You can still get a nationwide PPO in Texas, even though HealthCare.gov offers Texans no PPO medical plan at all. Here's how plumbers and pipefitters running their own shop here are covering their families for less.
Hi, I'm Sam Jaber. I help people with health insurance from my office in Tampa, I'm licensed in Texas among 36 states, and all of it gets done on the phone, so you can call between a water heater swap and a slab leak.
Texas keeps a plumber's phone ringing. Clay soil shifts under slab foundations and lines crack, a hard freeze bursts pipes across a whole city in one night, and new construction keeps rolling out around Houston, Dallas, Austin and San Antonio. Plenty of plumbers take that demand and open their own shop. What they lose in the move is the group health plan, and what they find on the Texas marketplace isn't what they expected.
You can still get a nationwide PPO in Texas. It just won't come from HealthCare.gov.
For 2026, the Texas marketplace lists 834 individual medical plans, and zero of them are PPOs. Your choices there are HMOs, POS plans and EPOs. HMO coverage generally stops at the network's edge unless it's an emergency, and EPOs pay outside the network only for emergencies. The PPO is the plan type that keeps paying, at a higher cost, when you see a doctor outside the network, and without a referral. Don't be thrown by dental PPOs on the site; on the medical side, there are none.
Private plans with medical underwriting are the way around it. They run on national PPO networks and are priced on your health instead of the marketplace's rates, so a healthy plumber and family can often come out ahead.
Marketplace help in Texas comes through HealthCare.gov as a premium tax credit, sized to what your household brings in over the year. When you own the shop, the marketplace counts net self-employment income: revenue minus the truck, pipe, fittings, fixtures, the state license, insurance and whatever you pay a helper. A busy invoice book can still leave a net that qualifies.
There's also a calendar to respect. Open enrollment on HealthCare.gov starts November 1 and ends January 15, and you need to enroll by December 15 for a plan that starts January 1. Outside that window, you generally need a qualifying event like losing other coverage.
Here's how it usually plays out.
If your household lands in the credit range, HealthCare.gov is usually where your most affordable coverage is, because nothing sold outside the marketplace can use the credit.
You'll be choosing among HMO, POS and EPO plans built on local doctors and hospitals. For a family whose care is close to home, that's usually workable. Just make sure the pediatrician, the family doctor and the nearest hospital are in the network before you sign up.
Plumbing income jumps around, and a citywide freeze can fill a month with emergency calls. When your year runs bigger than the estimate you gave, report it, or some of the credit will be taken back at tax time.
Next step: Pull up your latest return and walk me through it, and we'll turn it into an income figure you trust and a plan that fits.
A shop with a few trucks on the road often puts the owner's household above the credit range. Then you pay HealthCare.gov's full price, and you still can't buy a PPO there.
For a healthy family, an underwritten nationwide PPO is the plan to price. The application includes health questions, and the insurer can accept you, decline you, or accept you with a past condition excluded. Being screened is exactly what lets a healthy household undercut HealthCare.gov's sticker price, and it's also why each plan's benefit list gets a careful read with me first.
Next step: Call me and I'll put a nationwide PPO quote for your family next to the HealthCare.gov plans in your county.
When the company plan ends because you left, HealthCare.gov treats it as a qualifying event, and the window to pick a new plan is usually 60 days regardless of the month. COBRA has a catch: cancel it early because you changed your mind and no new window opens, while reaching its end does open one.
A new shop's first year can be very lean, and Texas has almost no safety net underneath that. The state hasn't adopted the Medicaid expansion. Texas Medicaid covers parents only up to 15% of the federal poverty level, and adults without children who aren't disabled generally can't get it at all. Since marketplace credits generally start at the poverty level, a very thin first year can leave you with nothing.
And remember, workers' comp is for job injuries only. A child's ear infection or your own bout of flu falls outside it.
Next step: Ring me while you're still on the company payroll and we'll time the new plan to begin the moment the old one ends.
If anyone on your plan needs ongoing care or a medication they can't skip, the marketplace is usually the right place, even at full price. No one can be refused on HealthCare.gov, and health history can't raise your premium there. An underwritten plan plays by different rules.
The Texas decision then comes down to which HMO, POS or EPO network includes your specialists and covers your prescriptions. That's tedious plan-document work, and it's mine to do.
Next step: Tell me which doctors and prescriptions your family relies on, and I'll find the Texas plans near you that keep them.
Straight answers, no sales pitch.
No medical PPO. All 834 individual medical plans on the Texas marketplace for 2026 are HMOs, POS plans or EPOs. A nationwide PPO outside the marketplace is still available if you're healthy.
Open enrollment on HealthCare.gov runs from November 1 to January 15, and enrolling by December 15 starts your coverage January 1. Losing other coverage usually gives you 60 days to enroll outside that window.
Often, on the federal side. The deduction for self-employed people can't exceed what the shop netted, and it skips any month you were eligible for a subsidized plan through an employer, including a spouse's. Your tax preparer will know your exact figure.
Be careful. Texas hasn't expanded Medicaid, and marketplace credits generally start at the poverty level, which means a near-zero first year can fall between them. Talk with me before you apply.
Where you live in Texas, who needs coverage and a ballpark of what the shop cleared last year will get us going. I'll show you the option that fits and what it runs, and I'll tell you if you're better off keeping what you have.
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