You can still get a nationwide PPO in Texas, even though the marketplace offers none. Here is how owners of Texas LLCs, S-corps and small shops are covering themselves and their families.
Hi, I'm Sam Jaber. I'm a Tampa broker licensed in 36 states, and I help Texas owners by phone, whether the company is a solo LLC, an S-corp with a spouse on payroll, or a small shop with a crew of a few people.
The Texas marketplace tends to surprise owners. Anyone who had a PPO at a big company and goes looking for one on HealthCare.gov comes up empty. Here's what's actually available, how owners qualify for help, and the gap Texas leaves under a rough first year.
Texas's marketplace offers 834 individual medical plans this year, and each one is an HMO, an EPO or a POS plan. A PPO isn't among them.
You can still get a nationwide PPO in Texas, just not from HealthCare.gov. I can set one up for you as a private plan with medical underwriting: each applicant answers health questions, the premium follows those answers, and the network reaches providers nationwide. For an owner whose family is healthy, that's the obvious benchmark.
A company made up of the owners and their family uses the individual marketplace, meaning HealthCare.gov in Texas. Once you hire someone who isn't an owner or a relative, SHOP, the small-business marketplace, may open up for a group plan.
On the individual side, the premium tax credit is figured from household income for the coverage year. Sole proprietors and single-member LLCs start from the business's net profit. S-corp owners count the salary they draw plus the profit that flows through to the personal return.
One warning on estimates. Since tax year 2026, an owner who underestimates profit faces no repayment ceiling: every dollar of extra credit can be reclaimed at filing.
Lean early years and heavy reinvestment years often qualify. In that case HealthCare.gov is generally where your family pays least, because the credit is spent only on marketplace plans.
Run every family member's pediatrician and specialists past the network. All Texas marketplace options are HMO, EPO or POS designs, and they vary a lot in which doctors they include. Revise your profit estimate whenever a big contract or a bad quarter shifts it.
Next step: Grab last year's business return and your read on this year, and we'll match an estimate to a plan that keeps the family's doctors.
Without a credit, the household pays full freight per person, and every option still has network limits. That's the point many Texas owners step off the marketplace.
With an underwritten nationwide PPO, each applicant's health answers go to the insurer, which accepts the application, rejects it, or accepts it with a named condition left uncovered. A healthy family often pays less than the marketplace's full price and gets a network that works on business trips and vacations alike. Each policy lists its own benefits, and we'll go over them carefully.
Next step: Phone me, and I'll quote a nationwide PPO for the whole family alongside the marketplace plans in your county.
Keep that person on the marketplace even at full price. Marketplace insurers accept everyone and can't price by medical history; underwriters can.
The real choice then is which network includes that family member's specialists and how its referral process works.
Next step: List the doctors and medications your family relies on, and I'll find which county plans include them.
Plenty of owners pay themselves next to nothing while a company gets going. Texas makes that risky. Picture three numbers: a parent's Texas Medicaid ceiling at 15% of the federal poverty level, a credit that generally begins at 100% of it, and nothing in between, because Texas declined the Medicaid expansion.
A startup year is the time to forecast honestly, knowing one good contract can lift the whole year.
Next step: Before enrolling in that first lean year, call me and we'll work out what your household qualifies for.
Straight answers, no sales pitch.
No. Texas's 834 individual medical plans on HealthCare.gov are HMO, EPO or POS plans. A healthy family can get a nationwide PPO privately through me.
On HealthCare.gov or the private market. SHOP is for businesses that employ at least one person who isn't an owner or relative.
You may have to return extra credit, and since 2026 there's no repayment cap. Update HealthCare.gov as profit changes.
Often, through the self-employed health insurance deduction, which can't exceed the business's net profit. Check the specifics with your tax preparer.
Start with how the company is organized, its rough profit, your county, and the family members who need coverage. I'll come back with the option I'd pick in your position and what it would run.
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