You can still get a nationwide PPO in Georgia, even where Georgia Access sells nothing but HMOs. Here's how plumbers and pipefitters who run their own shop in Georgia are covering their families for less.
Hi, I'm Sam Jaber, a licensed health insurance broker who works out of Tampa. Georgia is on my license, and I handle everything by phone, so you can call me from the truck between a water heater and a sewer line.
Georgia keeps a plumber's schedule full. Atlanta's older intown neighborhoods are full of aging pipe, the suburbs keep adding houses, Savannah and the coast keep growing, and summer downpours find every weak spot in a crawl space. Many plumbers who've built a following open their own shop. The group plan doesn't come with them, and what Georgia's marketplace offers in return depends heavily on the county.
You can still get a nationwide PPO in Georgia. Georgia Access may not sell you one, but I can.
For 2026, Georgia's marketplace lists 211 individual medical plans: 203 HMOs and just 8 PPOs. Those PPOs come from one insurer and reach 71 counties, but not Fulton, DeKalb, Cobb, Gwinnett, Clayton or Savannah's Chatham County. In those counties, a plumber shopping the marketplace can only buy an HMO, which usually covers out-of-network care only in an emergency. A PPO keeps paying when you go outside its network, at a higher out-of-pocket share, without a referral.
Private medically underwritten plans run on PPO networks covering the whole country, and their price depends on your health. For a healthy plumber, that's often the better buy.
You enroll through Georgia Access, the state's own exchange. Your household income for the year, which for a shop owner is profit after the truck, pipe, fittings, fixtures, licensing, insurance and a helper's pay, decides where you land.
At the bottom, Georgia never took the Medicaid expansion. Georgia Pathways offers Medicaid to adults up to 100% of the federal poverty level who meet a work, school or volunteer hours requirement. In the middle, the federal premium tax credit generally starts at the poverty level and lowers what marketplace plans cost. At the top, the credit runs out.
When the company plan ends, you'll generally get a special enrollment window on Georgia Access. Georgia's own continuation law can also keep you on the company's group plan, but only briefly: the rest of the month the coverage would end, plus three more months. That's a short bridge, so treat it as a way to avoid a gap, not a long-term plan.
Then line up something permanent. Compare a Georgia Access plan with, if you're healthy, an underwritten PPO. A new shop's first year can also be lean, and in Georgia that's risky: below the poverty line, the marketplace credit generally doesn't apply, and Pathways requires hours. Plan the income estimate carefully.
Next step: Ring me before your last day with the company and we'll map out the bridge and the plan you'll land on.
Between the poverty line and the credit's upper limit, a Georgia Access plan with the credit almost always beats any private option on monthly cost.
In metro Atlanta and Savannah you'll be choosing among HMOs. That suits a family whose care is close to home; we'll check your doctors are in the network. If anyone in the house manages a chronic condition or relies on a daily medication, the marketplace is the safer home at any income, because no one can be refused there or charged more for their health.
A summer of burst lines and flooded crawl spaces can push your income past what you reported. Update it when that happens so you don't owe credit back when you file.
Next step: Go through last year's return with me and we'll land on an income estimate and a Georgia Access plan that fit.
A shop with a few trucks on the road usually puts the owner's household above the credit range. In Atlanta's core counties and Chatham, full price still buys only an HMO.
A medically underwritten nationwide PPO is the comparison a healthy family should make. Answer the health questions, and the insurer will offer coverage, decline, or offer coverage minus one condition. A clean bill of health is what lets these plans undercut the marketplace's full price. Each plan's benefits are its own, so we review them together.
Workers' comp, if you carry it, is for injuries at work and nothing else. A health plan is what covers illness and your family.
Next step: Tell me your county and everyone's ages, and I'll quote a nationwide PPO beside the Georgia Access plans sold there.
Straight answers, no sales pitch.
Only in some counties. For 2026, the 8 marketplace PPOs aren't sold in Fulton, DeKalb, Cobb, Gwinnett, Clayton or Chatham. A healthy plumber anywhere in Georgia can still get a nationwide PPO outside the marketplace.
Georgia's continuation law, O.C.G.A. 33-24-21.1, lasts the rest of the month your coverage would end plus three more months. Federal COBRA may apply instead at larger employers.
Only through Georgia Pathways, which covers adults up to 100% of the federal poverty level who meet an hours requirement. Georgia did not adopt the full Medicaid expansion.
No. Georgians enroll through Georgia Access, the state's own marketplace, since plan year 2025.
Your Georgia county, the people you're covering and a rough idea of the shop's profit last year are enough for me to work with. I'll price the route that suits you, and if your current plan is the better deal, you'll hear that from me.
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