You can still get a nationwide PPO in Indiana once your shop is established, and the Healthy Indiana Plan can carry a lean start. Here's how plumbers and pipefitters opening their own business in Indiana are planning both.
Hi, I'm Sam Jaber. Health insurance is the only thing I sell, I work out of Tampa, Indiana is one of my licensed states, and everything is done by phone.
Indiana keeps a plumber's truck moving. Older houses in Indianapolis, Fort Wayne and South Bend need repipes and new water heaters, winter freezes split lines in crawl spaces, and new subdivisions keep going in around the cities. A lot of plumbers who've built a following open their own shop. The first year is usually the hard one financially, and Indiana gives you a specific tool for it, with a rule change coming that you need to know about.
Once the shop is steady, you can still get a nationwide PPO in Indiana, and I'm happy to price one.
It won't be on HealthCare.gov. For 2026, Indiana's 80 individual medical plans, from 5 insurers across all 92 counties, are 45 HMOs, 33 EPOs and 2 POS plans. None of them is a PPO. HMOs and EPOs generally pay out of network only for emergencies, while a PPO covers outside doctors as well, at a higher cost, with no referral. For a PPO, you go to private plans with medical underwriting, which run on national networks and set your price by your health.
Indiana covers low-income adults through the Healthy Indiana Plan, known as HIP, which is the state's version of the Medicaid expansion. Adults with household income up to 138% of the federal poverty level can qualify. For a shop owner, income means profit: what's left after the truck, pipe, fittings, fixtures, the license, insurance and a helper's pay.
Here's the change. From January 1, 2027, most adults on HIP or applying for it, from 19 through 64, need 80 qualifying hours each month. Paid work counts, and so do job training, part-time school, an apprenticeship or volunteering in the community. If you're counting on HIP for a lean year, find out how your hours running the shop will be documented before you need it.
This is the situation this page is built around. If your household's income for the year lands at or below the HIP limit, HIP can cover you while the shop finds its feet. Keep records of the hours you put in, and confirm with the state how self-employment hours are counted under the new rule.
As the shop grows and your income passes the HIP line, report it. That's when you'll typically move to a HealthCare.gov plan with the federal premium tax credit, which only works on marketplace plans and usually makes them the least expensive option for a modest income.
Next step: Send me your expected income for this year and I'll show you whether HIP or a marketplace plan fits you now.
After a few years, many shop owners earn past the credit range and pay full price for an HMO or EPO. If your family is healthy and wants doctors beyond one network, a medically underwritten nationwide PPO is worth pricing. The insurer reviews a health questionnaire and then approves you, declines you, or approves you minus one past condition. Good health is what lets the premium come in under the marketplace's full rate. We'll go through each plan's benefits before you choose.
Next step: Call me with your county and your family's ages and I'll quote a nationwide PPO beside the Indiana plans available there.
If anyone you cover manages a chronic illness or a daily prescription, plan on HealthCare.gov instead of an underwritten plan. Marketplace plans must accept you and can't use your health to set your price. We'll choose the network that keeps your specialists. And workers' comp, if the shop carries it, only answers for job injuries.
Next step: Send me your doctors and medications and I'll find which Indiana plans in your county include them.
Straight answers, no sales pitch.
In a low-income year, possibly. The Healthy Indiana Plan covers adults with income up to 138% of the federal poverty level.
Beginning with January 2027, adults aged 19 to 64 on HIP, or applying, must log 80 hours a month in a job, training, part-time classes, an apprenticeship or community service.
No medical PPO for 2026; the plans are HMOs, EPOs and POS plans. A healthy plumber can get a nationwide PPO outside the marketplace through me.
Report the change. You'll usually move from HIP to a HealthCare.gov plan with the premium tax credit.
Your Indiana county, the people in your household and a realistic profit figure for this year are what I need. I'll tell you which option fits now and what it costs, and help you plan the switch when the shop grows.
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