You can still get a nationwide PPO in South Dakota through me. Here is how a Yankton couple living on long-term rents thinks about coverage in the year they trade a fourplex for a bigger building.
Hi, I'm Sam Jaber. I work out of Tampa as a broker licensed in 36 states, and South Dakota landlords set up their health coverage with me by phone.
The investor I have in mind is a couple in Yankton. Over twenty years they've bought older duplexes near downtown, a few houses close to the college campus, and a fourplex a short drive from the Missouri River bridge. Tenants sign year-long leases, so the rent comes in steadily, and that rent is now the household's living. This year they want to trade the fourplex for a larger building through a like-kind exchange, and they've heard that a big transaction can wreck a marketplace credit. Sometimes it does, and sometimes it doesn't.
Yankton County has 32 individual medical plans for 2026 from two insurers: 21 PPOs and 11 HMOs. Here the PPO is the premium option by a wide margin: price the lowest silver PPO and the lowest silver HMO for a 40-year-old, subsidy aside, and the PPO comes out 32% higher.
Outside the marketplace, a nationwide PPO is still available to South Dakotans through me, sold privately and priced on health instead of on the county's rate table. The network is nationwide, so it isn't built around one county, whether you see a doctor across the river in Nebraska or spend a winter somewhere warmer.
The marketplace counts net rental income: rents minus repairs, property taxes, insurance, management, utilities you cover and depreciation, added to anything else the household earns. Premium help stops once modified adjusted gross income passes four times the federal poverty level.
The trade is where it gets interesting. Under federal tax law, swapping investment real estate solely for like-kind real estate generally means no gain is recognized that year. But if you take cash out of the deal, gain is recognized up to the cash you receive, and that recognized gain can raise the income your credit is based on. Your tax preparer will know which way your deal falls; I need that answer before I can price your year.
Your credit is a set amount tied to the benchmark silver plan, so any extra premium for a pricier plan comes out of your pocket. In Yankton County the PPO's extra is 32%. An HMO generally won't pay for care outside its network except in an emergency, while a PPO still pays, with a bigger share left to you.
So for a couple whose doctors all practice in Yankton and take the HMO, the HMO tends to win once the credit is applied. Paying up for the PPO makes sense mostly when a doctor you rely on, maybe in Sioux Falls or Omaha, sits outside the HMO's network.
Next step: Send me last year's Schedule E and your doctors' names, and I'll price Yankton County's HMOs and PPOs after the credit.
Then part of the gain likely shows up in this year's income. If you've been receiving the credit in advance and the year ends higher than you told HealthCare.gov, the extra credit comes back at tax time, and for tax years after 2025 there's no cap on what you repay. Update your estimate as soon as the closing statement is final.
If the year now lands above four times the poverty line and you're both healthy, compare the full marketplace price with a private nationwide PPO. It asks health questions first and then approves you, approves you minus one condition, or declines. Healthy couples often land below the unsubsidized marketplace price, and we'll go over the benefits of each plan before you choose.
Next step: Call me before the exchange closes, and I'll price a private PPO alongside the full-price Yankton County plans for that year.
Keep that spouse on a marketplace plan, with or without a credit. Marketplace plans can't refuse anyone or charge more for health history. With only two insurers in Yankton County, the network that includes the specialist and the hospital you already use matters more than the premium gap.
Next step: Share the specialists and prescriptions involved, and I'll check which Yankton County plans keep them in network.
Straight answers, no sales pitch.
A pure like-kind exchange generally defers the gain, so it doesn't. Cash taken out of the deal generally makes part of the gain taxable that year, which can raise your income.
Yes. In Yankton County the least expensive silver PPO costs 32% more than the least expensive silver HMO, before any subsidy.
Yes. HealthCare.gov counts net rental income, meaning rent after your expenses.
Yes. Investors in good health can buy one privately through me, outside the marketplace.
Tell me your county, who's on the policy, what last year's Schedule E showed and whether a sale or an exchange is coming. I'll price coverage for that year and tell you which way I'd go.
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