You can still get a nationwide PPO in Maryland, and a heating and cooling owner whose jobs cross into Pennsylvania and West Virginia has good reason to price one. Here's how Hagerstown-area owners are choosing.
Hi, I'm Sam. Tampa is home base, Maryland is one of the states I'm licensed to sell health insurance in, and every step happens by phone.
Imagine a heating and cooling company in Hagerstown with three vans running I-81 and I-70: furnace and heat pump calls in Williamsport and Boonsboro, rooftop units on the warehouses near the interstates, and the odd job over the line in Pennsylvania or West Virginia. Western Maryland winters keep the heating side busy, and humid summers fill the AC schedule. The owner buys his own health plan and, like most busy owners, renews whatever he had last year.
To get it out of the way: you can still get a nationwide PPO in Maryland, whatever the marketplace shows.
On Maryland Health Connection, Washington County gets 28 HMOs and 4 PPOs for 2026 from 3 insurance companies. Maryland plans carry the same rates in all four of the state's rating areas, so the PPO is priced no differently here than in Baltimore: for a 40-year-old on silver before any subsidy, the lowest-priced PPO runs 64% above the lowest-priced HMO. An HMO generally covers out-of-network care only in an emergency, which matters when a job keeps you in Chambersburg or Martinsburg for a week. A PPO pays outside doctors too, at a higher share and without a referral, and a nationwide one comes from medically underwritten private plans priced on your health.
Maryland does a lot to hold down marketplace prices. CMS approved the state's amended section 1332 waiver for 2026 through 2028, keeping its reinsurance program, and actuarial analyses projected 2026 individual premiums about 34% lower on average than they'd be without it. Maryland Premium Assistance also adds state money for 2026, stacked on the federal credit, for households earning up to 400% of the federal poverty level, whatever their age.
Both kinds of help depend on household income for the coverage year: net self-employment income after equipment, refrigerant, parts, the vans, licensing and insurance. You estimate it when you enroll and fix it whenever the season surprises you, up or down.
In the help range, Maryland Health Connection is usually the least expensive place to buy, because the federal and state help only apply there. Choose among the Washington County HMOs by network, meaning the one that already includes the family's doctors. If a bitter January sends every van out and the year runs hot, raise the estimate so the help adjusts for the rest of the year.
Next step: Share last year's profit and who your doctors are, and you'll see the Washington County HMOs priced with all the help you're due.
Steady maintenance contracts and a few vans usually mean a household earning past the help range, and from there every marketplace plan is full price. A healthy household should compare a medically underwritten nationwide PPO. The insurer works through your medical history and then issues the policy, issues it with one prior condition excluded, or declines. That screening is how a healthy family's premium can land under the marketplace's full rate, and the network keeps working across the Pennsylvania and West Virginia lines. Each plan sets its own benefits, so we'll go through them before you choose.
Next step: Give me the ages on your plan and your zip code, and I'll set a nationwide PPO quote beside the Washington County plans.
A mild winter can leave the books thin, and Maryland's Medicaid expansion is there too, with a cutoff for adults at 138% of the federal poverty level. If someone at home has a chronic condition, stay on Maryland Health Connection at any income; its plans can't refuse you or price your health. Then the task is matching specialists and prescriptions to a network, and if a specialist you need sits outside every HMO, the PPO's extra cost may be worth it.
Next step: Tell me which doctors and medicines matter and I'll check them against the western Maryland plans.
Straight answers, no sales pitch.
No. Each plan's 2026 rate is identical across the state, so a Hagerstown household sees the same 64% PPO premium over the least expensive HMO as a family in Baltimore.
It reimburses insurers for part of the cost of large claims, which lets them charge less. CMS approved it through 2028, and analyses projected 2026 individual premiums about 34% lower on average than without it.
For 2026, any Maryland resident whose household income is no more than 400% of the federal poverty level may get it, stacked on the federal credit.
Generally only in an emergency, unless the provider is in the plan's network.
Your county, who you want covered and last year's profit will do it. I'll price Washington County's marketplace plans with any help you qualify for, put a nationwide PPO beside them, and give you my pick.
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