You can still get a nationwide PPO in Alabama, and a plumber working Birmingham's older neighborhoods and growing suburbs can make a smart call on coverage in one conversation. Here's how Birmingham-area plumbers are deciding.
Hi, I'm Sam Jaber. I do health insurance from an office in Tampa, Alabama is one of my licensed states, and it all gets handled by phone between your calls.
Picture a plumber in Hoover with two trucks and a steady book across the Birmingham area. Half his week goes to older neighborhoods like Crestwood, Avondale and Homewood, where clay laterals crack and galvanized lines rust through. The other half is new-home rough-ins down in Shelby County around Pelham and Chelsea. He left a larger shop years ago, and the health plan has been his to pick ever since.
To be clear from the start: you can still get a nationwide PPO in Alabama, and I'm glad to set one up.
Birmingham sits at the expensive end of a cheap spread. Alabama's 2026 marketplace has no HMOs, and Jefferson and Shelby each carry 44 EPOs and 10 PPOs from 4 insurers. A 40-year-old buying silver without a subsidy pays 9% more for the least expensive PPO than for the least expensive EPO there, the most anywhere in the state, a gap shared by the counties around Birmingham. The statewide median is 3%, small by the standards of most states. Outside its network, an EPO pays only in an emergency, while a PPO still pays its share. The nationwide version is a private plan with medical underwriting.
First, your income for the coverage year, because it decides the premium tax credit. For a shop owner that means net self-employment income: profit after the trucks, pipe, fittings, fixtures, the camera and jetter, licensing and insurance. You estimate it and keep it current.
Second, timing. HealthCare.gov opens 2027 enrollment November 1 and closes it January 15, and you'll need to finish by December 15 if you want coverage on January 1. Pencil it in for a slow week early in November.
Then buy on HealthCare.gov, since that's the only place the credit applies. With 44 EPOs in the county, one of them probably already includes your family's doctors and the hospital you'd go to. If not, or if you like having an out-of-network option, the PPO's 9% premium before credits is a fair price to weigh.
A really slow year needs care. Alabama never adopted the Medicaid expansion, which leaves working adults little to fall back on, and the credit usually starts at 100% of the federal poverty level.
Next step: Pass along last year's return and a list of your doctors, and I'll price the Birmingham EPOs and PPO with the credit taken off.
Strong years of service calls and new construction can push a household over the credit range, and from there HealthCare.gov charges full price on everything. For healthy families, that's when a medically underwritten nationwide PPO earns a look. These plans ask about your medical history before anything else; good answers usually mean an offer, sometimes with a single old condition excluded, and some applicants are declined. That's how a healthy household can come in below the marketplace's sticker, with a network that works on a Gulf fishing trip or a visit to family in Atlanta. I'll go through exactly what each plan pays.
Next step: Phone me with your county and who's on the plan, and I'll line up a nationwide PPO quote against the Birmingham marketplace.
If anyone on the plan has a chronic condition or a prescription they can't miss, keep the family on HealthCare.gov whatever the year brings. It can't refuse anyone or price by health history. Check every specialist and medication against the networks, and if a key doctor is outside the EPOs, the PPO's modest extra cost may be worth paying. Workers' comp, if you carry it for a helper, is for injuries on a job and nothing more.
Next step: Give me the doctors and medicines that matter and I'll show you which Birmingham plans cover them.
Straight answers, no sales pitch.
Yes. Jefferson and Shelby counties each have 10 marketplace PPOs for 2026, next to 44 EPOs.
9%. That's how much more the least expensive silver PPO costs than the least expensive silver EPO for a 40-year-old, before subsidies.
On HealthCare.gov from November 1 to January 15. Finish by December 15 for coverage starting January 1.
Usually not, since Alabama has not adopted the Medicaid expansion.
Tell me your county, the family members to cover and the shop's profit from last year. You'll see the Birmingham-area PPO and EPOs next to a nationwide PPO, all priced, plus my straight recommendation.
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