You can still get a nationwide PPO in Texas, even though the Texas marketplace doesn't sell a single PPO medical plan. Here's how general contractors, builders and remodelers here are covering their families for less.
Hi, I'm Sam Jaber, a licensed health insurance broker. I'm based in Tampa, I'm licensed in 36 states including Texas, and I do my work over the phone, which is handy when your office is a pickup parked at a slab in Katy or a framing job outside Austin.
Texas keeps builders busy. The metros keep spreading, remodels never stop, and hail and Gulf storms bring their own wave of repair work. What the state doesn't hand a contractor is an easy health plan. Once you're running your own firm, coverage is yours to buy, and the Texas marketplace has a gap most people don't notice until they go looking for a PPO.
Let me start with the headline: you can still get a nationwide PPO in Texas through me, even though the Texas marketplace sells none.
That second part surprises people. For 2026, the Texas marketplace on HealthCare.gov lists 834 individual medical plans across all 254 counties, and not one is a PPO. The lineup is HMOs, POS plans and EPOs. HMOs generally don't pay for care outside their network unless it's an emergency, and EPOs pay out of network only in an emergency. A PPO is the type that covers doctors outside the network, at a higher cost, without a referral. (You may see PPO dental plans on the marketplace. I'm talking about medical coverage.)
Outside the marketplace, private plans with medical underwriting are built on PPO networks that reach across the country. They price you on your health, so a healthy builder can often get one for less than you'd expect.
Texans buy marketplace coverage on HealthCare.gov, and the help it offers is a premium tax credit based on your household income for the year. For a contractor, that's the net, after lumber, concrete, subs, trucks, trailers, permits, insurance and bonding. A firm that books a lot of work can still net an amount that qualifies.
Where your household lands against the credit range decides most of what follows. Find your situation.
If the company's net puts your household inside the credit range, HealthCare.gov is usually the most affordable way to cover your family in Texas, because the credit can't be used on any plan sold outside it.
The trade-off is the network. Every plan you'll see there is an HMO, POS or EPO, built around doctors in your area. That's often fine for a family that gets its care close to home. Before you pick one, we'll make sure your pediatrician, your doctor and the hospital you'd actually use are inside it.
And get the estimate right. Draws, deposits and retainage make a builder's year hard to predict. When a big job closes ahead of schedule and HealthCare.gov never hears about it, the extra credit you received gets settled against your tax return.
Next step: Get me your most recent return plus what's signed for this year, and together we'll pin down a realistic income number and the Texas plan to match.
Established builders usually land above the credit range. That means full price on HealthCare.gov, and no PPO there at any price.
This is where an underwritten nationwide PPO makes sense. You answer health questions on the application, and the insurer can approve you, decline you, or approve you with a past condition left out. That screening is why a healthy family can often pay less than the marketplace's full rate. The network goes nationwide, which matters if you bid jobs in Oklahoma or Louisiana, or your kids are in college out of state.
Each plan sets its own benefits, so we read what a plan really pays before you choose it.
Next step: Call me and I'll price an underwritten PPO for your household and put it next to the Texas marketplace plans in your county.
If you or someone you cover sees a specialist regularly or depends on a daily prescription, the marketplace is usually still your home, even without the credit. A marketplace plan can't turn you down or charge more because of your health. An underwritten plan can.
In Texas, the choice is among HMO, POS and EPO plans, so the work is finding the one whose network includes your specialists and whose drug list covers your prescriptions. We'll go through your doctors by name.
Next step: Give me your doctors and medications and I'll check them against the marketplace plans sold in your county.
Starting your own firm, or a stretch when bids don't land, can leave a household with very little income. Texas is a hard place to be in that spot. The state has not adopted the Medicaid expansion. Texas Medicaid covers parents only at incomes up to 15% of the federal poverty level, and adults without children who aren't disabled generally can't qualify at any income. Meanwhile the marketplace credit generally doesn't start until income reaches the poverty level.
So a Texas household with a very thin year can end up with neither. If yours looks that way, the estimate you give HealthCare.gov and when you apply both matter a great deal.
Also, keep your coverage straight as you set up the business: workers' comp is for injuries on the job site. It isn't a health plan.
Next step: If your year looks lean, call me before you enroll and we'll sort out what you qualify for and how to report it.
Straight answers, no sales pitch.
Not for medical coverage. For 2026, none of the 834 individual medical plans on the Texas marketplace is a PPO; they're HMOs, POS plans and EPOs. You can still get a nationwide PPO outside the marketplace if you're healthy.
Usually not. Texas hasn't adopted the Medicaid expansion, covers parents only up to 15% of the poverty level, and generally doesn't cover adults without children at all. Call me before you enroll in a lean year.
Use your most recent net profit as the base, add or subtract for the contracts in hand, and give HealthCare.gov that number. Then revise it whenever a large project wraps up early or gets pushed.
No. Workers' comp covers injuries on the job. It doesn't pay for illness, routine care or your family.
Your county, who's on the plan and roughly what the company netted last year is all I need. I'll show you which way fits and what it costs, and if what you already have is the better call, I'll tell you that.
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