You can still get a nationwide PPO in Florida. Here is how practice-owner dentists are buying medical coverage for their families in a market that got pricier this year.
Hi, I'm Sam Jaber. I'm a licensed health insurance broker based in Tampa, I'm licensed in 36 states, and I help Florida families by phone from the Panhandle to the Keys.
A quick note before anything else: this page is about medical coverage for you and your family, not dental benefits. Dentists searching for help with their own health plan land on a lot of dental insurance ads, so I want to be clear about what we're solving.
Practice owners in Florida have had a rough year on this front. Full marketplace prices rose a lot, and the one PPO on the marketplace costs far more than anything else on the shelf. Here's how dentists are working through it.
Here's the main thing to take away: you can still get a nationwide PPO in Florida, and if your household is healthy, it's often the option that makes the most sense for a practice owner.
On HealthCare.gov, the PPO picture is discouraging. A single company sells the marketplace PPO, and while it's offered in all 67 counties, it costs a lot more than the plans next to it. Measured against the least expensive plan with a different network type in the same county, it runs 108% more in Brevard, 110% more in Volusia and 103% more in St. Johns. Statewide, the typical county gap is about double.
Outside the marketplace, private plans with medical underwriting run on PPO networks that cover the whole country. Their price depends on your household's health rather than the marketplace's rates.
The first question is whether your household qualifies for the premium tax credit on HealthCare.gov. The credit is based on household income for the coverage year, and for an owner that's what's left after the practice's expenses, not what the schedule produced. The cutoff is around four times the federal poverty level, higher for bigger households.
An established practice usually leaves its owner above that line. And above the line in Florida this year, you pay the full price after an average approved increase of 34.1% on 2026 individual plans, as reported by the state's regulator on an enrollment-weighted, pre-subsidy basis.
A practice purchase or a buy-in can change that picture for a year or two, though. Loan payments and new equipment can pull your personal income down a long way. Find your situation below.
For this household, the full marketplace price is the problem, and the marketplace PPO is roughly twice the cost of the other plans in your county.
A medically underwritten nationwide PPO is what I'd price first. Each person on the application answers health questions. The insurer then accepts the application, declines it, or accepts it with a particular condition excluded. When everyone is healthy, that screening is what lets the price come in below the full marketplace rate.
Benefits are set plan by plan, so we read what any plan you're considering actually pays before you choose. And we check that your family's physicians, here and anywhere the kids are at school, are in the network.
Next step: Call me and I'll set a nationwide PPO quote beside the marketplace plans for your county so the difference is plain.
If the buy-in or the loan payments push your household into the credit range, a HealthCare.gov plan with the credit is usually the most affordable coverage available to you. Nothing outside the marketplace can use the credit.
Two cautions for a Florida household here. First, the estimate: if the practice performs better than you projected, some of the credit can be owed back when you file. Second, the floor: Florida has not adopted the Medicaid expansion, and the credit generally starts at the federal poverty level, so a household whose income dips extremely low may qualify for neither. If your first-year projection is very low, talk to me before you enroll.
If you're leaving an associate job with benefits to do this, losing that coverage also opens a special enrollment window, generally 60 days long.
Next step: Send me your lender's or accountant's projection for the year and I'll help you set an estimate and pick a plan around it.
A chronic condition or a daily prescription in the family usually keeps you on the marketplace, even at full price. Marketplace plans must accept everyone and can't price based on health. An underwritten plan can decline someone or exclude the one condition you need covered.
Most Florida marketplace plans are HMOs or EPOs built around local networks. If your family's doctors are in one of those, that can be the sensible choice. If a key specialist is only reachable through the marketplace PPO, its higher price may be worth paying for your family.
Next step: Give me the doctors and medications your family depends on and I'll check them against every plan type sold in your county.
If you have no employees, you buy your own coverage like any self-employed Floridian. Contractors you pay don't count as employees. Once you have at least one employee who isn't an owner or family member, a small-business plan may become possible, which is a separate decision with its own rules. Your own household's coverage can still be handled on its own.
Straight answers, no sales pitch.
Yes. This is medical coverage for doctors, hospitals and prescriptions. Dental benefits for you or your patients are a separate kind of plan.
There is one, sold statewide by a single insurer. In most counties it costs far more than the least expensive plan with another network type, about twice as much in the typical county.
Approved 2026 rates for individual plans went up 34.1% on average, according to the state regulator, before subsidies. An owner above the credit range carries that whole increase.
That's what a nationwide network is for. If your household is healthy, I can price private underwritten plans on nationwide PPO networks for Florida families.
Your Florida county, who's on your plan, and roughly what you drew from the practice last year. I'll lay out the path that fits and what it costs, and if your current plan is already the right one, I'll tell you to keep it.
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