You can still get a nationwide PPO in Maryland, and a plumber who spends his days under century-old rowhouses can choose coverage as carefully as he chooses pipe. Here's how Baltimore plumbers are deciding.
Hi, I'm Sam Jaber. My work is health insurance, my office is in Tampa, Maryland is one of the states I'm licensed in, and every client conversation happens on the phone.
Picture a plumber who grew up in Highlandtown and now runs his own truck around Baltimore. Much of his work lives inside rowhouses built a century ago: cast-iron stacks that finally crack, old galvanized supply lines, basement drains nobody has looked at since the last owner. Add a new bathroom in a Canton rehab and a water heater in Hampden on the same day, and that's a normal week. Winter brings burst pipes in vacant houses; summer brings renovation work. He wants a health plan that makes sense for that kind of year.
First things first: you can still get a nationwide PPO in Maryland, and lining one up is my job.
Baltimore City shoppers see 39 HMOs and 4 PPOs on Maryland Health Connection for 2026, from 4 insurance companies, and the PPOs are pricey. Maryland's 2026 rates don't vary across its four rating areas, so the comparison is the same in Highlandtown as anywhere in the state: a 40-year-old buying silver without a subsidy pays 64% more for the least expensive PPO than for the least expensive HMO. An HMO usually pays nothing out of network except in an emergency. A PPO pays toward outside providers as well, at a bigger share for you and with no referral, and the nationwide version is sold privately, with medical underwriting setting the price.
Help with premiums is based on household income for the coverage year, meaning net self-employment income after the truck, the drain machine, pipe, fittings, fixtures, permits, your license and insurance. You estimate it at sign-up and change it as soon as the year looks different.
Maryland Health Connection lists open enrollment from Nov. 1 to Jan. 15. Sign up between Nov. 1 and Dec. 31 and coverage starts Jan. 1; sign up Jan. 1 to 15 and it starts Feb. 1. December can bring the first frozen pipes of the year, so the earlier in November you settle it, the better.
Then Maryland Health Connection is usually where you'll pay least, since premium help applies only there. Baltimore has plenty of HMOs, so the decision comes down to which network has your family's doctors and the hospital you'd want. If a run of big rehab jobs raises the year, update the estimate before tax season does it for you. And if a slow stretch pulls the household far down, Maryland's Medicaid expansion is open to adults earning no more than 138% of the federal poverty level.
Next step: Get me last year's return and a list of your doctors, and I'll find the Baltimore HMOs that keep them at the lowest net cost.
Once the household earns past the help range, all 43 plans sold in the city are full price, and the PPO costs 64% more than the least expensive HMO. A healthy household should look at a medically underwritten nationwide PPO. You fill out a health questionnaire, and the insurer accepts you, accepts you with one past condition left out, or turns you down. A healthy history is why the premium can come in below the marketplace's full rate, and the network works on a trip to the Outer Banks or a visit to family in Pennsylvania. Benefits differ by plan, and I'll walk you through them.
Next step: Call me with your zip code and everyone's birth year, and you'll get a nationwide PPO price next to the Baltimore marketplace plans.
If a family member sees specialists regularly or needs a daily medication, keep the household on Maryland Health Connection at any income. Its plans have to accept you and can't charge more for your health. The work is checking the specialists and prescriptions against each network, and that's the part I'm glad to do. Workers' comp, if you carry it for a helper, covers job injuries, not illness.
Next step: Send me the doctors and medicines that matter and I'll show you which Baltimore plans cover them.
Straight answers, no sales pitch.
Nov. 1 to Jan. 15. Enroll by Dec. 31 for coverage starting Jan. 1, or Jan. 1 to 15 for coverage starting Feb. 1.
Yes, Baltimore City has 4 for 2026, though a silver PPO starts 64% higher than a silver HMO for a 40-year-old before subsidies.
Not for 2026. Every plan on Maryland Health Connection carries the same rates in all four of the state's rating areas.
In a lean year, possibly, since Maryland's expansion reaches adults whose income stays at or under 138% of the federal poverty level.
Send your zip code, the people going on the plan and what the shop netted last year. You'll see Maryland Health Connection prices with any help you're due, a nationwide PPO quote beside them, and my straight recommendation.
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