You can still get a nationwide PPO in South Dakota, but in Sioux Falls the marketplace's HMOs undercut its PPOs by a wide margin. Here's how electricians with families are choosing.
Hi, I'm Sam Jaber. I'm a Tampa-based broker who does nothing but health insurance, I'm licensed in South Dakota, and I handle everything on the phone, between your service calls.
Here's the electrician I'm thinking of. He works for himself out of Sioux Falls with one apprentice, and the work is everywhere: new houses in Harrisburg, Tea and Brandon, tenant finishes in strip centers along the interstate, service upgrades in older homes near downtown, and the occasional call across the line in Iowa or Minnesota. His wife does the scheduling and invoices. They have three kids, one with asthma who sees a pediatric specialist a few times a year. The household nets enough to live well but still sits inside the credit range most years.
Let me start there: you can still get a nationwide PPO in South Dakota, and I can price one for a Sioux Falls family.
The marketplace has PPOs here, but they cost a lot more than its HMOs. Minnehaha County's 2026 options are 41 medical plans from 2 insurance companies: 21 PPOs and 20 HMOs. For a 40-year-old on silver before any credit, the least expensive PPO costs 30% more than the least expensive HMO, and every one of the 7 silver HMOs comes in under the lowest-priced silver PPO. That's the price of going outside a network without a referral. A nationwide PPO is different again: bought privately, priced after a health review, and not tied to a South Dakota network.
Before we talk price, list the people your family can't do without: the pediatric specialist, the family doctor, the hospital you'd choose. In Sioux Falls, which network those doctors belong to tends to settle the choice faster than any premium does.
Then the number. Your credit rides on the household's estimated net for the coverage year, which for a shop is billings minus the apprentice's wages, the truck, tools, wire and gear, licensing and insurance. Update it when a contract shifts.
This is the most common case I'd expect in Sioux Falls, and the HMO usually wins it. Your credit is figured from the second-lowest-priced silver plan, not the plan you choose, so it doesn't stretch to cover a PPO that costs 30% more. If your son's specialist, your family doctor and your hospital all sit in one HMO's network, that HMO is the better buy. An HMO generally pays nothing out of network except emergencies and may expect you to live or work in its service area, which a family rooted in Minnehaha County does.
Next step: Send me the doctors' names and last year's return, and I'll match them against Minnehaha County's HMOs with your credit applied.
If one child's specialist is in a different network from everyone else, or you'd like a clinic across the border, the HMO stops being simple. That's when the marketplace PPO earns its higher price, or when a nationwide PPO is worth quoting if the family is healthy. We'll price both before you decide.
Next step: Tell me who you see and where, and I'll compare a Minnehaha County PPO with a nationwide PPO for your family.
A strong year of new construction can push the household past the credit range, and then every Sioux Falls plan is full price. With a healthy family, a medically underwritten nationwide PPO belongs in the comparison. Each of you answers health questions, and the insurer agrees to cover you, covers you with an earlier condition excluded, or declines. A child's asthma will come up in those questions and can change the answer, which is why a family like this one often stays on the marketplace. Marketplace plans have to take everyone and can't price health.
Next step: Call me with the family's birth years and health history, and I'll tell you honestly whether underwriting makes sense for you.
Straight answers, no sales pitch.
Yes. For a 40-year-old on silver, before credits, the least expensive PPO costs 30% more than the least expensive HMO.
Two, with 41 medical plans between them for 2026.
Generally only in an emergency, unless that doctor is part of the HMO's network.
No. It's figured from the second-lowest-priced silver plan, so the PPO's extra cost is yours.
Tell me your county, the family members on the plan, every doctor you'd hate to lose and last year's net. I'll show you Minnehaha County's HMOs and PPOs with your credit, and a nationwide PPO.
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