You can still get a nationwide PPO in Delaware. For a Wilmington contractor whose family's care runs up I-95 into Pennsylvania, the marketplace's PPO costs a bit more, and here's how to tell if it's worth it.
Hi, I'm Sam Jaber. I sell health insurance and nothing else, under a Delaware license, and I work with Delaware clients by phone.
Picture a contractor in Wilmington. Most of his work is gut renovations of rowhouses in Trolley Square and the neighborhoods around the city, kitchens and additions out in Brandywine Hundred, and the occasional new house down Route 1 near Middletown. He runs a small crew and subs out the rest. His wife runs a small bookkeeping practice from home, so the household buys its own coverage. Their daughter has epilepsy and has seen the same neurology team in Philadelphia since she was small, a 40-minute drive up I-95.
For this family: you can still get a nationwide PPO in Delaware, and I can price one for a Wilmington household.
On the marketplace, Delaware sells the same 40 medical plans in all three counties for 2026, from 3 insurance companies: 17 EPOs, 15 PPOs and 8 HMOs. Here the PPO is the premium option. Price it for one 40-year-old buying silver, credit not yet applied, and the lowest PPO runs 6% over the lowest HMO and 17.5% over the lowest EPO. An HMO generally pays nothing out of network except in an emergency; a PPO pays part of an out-of-network visit without a referral. For a child whose specialists are in another state, that difference can matter more than the premium.
Before talking price, we look up the daughter's neurologist and the Philadelphia hospital where she's treated, plan by plan. If one of the lower-priced HMOs or EPOs includes them, the choice gets easier. If none does, the PPO is the plan that still pays something there.
Then the household's estimated net income for the coverage year, which for a renovation contractor is billings minus subs, materials, dumpster and equipment costs, the truck, permits and liability coverage. That number sets the credit.
Whether a private nationwide PPO is open to your daughter depends on her condition, so tell me what's going on and I'll price that route as well. On the marketplace, if the Philadelphia team is out of every HMO and EPO network, I'd usually choose the PPO, even at 6% more than the lowest HMO, because an HMO would leave her regular visits unpaid outside an emergency. If the team is in one of the lower-priced networks, take that plan instead.
Next step: Send me her neurologist's name and the hospital, and I'll check every Delaware plan's network for them.
For a family that sees doctors only in Delaware, the honest answer leans away from the PPO. The credit is a fixed amount set by the benchmark silver plan, not by your choice, so every dollar the PPO costs above a lower-priced HMO or EPO comes out of your pocket. If your doctors are in one of those networks, that's usually the better buy.
Next step: Bring last year's return and a list of your doctors, and I'll price Delaware's HMOs and EPOs against the PPO with your credit applied.
When the company has a big year and the household earns past the credit range, all 40 plans are full price. If everyone is healthy, a medically underwritten nationwide PPO should be quoted. Each person answers health questions; the insurer accepts, accepts while excluding one past condition, or declines. Healthy families often pay less than the marketplace's full price, and the network reaches Pennsylvania, Maryland and New Jersey as easily as Delaware.
Next step: Tell me everyone's birth year and health history, and I'll be straight with you about whether underwriting makes sense.
Straight answers, no sales pitch.
Yes. For a 40-year-old on silver before credits, it costs 6% more than the least expensive HMO and 17.5% more than the least expensive EPO.
Only if that specialist is in the HMO's network, or in an emergency.
No. It's set by the benchmark silver plan, so the PPO's extra cost is yours.
No. For 2026 the same 40 marketplace plans are sold in all three Delaware counties.
Your family's doctors in Delaware and Pennsylvania, who's on the plan, and what the company netted last year. I'll check them against Delaware's HMOs, EPOs and PPOs and price a nationwide PPO beside them.
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