I can still help you obtain a nationwide PPO in Texas, despite the fact that none are sold on the marketplace. Here's how people operating Texas LLCs, S-corps and smaller businesses are getting coverage for themselves and their households.
Hi, I'm Sam Jaber. I hold broker licenses in 36 states and help Texas business owners find coverage by phone. Whether you're operating an LLC alone, running an S-corp that employs your spouse or managing a small business with several workers, we can go through your options together.
A lot of Texas business owners are surprised when they start shopping for health insurance. They remember having a PPO through a large employer, then search HealthCare.gov and discover there aren't any. Let's go through the plans Texas actually offers, how business owners can receive financial assistance, and what happens when a difficult first year leaves income too low for certain coverage options.
This year, Texas has 834 individual medical plans available through its marketplace. Every one falls into the HMO, EPO or POS category. Not a single marketplace plan is a PPO.
Although HealthCare.gov doesn't sell them in Texas, I can still arrange a nationwide PPO privately. The insurer medically underwrites each applicant by reviewing their health questionnaire, then determines the premium from those answers. Its provider network includes doctors throughout the country. For a business owner with a healthy family, I'd make that the starting point for comparing other coverage.
If your business employs only its owners and their relatives, you'll use individual coverage through HealthCare.gov in Texas. Hiring an employee who has no ownership stake and isn't related to you may make the company eligible for SHOP, the small-business marketplace, where group insurance becomes an option.
On HealthCare.gov, your premium tax credit depends on household income for the year you're insured. If you're a sole proprietor or own a single-member LLC, the starting point is net business profit. For an S-corp owner, the calculation includes the salary paid to you and the business profit passed through to your individual tax return.
Be particularly careful when forecasting income. Beginning with tax year 2026, there's no maximum repayment limit if your business earns more than projected. The government can recover every dollar of advance credit you received beyond your actual eligibility when you file.
Businesses in their early stages, companies reinvesting heavily and owners experiencing low-profit years often qualify for assistance. When that happens, HealthCare.gov is usually the lower-cost route for family coverage because marketplace credits can't be used on private plans.
Check the provider network for every family member's specialists and pediatricians before choosing. Texas marketplace policies are all HMOs, EPOs or POS plans, and the doctors participating in each can differ significantly. If you land a major contract or experience a difficult quarter, adjust your projected profit to reflect that change.
Next step: Have your previous year's business tax return ready, plus your best estimate for the current year. We'll use those figures to find coverage that includes the doctors your family already sees.
When your household doesn't qualify for a credit, every covered person pays the full marketplace premium. You're also still dealing with network restrictions on every plan. That's often when Texas business owners begin looking beyond HealthCare.gov.
For a private nationwide PPO, the insurance company evaluates each applicant's medical answers. It may approve the policy, decline the application or approve it while excluding one identified condition. Healthy households often find that these policies cost less than unsubsidized marketplace coverage, while offering provider access during vacations and business travel. Benefits aren't identical across policies, so I'll carefully review the details with you before you choose.
Next step: Call me, and I'll prepare a nationwide PPO quote for everyone in your family and compare it with the marketplace plans available where you live.
It's common for new business owners to take home very little while their companies get established, but that creates a serious coverage problem in Texas. Keep three figures in mind: Texas Medicaid eligibility for a parent stops at 15% of the federal poverty level, marketplace tax credits generally begin at 100%, and the income range between them offers neither option because Texas didn't expand Medicaid.
During your first year in business, make your income forecast as realistic as possible. Remember that one substantial contract could change your earnings for the entire year.
Next step: Call me before enrolling during that first low-income year, and we'll review what coverage your household may qualify to receive.
Straight answers, no sales pitch.
No. All 834 individual medical plans on Texas HealthCare.gov are HMOs, EPOs or POS policies. I can arrange private nationwide PPO coverage for a family in good health.
You can purchase coverage privately or through HealthCare.gov. SHOP requires at least one employee who isn't related to the owners and doesn't own the business.
If earnings exceed your estimate, you could owe back excess credits. Starting in 2026, repayment has no cap, so keep HealthCare.gov updated whenever business profits change.
In many cases, yes. The self-employed health insurance deduction may apply, but it can't be greater than your business's net profit. Ask your tax preparer to review your particular situation.
Tell me how your company is structured, approximately what it earns in profit, which county you're in and who in the family needs insurance. I'll compare the costs and explain which choice I'd make if I were in your situation.
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