You can still get a nationwide PPO in North Carolina, including in the Triangle counties where HealthCare.gov doesn't sell one. Here's how electricians wiring the Raleigh and Durham area are choosing coverage.
Hi, I'm Sam, a health insurance broker based in Tampa. My license list runs to 36 states with North Carolina among them, and I handle everything by phone, which works fine when you're calling from a crawlspace.
Say you're an electrician who lives in Clayton and spends the week wiring townhomes in Wake County, a lab upfit in Durham, and the odd panel swap in Garner. A few years ago you were a journeyman for a big shop. Now the license is yours, the van is yours, and so is the job of finding a health plan. You go looking for a PPO, because you like the idea of seeing any doctor you want, and HealthCare.gov doesn't show you one.
You aren't imagining it, and it isn't the end of the road: you can still get a nationwide PPO in North Carolina, and I set them up for Triangle households.
For 2026, the marketplace sells a medical PPO in 90 of the state's 100 counties. Wake, Durham, Orange, Johnston and Chatham are among the ten where it doesn't. In Wake and Johnston you'll find 35 HMOs and 9 EPOs from 4 insurers, and in Durham, 22 HMOs and 9 EPOs from 3. An HMO generally won't pay for care outside its network unless it's an emergency, and an EPO works the same way. A PPO pays outside its network too, at a higher cost to you, without a referral. Private plans that use medical underwriting are where the nationwide version lives.
The fork in the road is the premium tax credit. If your household qualifies, a marketplace plan is usually the most affordable thing you can buy, PPO or not. If you earn past the credit range, you pay the marketplace's full rate, and that's when other plans earn a look.
The figure HealthCare.gov wants is your net self-employment income: what the business keeps after wire, breakers, the van, permits, your liability policy and any helper you pay. It's an estimate for the coverage year, and you're expected to update it as soon as it moves.
Once a couple of crews are running and your household clears the credit range, you're paying full freight for a plan with no out-of-network coverage. For a healthy family, a medically underwritten nationwide PPO is the comparison to make. You answer a health questionnaire, and the insurer can accept you, turn you down, or accept you with a particular past condition excluded. If your answers are clean, the premium can come in under the marketplace's full rate, and the network goes wherever you do, whether that's a kid's college in another state or a job site in Virginia. Benefits differ from plan to plan, so we'll go through them line by line.
Next step: Call me with your zip code and the ages on your plan, and I'll quote a nationwide PPO next to the Triangle marketplace plans.
Losing the health plan that came with your job can open a special enrollment period, so you can pick a marketplace plan without waiting for the fall. If the old shop offers COBRA, don't drop it early by choice, because that alone won't open a new window. An underwritten plan needs time for its review, so start that conversation a few weeks before your last day. Workers' comp, which you'll be pricing at the same time, pays for injuries on the job and nothing else.
Next step: Call me before you give notice and we'll have coverage lined up for the day the old plan ends.
If anyone on your plan needs regular specialist care or a prescription that can't lapse, keep the family on HealthCare.gov regardless of income. Its plans can't refuse you or price you on your health. In the Triangle that means choosing among HMOs and EPOs, so the network check carries extra weight: make sure every specialist, and the hospital you'd want, is in it.
Next step: Give me the names of your doctors and medications, and I'll find the Triangle plans that keep them.
Straight answers, no sales pitch.
Not a medical PPO for 2026. Wake County's marketplace plans are HMOs and EPOs. A healthy household can still get a nationwide PPO outside the marketplace.
For 2026: Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person and Wake.
Your expected net self-employment income for the coverage year, meaning profit after business costs. Update it when the year changes.
Not if your doctors are in it and the credit makes it affordable. The HMO's limit is care outside its network, which usually isn't covered unless it's an emergency.
Your county, who needs coverage and a rough figure for what the business netted are enough to start. I'll show you the marketplace options there next to a nationwide PPO, with prices, and tell you straight which one I'd pick.
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