You can still get a nationwide PPO in South Dakota, and around Rapid City the marketplace PPO is priced close to the EPO. Here's how Black Hills contractors are deciding.
Hi, I'm Sam Jaber. I'm a health insurance broker in Tampa, I hold a South Dakota license, and I work entirely by phone, which is handy when you're on a roof outside Hill City with no reason to come down.
Picture a contractor in Rapid City with a small crew. Spring through fall he's framing and finishing homes on the west side of town, putting additions on cabins near Sheridan Lake, and remodeling rentals that fill up with visitors once the summer traffic heads for Mount Rushmore. Snow in the Hills slows outside work, so winter becomes kitchens, basements and bids. His wife keeps the books and his two kids ski at Terry Peak. Some years the household's income lands in credit range. In a busy year it doesn't.
For a builder like that: you can still get a nationwide PPO in South Dakota, and I can arrange it for your household from Rapid City.
The marketplace here sells PPOs too. Pennington County's 2026 lineup is 28 medical plans from 3 insurance companies, 21 of them PPOs and 7 EPOs. For a 40-year-old on silver before any credit, the least expensive PPO costs 6% more than the least expensive EPO. That's a small step up. An EPO pays only its own network outside of emergencies, while a PPO pays something toward providers outside the network with no referral. A nationwide PPO is a separate, privately sold plan, priced after a look at your health.
It comes down to the household's net income for the year you want coverage. For a contractor, that's billings minus the crew, lumber, drywall and trusses, the skid steer and trailer payments, permits and liability coverage. Estimate it honestly, then change it on HealthCare.gov when a job is canceled or a big one signs.
Open enrollment for 2027 runs November 1 to January 15. To have coverage on January 1, choose by December 15. That's after the last exterior work of the season for most crews, so it's an easy time to call.
Then HealthCare.gov is usually where you'll pay least, because the credit can only be used there. With only 6% between the lowest-priced PPO and the lowest-priced EPO before credits, I'd look hard at the PPO here. Your credit is based on the second-lowest-priced silver plan, not the one you pick, so the step up is yours to pay. But it's small, and it buys coverage for the out-of-network doctor the EPO wouldn't pay. If every doctor your family uses is already in an EPO network and you rarely leave the Hills, the EPO is a fine buy too.
Next step: Send me last year's return and a rough picture of this season, and I'll price Pennington County's PPOs and EPOs with your credit applied.
A summer of full books can carry the household past the credit range, and then all 28 Pennington County plans cost full price. That's when a medically underwritten nationwide PPO deserves a side-by-side look.
You'll answer a set of health questions for each family member. The insurer then accepts everyone, accepts with one prior condition written out, or says no. A healthy household often pays less this way than the marketplace's full price. And the network isn't limited to one region, which counts when your kids are at a tournament in Denver or you're visiting family in Minnesota.
Next step: Give me everyone's birth year and the doctors you see, and I'll quote a nationwide PPO against Pennington County's full-price plans.
If a family member sees a specialist or relies on a pricey prescription, keep the household on HealthCare.gov whatever the business makes. Marketplace plans can't refuse you or charge more because of health. Here the PPO is priced close enough to the EPO that it's often the natural home for that care, particularly if the specialist is outside Rapid City. Your general liability and the crew's workers' comp cover jobsite claims, never a family member's illness.
Next step: Tell me the specialist and the prescriptions, and I'll match them to Pennington County's PPO and EPO networks.
Straight answers, no sales pitch.
Yes. Pennington County has 21 marketplace PPOs for 2026, along with 7 EPOs, from 3 insurance companies.
For a 40-year-old on silver, before credits, the least expensive PPO costs 6% more than the least expensive EPO.
No. It's figured from the second-lowest-priced silver plan, so you pay any difference above that.
From November 1 to January 15; pick by December 15 for a January 1 start.
Your county, who's on the plan, the doctors you use and what the business netted last year. I'll line up Pennington County's PPOs and EPOs with your credit next to a nationwide PPO quote.
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