You can still get a nationwide PPO in Kentucky, and a slow year doesn't have to leave you uninsured. Here's how plumbers and pipefitters along the Ohio River and across Kentucky are handling income that rises and falls with the water.
Hi, I'm Sam Jaber. I'm a broker who works only in health insurance, my office is in Tampa, Kentucky is on my license, and you can do all of it with me by phone.
Plumbing in Kentucky's river towns follows the water. When the Ohio runs high in Paducah, Owensboro, Henderson or Maysville, basements flood, sump pumps fail and water heaters get replaced by the dozen. Then a dry stretch comes and the calls thin out. A shop owner in that kind of market sees income swing from year to year, and the right health coverage can change with it. Kentucky gives you more room to handle those swings than most states do.
In a good year, you can still get a nationwide PPO in Kentucky, and I can price one for you.
kynect, Kentucky's marketplace, doesn't offer it. For 2026 there are 85 individual medical plans from 3 insurers, and all 85 are HMOs, which usually leave out-of-network care uncovered unless it's an emergency. A PPO pays when you see a doctor outside its network too, with more of the cost on you, and no referral. Underwritten private plans offer national PPO networks priced on your health.
Kentucky expanded Medicaid, so a plumbing household's income for the year can point three ways. At or under 138% of the federal poverty level, Medicaid, and you can apply any month. Above that, a kynect HMO with the federal premium tax credit. Higher still, full price, which is where an underwritten PPO starts to make sense for a healthy family.
The income that counts for a shop owner is net self-employment income: profit after the truck, pipe, fittings, fixtures, licensing, insurance and a helper's pay. You estimate it for the year and update it when it changes.
This is the situation the page is built around. If a slow season drops your household income to the Medicaid line or below, apply for Medicaid when it happens; you don't have to wait for open enrollment. That keeps you and your family covered while business is thin, without spending savings you need for the truck and the shop.
Then plan for the next flood season, because in a river town it usually comes. When the calls come back and your income climbs past 138% of the poverty level, report the change, and you'll typically move to a kynect plan with the credit. The point is to keep coverage continuous as your income moves, not to lock into one choice for good.
Next step: Call me as soon as you can see the year is running light and we'll sort out whether Medicaid or kynect fits now.
When high water fills your calendar, update your income on kynect promptly so the credit tracks what you're really earning; otherwise the difference gets settled at tax time. If the year carries your household past the credit's reach and everyone is healthy, a medically underwritten nationwide PPO is worth a quote. The insurer reviews a health questionnaire and writes the policy, declines, or writes it with a particular earlier condition excluded. Good health is what can bring the premium below kynect's full rate.
Next step: Send me your county and your family's ages, and I'll price a nationwide PPO beside the kynect HMOs available there.
If a family member manages a chronic condition or a daily prescription, stay with kynect at any income above the Medicaid line, because marketplace plans can't refuse you or charge more for health. We'd pick the HMO whose network includes your specialists. Workers' comp, if you carry it, covers only on-the-job injuries.
Next step: Give me your doctors and medications and I'll show you which kynect HMOs keep them covered.
Straight answers, no sales pitch.
Yes, if household income is at or below 138% of the federal poverty level. Kentucky expanded Medicaid, and you can apply any time of year.
Update your income estimate on kynect as soon as you can, so your premium tax credit follows your real income.
kynect's 2026 medical lineup is HMOs only, so no. If you're in good health, a private nationwide PPO is the way to get that kind of network, and I can quote one.
No. Kentucky runs its own marketplace, kynect.
Let me know your county, the people you're covering and whether this year is running ahead of or behind the last one. I'll tell you which of Kentucky's options fits right now, with prices, and when to switch.
The guide for every state, and other work I help with