You can still get a nationwide PPO in Michigan, and around Grand Rapids that matters, because the marketplace's own PPO costs more than twice what the plans beside it do. Here's how West Michigan builders are handling it.
Hi, I'm Sam Jaber. I'm a licensed health insurance broker based in Tampa, Michigan is one of the states on my license, and all of my client work happens over the phone.
Imagine a builder in Ottawa County, somewhere between Hudsonville and Allendale. Families keep moving out from Grand Rapids looking for a yard, and his crews have spent the last few seasons framing, finishing and punching out houses for them, with some remodels in Kent County filling the gaps. Business is good. Then renewal season comes, he checks HealthCare.gov for a PPO so his family can keep seeing whoever they like, and the price is hard to believe.
Let me start with the answer: you can still get a nationwide PPO in Michigan, and I can get it set up.
Michigan's marketplace does sell PPOs in every county, from a single insurer. In Kent, Ottawa and Muskegon, though, comparing silver plans inside the same county for a 40-year-old before any subsidy, the lowest-priced PPO costs 105% more than the lowest-priced HMO or EPO. That's more than double. Statewide the median gap is 35%, so West Michigan sits at the steep end. Outside the marketplace, private plans that use medical underwriting run on PPO networks across the country, and their price follows your health.
The first is whether your household qualifies for the premium tax credit. HealthCare.gov judges that on net self-employment income for the coverage year: what the business keeps after lumber, trusses, subs, equipment, your builder's license, insurance and the truck. You give an estimate and update it whenever the year moves.
The second is whether everyone at home is healthy. Those two answers point you down one of the paths below. One more piece of context: KFF figures Michigan's benchmark premium climbed about 29.5% for 2026, which lands hardest on people paying full price.
This is the Ottawa County builder. No credit, so he'd pay the whole marketplace premium, and the PPO he wanted costs more than twice what the HMO next to it does.
A medically underwritten nationwide PPO is the plan to price against that. The insurer looks at your answers to a health questionnaire and approves you, declines you, or approves you with one past condition excluded. For a healthy family, that's how the premium can come in under the marketplace's full rate. The network also travels, which helps when a kid plays travel hockey in Ohio or the family spends a week up north. Benefits vary plan to plan, and we'll read them together before you choose.
Next step: Call me with your county and the ages on your plan, and I'll put a nationwide PPO quote next to the West Michigan marketplace prices.
Michigan building slows when the ground freezes. If a thin winter and a few delayed starts pull the household's net into the credit range, the marketplace is usually where you'll find the most affordable coverage, since the credit works nowhere else. In Kent and Ottawa, the HMOs and EPOs are where the credit goes furthest, so the job is picking one that already has your family's doctors.
If the year gets very lean, Michigan expanded Medicaid through the Healthy Michigan Plan, and adults with income up to 138% of the federal poverty level can qualify. When spring starts pick up again, raise your estimate so the credit keeps pace.
Next step: Bring last year's return and your schedule of starts to a call, and we'll set an estimate and choose a plan that fits it.
When a family member sees a specialist regularly or takes a medicine that can't lapse, stay on HealthCare.gov at any income. Its plans can't decline anyone or charge extra for a medical history, which an underwritten plan can. Then the question is network. If that care sits with doctors the HMOs don't include, the marketplace PPO may justify its price for your family. If they're already in an HMO, that's usually the better buy.
Next step: Send me your family's doctors and prescriptions, and I'll check them against the Kent and Ottawa County plans.
Straight answers, no sales pitch.
Yes. For 2026 a medical PPO is sold on HealthCare.gov in all 83 Michigan counties, by one insurer.
I can't tell you how the insurer set its rates, only what the filings show: in Kent, Ottawa and Muskegon the lowest-priced silver PPO costs 105% more than the lowest-priced silver HMO or EPO, before subsidies.
KFF's figures show Michigan's average benchmark premium rose about 29.5% from 2025 to 2026.
Possibly. Michigan's Healthy Michigan Plan covers adults with income up to 138% of the federal poverty level.
Give me your county, who's on your plan and about what the company netted last year. I'll price the West Michigan marketplace and a nationwide PPO side by side and tell you which one I'd buy in your shoes.
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