You can still get a nationwide PPO in South Carolina, and an AC company on the Grand Strand, where salt air and storms keep the vans busy, has good reason to think it through. Here's how coastal owners are choosing.
Hi, I'm Sam. I'm a health insurance broker working out of Tampa, I'm licensed in South Carolina, and I do all of it by phone, which suits an owner who's on a roof in Surfside Beach half the day.
Picture an air conditioning company in Conway with four vans covering the Grand Strand, from North Myrtle Beach down to Pawleys Island and Georgetown. Summers mean no-cool calls in rental condos and beach houses, where the systems run nonstop and salt air eats at the outdoor units. When a tropical storm or hurricane pushes water and wind ashore, the year changes overnight: flooded condensers, wet ductwork in crawlspaces, and a waiting list for replacements. That makes the company's income hard to predict, and the owner picks his own health plan every fall.
Here's the anchor: you can still get a nationwide PPO in South Carolina, and I'll set one up when it's the right fit.
Horry and Georgetown each list 9 PPOs, 13 EPOs and 26 HMOs on HealthCare.gov for 2026, from 3 insurers. For a 40-year-old on silver with no subsidy, the lowest-priced PPO runs 24% above the lowest-priced HMO or EPO in each county. HMOs and EPOs generally pay for out-of-network care only in an emergency. A PPO pays toward doctors outside its network as well, at a higher share for you and with no referral. Private nationwide PPOs are medically underwritten, so the price follows your health.
The premium tax credit is based on household income for the coverage year, which for an AC owner means net self-employment income: revenue minus equipment, refrigerant, parts, the vans, your mechanical license and insurance. You give HealthCare.gov an estimate and change it when the year changes.
A storm year can double the replacement work in a few weeks. As soon as you can see that happening, raise your estimate so the credit adjusts for the months left instead of being reconciled on your return. In a calm season the reverse applies, and a lower estimate can mean a bigger credit.
In the credit range, HealthCare.gov is usually the least expensive way to buy, because the credit only works there. On the Grand Strand the choice is real: if your family wants room to see doctors outside one network, the PPO's 24% markup before credits can be worth paying. If everyone you see is already in an HMO or EPO, that plan stretches the credit further.
Be careful in a lean year, though. There's no Medicaid expansion here, which leaves working adults little Medicaid to fall back on, and the credit generally doesn't start until income reaches 100% of the federal poverty level. An estimate that's too low can cost you the credit entirely.
Next step: Ring me with your county, who's on the plan and last year's profit, and we'll look at the Grand Strand plans priced after your credit.
With four vans and a book of maintenance agreements on condos and rentals, a household often earns past the credit range, and every marketplace plan is then full price. If the family's healthy, weigh a medically underwritten nationwide PPO against it. The insurer reviews your answers to a health questionnaire and then approves, approves with one earlier condition excluded, or declines. Clean answers are how the premium can land below HealthCare.gov's full rate, and the network goes wherever you do, whether that's a supply run to Wilmington or a family visit in Ohio. Benefits are set plan by plan, and we'll compare them side by side.
Next step: Give me your zip and the birthdays on your plan, and a nationwide PPO quote will sit beside the Horry County marketplace prices.
If someone at home lives with a chronic condition or relies on a daily prescription, stay on HealthCare.gov whatever the business earns. Marketplace plans must accept you and may not raise the price over a health history. Then it's about the network, and if a needed specialist isn't in any HMO or EPO network, the PPO may be the plan to choose.
Next step: Tell me the doctors and prescriptions that matter and I'll check them against the Grand Strand plans.
Straight answers, no sales pitch.
Yes. Horry County's 2026 marketplace includes 9 PPOs alongside 26 HMOs and 13 EPOs.
For a 40-year-old on silver before any subsidy, the least expensive PPO is priced 24% over the least expensive HMO or EPO in both counties.
Yes, as soon as you can see the storm work will make the year bigger, so the credit adjusts now instead of at tax time.
No. South Carolina has not adopted the Medicaid expansion.
Your county, everyone you want covered and last year's profit are enough to get going. I'll put the Grand Strand marketplace plans next to a nationwide PPO, with real prices, and tell you which I'd choose.
The guide for every state, and other work I help with