You can still get a nationwide PPO in Ohio, even with nothing but HMOs on the state's marketplace. Here's how plumbers and pipefitters running their own shop in Ohio are covering their households for less.
Hi, I'm Sam Jaber, a licensed health insurance broker. My office is in Tampa, my licenses cover 36 states with Ohio among them, and every client I help, I help by phone.
An Ohio plumber knows what January brings. A cold snap freezes lines in crawl spaces and exterior walls, basements flood when a sump pump quits, and the older housing in the state's cities is full of cast iron and galvanized pipe that's ready to give out. That keeps a shop owner busy. It also leaves little time to sort out health insurance after you've walked away from a company plan, and the Ohio marketplace isn't set up the way most plumbers expect.
You can still get a nationwide PPO in Ohio. HealthCare.gov just isn't where it comes from.
For 2026, Ohio's marketplace has 189 individual medical plans from 11 insurers, sold in all 88 counties, and every last one is an HMO. HMO coverage generally stops at the edge of the network except for emergencies. A PPO covers doctors outside the network, at a higher cost, with no referral required. Any PPOs you spot on the site are dental plans; for medical coverage, Ohio's marketplace has zero.
Underwritten private plans are built on PPO networks that cover the country, and the premium is based on your health. For a healthy plumber and family, that's often the closest thing to a group PPO.
Ohio expanded Medicaid, which gives plumbers here a safety net plenty of other states don't. Your household income for the year decides which of three paths you take: Medicaid up to 138% of the federal poverty level, a HealthCare.gov HMO with a premium tax credit above that, or full price once the credit runs out. For a shop owner, income is net: after the truck, pipe, fittings, fixtures, the license, insurance and your apprentice's pay.
Here's how each path looks.
Opening your own shop can mean a lean first year, and a mild winter can thin out the emergency calls. If your household income falls at or below 138% of the poverty line, Ohio's expansion means you can get Medicaid, and you can apply in any month, not just during open enrollment.
The thing to plan for is the step up. When the calls come back and your income rises, report it, because you'll likely move from Medicaid onto a marketplace plan.
Next step: Call me if your income has dropped, and we'll figure out whether Medicaid or a HealthCare.gov plan is the better fit for this year.
Above the Medicaid line, a HealthCare.gov HMO with the credit is usually the most affordable coverage in Ohio, since the credit can't be used on plans sold elsewhere.
HMO networks are local, so we'll check that your family doctor, the kids' pediatrician and your nearest hospital are inside. Then mind the estimate. A deep freeze can fill a month with emergency calls, and if your income ends up higher than what you reported, you may owe part of the credit back at tax time.
Next step: Go over last year's numbers with me on a short call, and we'll pick an income estimate and an HMO that both make sense.
A plumbing company with several trucks usually puts the owner's household above the credit range. Full price on HealthCare.gov gets you an HMO, and a healthy family may want more freedom than that.
An underwritten nationwide PPO is the plan to price. The application asks medical questions, and the insurer can approve you, decline you, or approve you with something from your past excluded. When you're healthy, that screening is what can bring the price below the marketplace's full rate. Plans write their own benefits, so we read each one before you choose.
Next step: Call me and I'll quote a nationwide PPO for your household and set it beside the HMOs sold in your county.
A chronic condition or a must-have prescription is a strong reason to stay on HealthCare.gov, even at full price. Plans there have to accept you and can't use your health to set your premium. Underwritten plans can decline.
Since every Ohio marketplace plan is an HMO, the work is finding the network that already includes your specialists and the formulary that covers your medications. And if you're hurt on a job, that's workers' comp territory; it covers work injuries only, not your family's care.
Next step: Tell me your doctors and prescriptions and I'll find which HMOs in your county keep them covered.
Straight answers, no sales pitch.
No medical PPO. All 189 individual medical plans on the Ohio marketplace for 2026 are HMOs. A nationwide PPO outside the marketplace is still available if you're healthy.
In a low-income year, yes. Ohio adopted the Medicaid expansion, which covers adults with household income up to 138% of the federal poverty level, and you can apply any month.
Ohio's income tax return starts from your federal adjusted gross income, and the self-employed health insurance deduction is taken in figuring that number. Your tax preparer can confirm how it applies to you.
Only for injuries on the job. You still need a health plan for illness, checkups and your family.
Your Ohio county, the people on your plan and roughly what the shop cleared last year is all it takes. I'll show you which way fits and what it costs, and if your current coverage already holds up, I'll tell you to keep it.
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