You can still get a nationwide PPO in Michigan, and in the Upper Peninsula the marketplace's own PPO isn't priced out of sight either. Here's how UP plumbers are deciding between them.
Hi, I'm Sam Jaber. I work in health insurance and nothing else, I'm based in Tampa with a Michigan license, and I do the whole job by phone, which beats driving to an office in a UP snowstorm.
Picture a plumber working out of Marquette who covers jobs from Ishpeming over to the Keweenaw. Winter is long and it does the selling for him: frozen service lines, split pipes in camps nobody drained, boilers that quit in the coldest week of February. Summer brings new builds, remodels and cottage work along Lake Superior. The money is real, but the year leans on the weather, and that's exactly what makes the health insurance choice worth a careful look.
Up front: you can still get a nationwide PPO in Michigan, and I can arrange one for a UP household.
Here the marketplace actually puts a PPO within reach. In Marquette, Houghton, Keweenaw, Baraga and Alger, HealthCare.gov lists 8 HMOs and 8 PPOs for 2026 from 2 insurers. At age 40 on silver, before any subsidy and compared within the county, the least costly PPO comes to 19% more than the least costly HMO. Statewide the median gap is 35%, so the UP is gentler than most of Michigan. An HMO pays out of network only in an emergency, while a PPO also covers doctors outside it at a higher share, with no referral.
The premium tax credit is figured from what the shop actually keeps in the coverage year, its net self-employment income after the truck, pipe and fittings, the thaw machine, tools, your license and insurance. You estimate it when you enroll and update it when it changes.
A UP winter is impossible to predict in November. A brutal January with weeks of subzero nights can carry the year well past your guess. When you can see that happening, raise the estimate so the credit shrinks for the remaining months, rather than meeting the difference at tax time.
Start on the marketplace, because the credit only works there and usually makes it the most affordable route. In the UP the real choice is between those 8 HMOs and 8 PPOs. If your family sees doctors both in town and downstate, or you'd simply like room to choose, the PPO's 19% premium before credits is worth weighing seriously. If every doctor you use is already in an HMO's network, the HMO keeps more money in your pocket.
Next step: Get me last year's return and a list of your doctors, and I'll price the UP HMOs and PPOs after your credit.
After a few big winters, a two-truck shop can carry the household past the credit range, and then every marketplace plan is full price. For a healthy family, compare a medically underwritten nationwide PPO. The insurer reads your health questionnaire and approves you, declines you, or approves you with one prior condition excluded, and a clean history is why the price can land below the marketplace's full rate. The network also covers you when you're in Green Bay for parts or visiting family in lower Michigan. Benefits vary by plan, and I'll go through them plainly.
Next step: Phone me with your county and the birth years of everyone on the plan, and you'll see a nationwide PPO quote beside the UP marketplace plans.
A soft winter can leave a shop's year thin. In a year like that, a household whose income drops to 138% of the federal poverty level or below can apply for the Healthy Michigan Plan, the state's Medicaid expansion. If anyone in the family lives with a long-term illness, keep them on HealthCare.gov no matter what the shop earns, because those plans have to accept you and can't price your health. Workers' comp handles injuries on a job, not illness.
Next step: If either one sounds like your year, call me and we'll find the coverage that fits.
Straight answers, no sales pitch.
Yes. For 2026 Marquette County's marketplace has 8 PPOs and 8 HMOs.
In Marquette, Houghton, Keweenaw, Baraga and Alger, the lowest-priced silver PPO costs 19% more than the lowest-priced silver HMO for a 40-year-old, before subsidies.
Yes. Update the estimate once a heavy run of frozen-pipe work makes it clear the year will beat your guess.
It can happen in a weak year. The Healthy Michigan Plan is Michigan's Medicaid expansion, and its income line for adults sits at 138% of the federal poverty level.
Send me your county, the people going on the plan and the shop's net from last year. You'll see the UP marketplace plans priced next to a nationwide PPO, and we can settle it before winter fills your calendar.
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