You can still get a nationwide PPO anywhere in Virginia, even where the state marketplace sells none. Here is how agents paid at closing are choosing coverage around commissions and their health.
Hi, I'm Sam Jaber, a licensed health insurance broker. I work from Tampa, hold licenses in 36 states, and help Virginia agents by phone, whether your listings are townhomes in Arlington or acreage near Roanoke.
Virginia does things its own way. The state runs its own exchange, Virginia's Insurance Marketplace, rather than HealthCare.gov. Its only PPO is confined to a corner of Northern Virginia. And Medicaid reaches adults up to 138% of the poverty line. For an agent with uneven commissions, all three matter.
Virginia's marketplace lists 83 individual medical plans this year. Four are PPOs, all from one insurer, and they're sold only in seven Northern Virginia localities: Alexandria, Arlington, Fairfax City, Falls Church, and parts of Fairfax, Loudoun and Prince William counties. Even there, the lowest-priced silver PPO runs 131% more than the lowest-priced silver plan on another network. From Richmond, Norfolk or the Shenandoah Valley, there's no marketplace PPO at all.
You can still get a nationwide PPO anywhere in Virginia, through me. It's an underwritten private plan, priced on your health, with a national network and no referral needed to see a specialist. If you're healthy, put it next to whatever the marketplace shows for your locality.
Your household income for the coverage year places you in one of three bands. Up to 138% of the federal poverty level, Virginia's expanded Medicaid may cover you, and Medicaid eligibility generally means no marketplace credit. Above that, the premium tax credit lowers what you pay on Virginia's Insurance Marketplace. Beyond the credit range, you pay the full price.
For a self-employed agent, income is net commission after the split, dues, fees, marketing and mileage. Because closings arrive in clumps, keep your estimate current. For tax years after 2025, there's no ceiling on repaying credit you received but didn't qualify for.
Here a plan on Virginia's Insurance Marketplace is usually your best value, since the credit works only on marketplace coverage. Most options are HMOs or EPOs, so check your doctors against each network first.
When a large closing funds, update your income with the marketplace instead of waiting for tax season.
Next step: Send me last year's numbers and what's under contract, and we'll set an estimate and pick a plan your doctors accept.
Past the credit range, you're paying full price for HMOs and EPOs, or, in Northern Virginia only, for a PPO priced at more than double. Healthy team leads and top producers often do better privately.
The underwriter reviews your health answers and offers coverage, declines, or offers it with a specific condition excluded. A healthy agent can often pay less than the full marketplace rate and get a network that works in every state. Benefits vary by policy, and we'll read them together.
Next step: Call me, and I'll quote a nationwide PPO for your household next to the marketplace plans in your locality.
Virginia gives you a floor. With income up to 138% of the poverty level, adults can qualify for the state's expanded Medicaid. When a closing lifts you above that line, the marketplace credit takes over, so report the change and move.
Next step: If the year looks thin, call me and we'll figure out which side of the Medicaid line you're on and what happens when the next deal closes.
Even at full price, a household with ongoing care needs usually belongs on the marketplace, where insurers must accept you and can't price by health history.
The decision then comes down to which HMO or EPO in your locality includes your specialists, or, in Northern Virginia, whether the PPO's higher price buys access to a doctor the others leave out.
Next step: Give me your doctors and medications, and I'll find the Virginia plans that cover them.
Straight answers, no sales pitch.
Only in parts of Northern Virginia, from a single insurer, and at a steep premium. Elsewhere in the state there isn't one. A healthy agent anywhere in Virginia can get a nationwide PPO privately through me.
No. Virginia runs its own exchange, Virginia's Insurance Marketplace.
Possibly. Virginia expanded Medicaid to adults with income up to 138% of the poverty level.
You may owe back extra credit, and for tax years after 2025 there's no cap on that repayment. Update the marketplace when a big deal closes.
Tell me your city or county, who's on the plan, and about what you kept after the split last year. I'll show you whether Medicaid, a marketplace plan or a nationwide PPO fits and what each would cost.
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