You can still get a nationwide PPO in South Carolina, and a Lowcountry builder should know that the marketplace PPO's markup changes from one county line to the next. Here's how Summerville-area contractors are choosing.
Hi, I'm Sam Jaber, a health insurance broker. I'm based in Tampa, I'm licensed in South Carolina, and every bit of my work with clients happens on the phone.
Picture a builder who lives in Summerville and builds wherever the Lowcountry is growing: new neighborhoods in Dorchester County, remodels in West Ashley, raised homes and storm repairs closer to the water in Charleston and Mount Pleasant. After a hurricane season brushes the coast, the phone fills with roof, siding and flood repair calls on top of the new construction. The business is strong, and he's the one who decides what the family's health plan is each year.
I'll start with what matters most: you can still get a nationwide PPO in South Carolina, and I can arrange it.
HealthCare.gov sells a medical PPO in all 46 South Carolina counties, from one insurer, and what it costs relative to everything else depends on your county. Matching silver plans for a 40-year-old before subsidies, the lowest-priced PPO runs 24% above the lowest-priced HMO or EPO in Dorchester, but 42% above it in Charleston and Berkeley. The median across the state is 28%. HMOs and EPOs generally cover outside doctors only in an emergency, while a PPO pays toward them too, at a higher share for you, without a referral. Away from the marketplace, medically underwritten private plans offer PPO networks that span the country, with premiums set by your health.
Everything starts with whether the household qualifies for the premium tax credit. That's figured from net self-employment income for the coverage year: the company's profit after lumber, trusses, subs, equipment rentals, permits, builder's risk and the trucks. You estimate it when you enroll and update it the moment the year changes shape, which storm work can do in a single week.
For anyone paying full price, the South Carolina Department of Insurance's 2026 summary shows a weighted average increase of 19.49% for individual plans. That's the context for everything below.
This is the Summerville builder in a strong year. No credit means full price for every plan, and the PPO's markup sits on top.
For a healthy family, the comparison to run is a medically underwritten nationwide PPO. You answer a health questionnaire, and the insurer approves you, approves you with one past condition carved out, or turns you down. A clean history is what can bring the premium below the marketplace's full price, and the network keeps working when the family heads to the mountains in North Carolina or follows a kid's travel team to Atlanta. Each plan has its own benefit rules, so we look at them together before you choose.
Next step: Call with your county and everyone's ages, and you'll get a nationwide PPO quote measured against the Lowcountry marketplace prices.
Building has dry spells, and a year with fewer closings can drop the household's net into the credit range. Then HealthCare.gov is usually where coverage costs least, because the credit works nowhere else. If you live in Dorchester, the PPO's smaller markup there makes it worth pricing next to the HMOs and EPOs. In Charleston or Berkeley, the bigger gap usually points to an HMO or EPO whose network your family already uses.
Be careful with a very lean year. South Carolina hasn't adopted the Medicaid expansion, so Medicaid is very limited for working adults, and the credit generally starts only at 100% of the federal poverty level. Estimate honestly and call me before you enroll.
Next step: Send me last year's return and your schedule of closings, and together we'll settle on an income estimate and the plan that fits it.
When a family member manages a chronic illness or needs a daily prescription, stay on HealthCare.gov at any income. Marketplace plans take everyone and can't charge more for a health history. From there, it's a network decision: if that care is with doctors the HMOs and EPOs leave out, the PPO may earn its premium, especially in Dorchester. If the doctors are already in an HMO, keep the savings.
Next step: Give me the doctors and medicines your family depends on, and I'll check them against the plans in your county.
Straight answers, no sales pitch.
Yes. One insurer sells a medical PPO on HealthCare.gov in every one of South Carolina's 46 counties for 2026.
No. For a 40-year-old on silver before subsidies, it costs 24% more than the lowest-priced alternative in Dorchester, and 42% more in Charleston and Berkeley.
The state Department of Insurance's summary shows a weighted average increase of 19.49% for individual plans.
No. South Carolina has not adopted the Medicaid expansion.
Your home county, everyone you want on the plan and a rough figure for what the company netted last year. I'll lay out the marketplace plans where you live next to a nationwide PPO, with prices, and tell you which I'd buy.
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