it early doesn't create another enrollment opportunity, while COBRA reaching its scheduled expiration does.
A plumbing shop may bring in very little during its first year, and Texas offers limited assistance when that happens. The state hasn't expanded Medicaid. Texas Medicaid eligibility for parents reaches only 15% of the federal poverty level, while adults without children who aren't disabled generally don't qualify at all. Marketplace premium credits typically begin at the poverty threshold. So when a new business produces extremely low household income, you can end up without help from either program.
Don't confuse workers' comp with family health insurance. It covers injuries from your job, not your child's earache or the flu.
Next step: Call me before you leave the company's payroll. We'll coordinate your new coverage so it starts when your employer plan ends.
Straight answers, no sales pitch.
No medical PPOs are offered. Texas's 834 marketplace individual medical plans for 2026 consist of HMOs, POS plans and EPOs. Healthy applicants can still obtain private nationwide PPO coverage.
HealthCare.gov enrollment is November 1 through January 15. Apply by December 15 to start January 1. Losing existing coverage typically provides a separate 60-day enrollment opportunity.
Often, yes, federally. Your self-employed deduction is limited to the shop's net earnings, and you can't claim it for months when subsidized employer coverage was available to you, including through your spouse. Ask your tax preparer to calculate the amount.
Proceed carefully. Texas hasn't expanded Medicaid, while marketplace tax credits generally require income at least at the poverty level. An almost profitless first year can leave you between both programs. Call me before enrolling.
Start by telling me your Texas location, who needs insurance, and approximately what the business profited last year. I'll compare prices and recommend a suitable plan, even if that means sticking with your current coverage.
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