You can still get a nationwide PPO in Louisiana, and an AC company working the heat and humidity of the bayou parishes faces an unusual marketplace. Here's how Houma and Thibodaux owners are choosing coverage.
Hi, I'm Sam. I broker health insurance and only health insurance, from Tampa, with a Louisiana license, and every client meeting I have takes place on the phone.
Imagine an air conditioning company in Houma with three vans running from Gray and Bourg down toward Chauvin and up the bayou to Thibodaux. In Terrebonne and Lafourche the heat and humidity barely let up, so systems run hard most of the year, and camps and houses near the water add their own wear. When a storm comes through, the work changes overnight: flooded condensers, soaked ductwork and long lists of replacements. The owner buys the family's health plan himself, and his marketplace looks different from most.
The fixed point: you can still get a nationwide PPO in Louisiana, and I can arrange one whenever it's the better fit.
Here's what makes bayou country unusual. HealthCare.gov sells no HMOs or EPOs in Terrebonne or Lafourche for 2026. Terrebonne has 9 POS plans and 8 PPOs, and Lafourche has 7 POS plans and 8 PPOs. A POS plan costs less when you stay in its network and asks your primary care doctor to refer you to specialists, while a PPO pays toward doctors outside its network at a higher cost, with no referral. For a 40-year-old on silver without a subsidy, the least expensive PPO costs 40% more than the least expensive POS plan in both parishes, a bit under the statewide median of 48%. Off the marketplace, nationwide PPOs are priced after medical underwriting.
The premium tax credit is based on the household's income for the coverage year, which for an AC business is net self-employment income: sales minus equipment, refrigerant, parts, the vans, your license and insurance. You give HealthCare.gov a forecast and revise it whenever the year changes direction.
A storm can bring months of replacement work in a few weeks. Once you can see that, raise the forecast so the credit shrinks for the rest of the year instead of coming back at tax time; a calm year works in reverse.
Then HealthCare.gov is usually the place to buy, since the credit is only good there. In Terrebonne and Lafourche the real comparison is POS versus PPO. If your family's doctors are in a POS network and you don't mind getting referrals, the POS plan saves money. If you'd rather skip referrals or see doctors in New Orleans or Baton Rouge outside the network, the PPO's 40% premium before credits may be worth it. And if a bad year leaves the household very thin, Louisiana's Medicaid expansion reaches adults up to 138% of the federal poverty level.
Next step: Send me your parish, the family's ages and last year's profit, and I'll price the POS plans and the PPO after your credit.
A business that size usually earns past the credit range, and then everything on HealthCare.gov is full price. If the family is in good health, a medically underwritten nationwide PPO is worth a quote. The insurer goes over your medical history before deciding, then offers a policy, offers one with a single earlier condition excluded, or declines. That review is what lets a healthy household pay less than the marketplace's full rate, and the network covers you on a supply run to Lafayette or a family trip out of state. I'll go through each plan's benefits before you choose.
Next step: Give me your zip and the birthdays on your plan, and I'll quote a nationwide PPO beside the bayou-parish marketplace plans.
A family member with a long-term illness or a daily medication should stay on HealthCare.gov whatever the business earns, because those plans accept everyone at the standard price. Then pick between POS and PPO by network: if a needed specialist isn't in a POS network, the PPO may be the better home for that care.
Next step: List the doctors and prescriptions that matter, and I'll check them against the Terrebonne and Lafourche plans.
Straight answers, no sales pitch.
No. For 2026, Terrebonne Parish's marketplace has 9 POS plans and 8 PPOs, and nothing else.
In Terrebonne and Lafourche, the least expensive silver PPO costs 40% more than the least expensive silver POS plan for a 40-year-old, before subsidies.
A POS plan costs less in its network and needs a referral from your primary care doctor to see a specialist. A PPO pays toward out-of-network doctors at a higher cost and needs no referral.
Yes, for adults with income up to 138% of the federal poverty level.
Tell me your parish, who needs coverage and how the business did last year. I'll price the Terrebonne or Lafourche marketplace plans beside a nationwide PPO and tell you which I'd choose.
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