You can still get a nationwide PPO in South Dakota. In Aberdeen the marketplace sells PPOs and HMOs, at very different prices. Here's how plumbers with a lean-winter, busy-summer year are choosing.
Hi, I'm Sam Jaber. Health insurance is the only thing I sell. My office is in Tampa, my license covers South Dakota, and I work with clients over the phone.
Think of a plumber in Aberdeen running a two-truck shop. January and February bring frozen supply lines in farmhouses, a burst pipe in a closed-up lake cabin, and water heaters that quit on the coldest night of the year. Once the ground thaws, it's yard hydrants, livestock waterers and service lines on farms across Brown and Edmunds counties, and rough-ins for new houses on the edge of town. Late fall is quieter. He and his wife cover themselves and a teenager, and the household's income looks very different in March than it does in August.
So, first: you can still get a nationwide PPO in South Dakota, and I can set one up for an Aberdeen family.
Two insurance companies sell Brown County's 41 marketplace medical plans for 2026, split into 20 HMOs and 21 PPOs. Price one 40-year-old on silver, no credit applied, and the lowest-priced PPO comes in 29% above the lowest-priced HMO. An HMO generally pays only for its own network unless it's an emergency. A PPO pays part of an out-of-network visit without a referral, and that's what the extra money buys. A private nationwide PPO, priced after a health review, is a third option.
The marketplace prices your credit off the household's expected net income for the coverage year: receipts minus trucks, fuel, pipe and fittings, the drain machine and camera, licensing and liability coverage. With a seasonal shop the danger is guessing low in a year that turns out busy, because some of the credit can come back as a bill at tax time. Use your last two or three years as a guide, then log in and change the estimate when the season tells you which way it's going.
Most families like this one do. HealthCare.gov is then usually the lower-priced route, since the credit only works there. In Brown County the HMOs are well under the PPOs, so if your family doctor and the hospital you'd use are in one HMO's network and you seldom need care elsewhere, the HMO is the better buy. If your teenager plays sports that travel, or you see a specialist in Sioux Falls or Fargo who isn't in that network, the PPO's extra cost starts to make sense.
Next step: Send me last year's return and your family's doctors, and I'll price Brown County's HMOs and PPOs with your credit applied.
If a hard winter and a busy summer stack up, the household can earn past the credit range, and every Brown County plan goes to full price. For a healthy family, that's when a medically underwritten nationwide PPO is worth quoting. Everyone answers health questions; the insurer can take the family, take it with an earlier condition excluded, or decline. Healthy applicants often come in under the marketplace's full price, with a network that works outside South Dakota. A family member with an ongoing condition is better served staying on HealthCare.gov, where nobody can be refused or charged more for health.
Next step: Call me with everyone's birth year and any health history, and I'll put a nationwide PPO quote beside Brown County's full prices.
Some years the freeze calls never come. South Dakota's constitution has required Medicaid expansion since July 1, 2023, after voters approved it in November 2022, and KFF lists the adult limit at 138% of the federal poverty level. Starting January 1, 2027, adults 19 through 64 on expansion will need to show 80 hours a month of work, job training, community service or school unless they're excluded, and their coverage will be renewed every 6 months. Work is one of the listed activities, so keep a record of your hours and jobs.
Next step: Tell me what the last few months brought in, and we'll work out whether Medicaid or a credit-reduced Brown County plan fits this year.
Straight answers, no sales pitch.
Yes. For a 40-year-old on silver, before credits, the least expensive PPO costs 29% more than the least expensive HMO.
Yes. Voters approved it in November 2022, and coverage began July 1, 2023. KFF puts the adult limit at 138% of the federal poverty level.
Starting January 1, 2027, expansion adults 19 through 64 must show 80 hours a month of qualifying activity unless excluded.
You could owe some of the credit back when you file, so update it on HealthCare.gov as soon as you see the year changing.
Tell me your county, who's on the plan and roughly what the shop clears in a slow month and a busy one. I'll price Brown County's HMOs and PPOs with your credit and check whether Medicaid applies.
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