You can still get a nationwide PPO in Tennessee, and you can avoid the coverage gap that catches new shop owners here. Here's how plumbers and pipefitters opening their own business in Tennessee are planning their first year.
Hi, I'm Sam Jaber, a broker who handles health insurance and nothing else. I work from Tampa, Tennessee is among my licensed states, and every client I help, I help by phone.
Tennessee winters keep a plumber honest. When a cold snap rolls through the Cumberland Plateau or the mountains east of Knoxville, pipes split in crawl spaces and the phone lights up. That kind of demand convinces a lot of plumbers to open their own shop. The trouble is the first year: a new shop usually earns less than the paycheck it replaced, and Tennessee is one of the hardest states to be low-income in when it comes to health coverage. This page is about getting through that year without a gap.
You can still get a nationwide PPO in Tennessee; when the shop finds its feet, I can price one for you.
The marketplace won't offer one. For 2026, Tennessee's HealthCare.gov lineup is 158 individual medical plans from 6 insurers, in all 95 counties, and every one is an EPO, which pays out of network only in an emergency. A PPO covers doctors outside the network as well, with you paying a larger share, and doesn't require a referral. Medically underwritten private plans provide that on national PPO networks, priced by your health.
Tennessee hasn't adopted the Medicaid expansion. A parent can get TennCare with income up to 105% of the federal poverty level, but a non-disabled adult with no kids generally can't, however little they earn. Meanwhile, the marketplace premium tax credit usually starts at the poverty level. So a household whose income falls too low can land in between, with no help from either.
For a self-employed plumber, the number the marketplace uses is net self-employment income for the coverage year: your estimate of profit after the truck, parts, fixtures, licensing, insurance and a helper's pay. You give that estimate when you apply and update it as things change. That estimate is the lever in your first year.
This is the situation this page is built for. If your realistic estimate for the year lands at or above the poverty level, you can generally get the premium tax credit on HealthCare.gov, and that's almost always your most affordable coverage. If it lands below, and you're not a parent under TennCare's limit, you may have no help at all.
So we look hard at the number. A shop's first year often builds month by month, and an estimate based only on a slow start can understate the year. Think about service agreements you've lined up, builders who've promised work, and winter emergency calls. The goal is an honest figure, and then updating it as the year unfolds.
Next step: Send me your expected income for the year and who's in your household, and I'll show you which side of Tennessee's gap you're likely on.
After the first year or two, many shop owners earn past the credit range and pay full price for an EPO. For a healthy family that wants doctors outside one network, a medically underwritten nationwide PPO is the comparison to make. The insurer reviews a health questionnaire, then covers you, declines you, or covers you with one condition left out. A good health history is what lets the premium undercut the marketplace's full rate. We'll go over each plan's benefits together.
Next step: Give me your county and your family's ages, and I'll quote a nationwide PPO beside the Tennessee EPOs available to you.
If anyone on your plan manages a chronic condition or relies on a daily prescription, plan around HealthCare.gov. Its EPOs can't refuse you or charge more for your health; we'd choose the one whose network includes your specialists. Separately, workers' comp, if you carry it, only covers injuries at work.
Next step: Send me your doctors and medications and I'll find which Tennessee EPOs in your county keep them covered.
Straight answers, no sales pitch.
Yes. Without the expansion, TennCare's door is narrow: parents up to 105% of the poverty line, and most childless adults not at all. Since marketplace credits usually begin at the poverty line, very low earners can miss both.
Your estimate of net self-employment income for the coverage year, meaning profit after business expenses. Update it as soon as it changes.
Through me, yes. HealthCare.gov's Tennessee lineup is EPO-only, so a healthy plumber who wants a PPO buys a private nationwide plan instead.
Only injuries on the job. Illness, checkups and your family need a health plan.
Give me your county, who's on your plan and your honest guess at what the shop will clear this year. I'll show you which option you qualify for and what it costs, and if waiting or staying put is wiser, I'll say so.
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