Nationwide PPO coverage is still available throughout Virginia, whether you're in Norfolk or Bristol. Here's how plumbers and pipefitters who left employers to start their own businesses can cover their households for less.
Hi, I'm Sam Jaber. I specialize in health insurance, hold a Virginia license, and work with clients entirely by phone.
Virginia plumbing work takes different forms depending on where you live. Around Hampton Roads, Navy facilities and shipyards create demand for pipefitters. Elsewhere, plumbers handle water heaters, older-home repiping, January freeze damage in mountain communities and expanding neighborhoods near Richmond and the northern suburbs. Eventually, many leave their employers to take contracts or run their own shops. Their group insurance ends with that move, and marketplace choices differ considerably between Norfolk and Arlington.
No matter where your Virginia plumbing business operates, I can help you get nationwide PPO coverage.
For 2026, Virginia's Insurance Marketplace lists 83 individual medical plans, but just 4 PPOs. Those PPOs are available in Alexandria, Arlington, Fairfax City and Falls Church, plus portions of Fairfax, Loudoun and Prince William. If you live in Suffolk, Lynchburg or Abingdon, your marketplace choices are HMOs and EPOs. Both generally restrict nonemergency benefits to network providers. PPOs also help pay for outside-network doctors, although your costs are higher, and they don't require referrals.
Medically underwritten private plans provide another option. Their PPO networks extend nationwide, and premiums are based on your medical history rather than marketplace rates.
Virginia uses Virginia's Insurance Marketplace instead of HealthCare.gov. Your projected household income, based on business profit when you're self-employed, determines which of three coverage routes makes sense. Because Virginia expanded Medicaid, adults earning up to 138% of the federal poverty level can qualify. Above that, federal premium tax credits can reduce marketplace costs. Beyond the credit limit, premiums are full price, although Virginia's federally approved reinsurance program aims to keep individual rates below what they'd otherwise be.
If you own the plumbing shop, calculate profit by subtracting truck costs, pipes, fittings, fixtures, licensing, insurance and helper wages from revenue.
Losing employer health coverage usually gives you 60 days to enroll through a marketplace special enrollment period. For smaller employers outside federal COBRA requirements, Virginia may offer another solution. Under Virginia Code 38.2-3541, someone covered continuously by the group policy for three months may keep it for 12 months. That can preserve your existing insurance while you establish the business.
Before choosing, compare that continuation coverage with marketplace prices and, if you're healthy, a medically underwritten PPO.
Next step: Call while your employer coverage is still active. We'll compare continuation and replacement plans before the enrollment deadlines arrive.
If your income is above Medicaid eligibility but within the tax credit range, a subsidized marketplace plan will generally cost the least. Federal credits can't reduce private plan premiums.
For most of Virginia outside the northern region, you'll choose a regional-network HMO or EPO. Those often work well when your family sees local providers. I'll check your doctors before we decide.
One month of frozen pipes and basement flooding can increase your income significantly. If you start earning more than projected, revise the estimate to avoid repaying tax credits when filing.
Next step: Bring last year's tax documents and let's go over them. We'll develop a reasonable income projection and match it to coverage.
Several busy plumbing trucks or consistent shipyard contracts can move household income beyond the tax credit limit. Across most of Virginia, that leaves you paying full marketplace premiums for an HMO or EPO.
If your household is healthy, let's compare a medically underwritten nationwide PPO. You'll complete medical questions, and the insurer can approve coverage, reject the application, or exclude a particular previous condition. Healthy applicants may qualify for premiums below full marketplace prices. I'll review the benefits and limitations of each policy with you.
Next step: Call me with your Virginia county and everyone's age. I'll compare nationwide PPO rates with the marketplace plans available locally.
A slow winter or newly opened plumbing shop can mean very low household earnings. Virginia's Medicaid expansion allows households at or below 138% of the poverty level to qualify, so a difficult income year doesn't automatically mean going uninsured.
While you're growing the shop, remember that workers' comp handles job-related accidents. Regular medical needs, such as your children's checkups or a sinus infection, require health coverage.
Next step: If your income has fallen, call me. We'll compare Medicaid eligibility with marketplace coverage to see what fits right now.
Straight answers, no sales pitch.
Only certain Northern Virginia areas offer marketplace PPOs, with 4 available for 2026. Healthy plumbers throughout Virginia can still purchase private nationwide PPO coverage.
Possibly. When federal COBRA doesn't apply to the group, Virginia Code 38.2-3541 may allow someone insured continuously for three months to extend coverage for 12 months.
No. Enrollment happens through Virginia's Insurance Marketplace, which the State Corporation Commission operates.
Virginia has expanded Medicaid. Adults whose household income doesn't exceed 138% of the federal poverty level may be eligible.
Tell me your Virginia county or city, who needs coverage, and approximately what your shop profited last year. I'll compare suitable options and their prices, including whether keeping your current insurance makes more sense.
The guide for every state, and other work I help with