You can still get a nationwide PPO in North Carolina, even where the marketplace version is priced well above everything next to it. Here's how builders working the growth around Charlotte are sorting out coverage.
Hi, I'm Sam Jaber, a licensed health insurance broker working out of Tampa. North Carolina is one of the states I'm licensed in, and every client conversation I have happens on the phone.
Picture a builder who lives in Union County and puts up houses in the neighborhoods spreading out from Charlotte: Waxhaw, Indian Trail, and over toward Concord. Two or three spec homes a year, a few custom builds, a framing crew he's trusted for a decade. The company does fine. Then he logs in to HealthCare.gov to price a PPO for his wife and kids, and the number stops him cold. That's the situation this page walks through, one step at a time.
The short version: you can still get a nationwide PPO in North Carolina, and I can arrange it for you.
The marketplace does sell a PPO in his county. The trouble is the price. For 2026, comparing silver plans inside the same county for a 40-year-old before any subsidy, the lowest-priced marketplace PPO in Mecklenburg, Cabarrus and Union runs 54% above the lowest-priced plan of any other network type. Only one insurer sells it. Outside the marketplace, medically underwritten private plans are built on PPO networks that reach across the country, and they're priced on your health instead.
Before we look at a single plan, I'd ask him one thing: does the household's income qualify for the premium tax credit on HealthCare.gov?
For a builder, that answer comes from net self-employment income, meaning what's left once lumber, subs, the truck, permits, the builder's risk policy and the rest are paid. You estimate it for the year you're buying coverage and update it as soon as the year changes direction. A closing that slips from December into January can swing that figure a long way, so the estimate deserves real attention.
This is our Union County builder. He's past the credit range, so whatever he picks on HealthCare.gov, he pays every dollar of it, and the PPO he wanted sits well above the HMOs and EPOs on the same screen.
A private plan priced on his family's health is the next place to look. The application asks medical questions, and the insurer approves you, declines you, or approves you with one past condition carved out. Clean answers are what can bring the premium under the marketplace's full rate. The network also follows his family to the beach, to a cabin in the mountains, or to a job he bids across the line in South Carolina. Each plan writes its own benefits, so we read them together before he signs anything.
Next step: Call me with your county and everyone's ages, and I'll put a nationwide PPO quote beside the Charlotte-area marketplace prices.
Spec building has lean stretches. If two houses sit unsold through the winter and the household's net drops into the credit range, the marketplace usually becomes the most affordable place to be, because the credit can't be used anywhere else. Around Charlotte the HMOs and EPOs are where that credit stretches furthest, so the real work is finding one whose network already has your family's doctors.
If the year falls further than that, North Carolina expanded Medicaid on December 1, 2023, covering adults 19 through 64 with income up to 138% of the federal poverty line. And keep the estimate honest in both directions: when a house finally closes and the money lands, update it.
Next step: Bring last year's return and your closing schedule to a call, and we'll settle on an income figure and a plan that matches it.
If your wife sees a specialist every few months, or a child needs a daily medication, stay on HealthCare.gov even at full price. Marketplace plans have to take everyone and can't charge more for a health history, and that's a protection an underwritten plan doesn't give you. If seeing doctors outside the network matters for that care, the marketplace PPO may be worth its premium for your family. If it doesn't, an HMO or EPO that already includes your doctors usually costs less.
Next step: Send me the doctors and prescriptions that matter most, and I'll check which Charlotte-area marketplace plans cover them.
Straight answers, no sales pitch.
Yes, in most of the state. For 2026 a marketplace medical PPO is sold in 90 of North Carolina's 100 counties, and one insurer offers it.
In Mecklenburg, Cabarrus and Union, the lowest-priced silver PPO costs 54% more than the lowest-priced silver plan of another network type, for a 40-year-old before subsidies.
Net self-employment income for the coverage year, which is the profit after business expenses. Update it whenever the year changes.
Often, yes. A medically underwritten plan on a nationwide PPO network is priced on your health, and I can quote one next to the marketplace plans.
Send me your home county, the people on your plan and roughly what the company cleared last year. I'll come back with real prices for the marketplace and a nationwide PPO, plus an honest read on which one fits.
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