You can still get a nationwide PPO in Montana, and a Billings heating and cooling company has a marketplace PPO close enough in price to consider. Here's how Yellowstone County owners are deciding.
Hi, I'm Sam. I sell health insurance from Tampa under a Montana license, and every conversation with a client is a phone call.
Imagine a heating and cooling company in Billings with four vans covering the Heights, the West End, Laurel and Lockwood. Montana winters run long, so the heating side keeps every van moving well into spring, and a hot, dry summer fills the AC schedule. A cold snap can put every van on no-heat calls at once. The owner buys his own family's coverage, and the choice deserves more thought than a quick renewal.
One thing holds regardless: you can still get a nationwide PPO in Montana, and I'm glad to arrange it.
Yellowstone County's marketplace also sells PPOs at a reasonable markup. For 2026 it offers 25 PPOs, 9 POS plans and 8 EPOs from 3 insurance companies, and for a 40-year-old shopping silver at full price, the least expensive PPO sits 10% above the least expensive POS or EPO plan. Out in much of rural Montana, the PPO actually runs 5% below the alternatives. An EPO pays out of network only in emergencies, a POS plan requires referrals for specialists, and a PPO pays toward any doctor at a higher out-of-network share without referrals. Private nationwide PPOs are priced after medical underwriting.
Your credit follows the household's income for the coverage year; for an HVAC company, HealthCare.gov counts net self-employment income, which is revenue after equipment, refrigerant, parts, the vans, licensing and insurance. Estimate it at sign-up and revise it whenever the season runs hotter or colder than you planned.
Montana also runs a state reinsurance program, the Montana Reinsurance Program, under a federal waiver approved for plan years 2025 through 2029. It's part of how marketplace premiums here are set.
Buy on HealthCare.gov then, because the credit isn't available anywhere else. In Billings, the PPO's 10% premium before credits buys referral-free care and out-of-network help; plenty of families find that worth it, especially if a specialist they rely on is outside the POS and EPO networks. A family happy with its network doctors can save the difference.
A soft heating season can leave the books thin; Montana's Medicaid expansion is available to adults at 138% of the federal poverty level or below.
Next step: Send your zip, the family's ages and last year's profit, and I'll run Yellowstone County's plans with your credit applied.
Four vans and a full book of service agreements generally put a household above the credit range, and then HealthCare.gov's sticker price applies across the board. A healthy family should get a medically underwritten nationwide PPO quote too. These plans start with health questions and may approve, approve with one earlier condition excluded, or decline. That screening is why healthy households often land below the marketplace's list price, and coverage still works on a parts run to Casper or a vacation out of state. I'll explain each plan's benefits before you decide.
Next step: Call with your county and everyone's ages, and you'll see a nationwide PPO quote beside Yellowstone County's full-price plans.
If someone at home needs regular specialist visits or a daily prescription, keep the family on the marketplace in every income year; those plans can't refuse anyone or price by health. For that person, a marketplace PPO can be worth its extra 10%, because it pays toward specialists outside the network without a referral.
Next step: Share your family's doctors and prescriptions, and I'll check which Billings plans include them.
Straight answers, no sales pitch.
Yes. Yellowstone County has 25 marketplace PPOs for 2026, priced 10% above the least expensive POS or EPO plan for a 40-year-old on silver before subsidies.
Yes. The Montana Reinsurance Program runs under a federal waiver approved for plan years 2025 through 2029.
With a POS plan you save by staying in network and get specialist referrals through your primary doctor. With a PPO you can see any doctor directly, paying more when they're outside the network.
Possibly. Montana's expansion covers adults whose income is no higher than 138% of the federal poverty level.
Give me your county, the people to cover and a sense of last year's profit. I'll put Yellowstone County's marketplace plans and a nationwide PPO side by side, priced, and say which I'd buy.
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