You can still get a nationwide PPO in West Virginia through me. Here is how an agent selling to buyers who move out from the DC suburbs prices her own coverage in a high-cost state.
Hi, I'm Sam Jaber, a broker in Tampa with licenses in 36 states. I help West Virginia real estate agents get their health coverage in order, all by phone.
The agent I'm thinking of works out of Charles Town. Her buyers are mostly families leaving Loudoun and Fairfax counties for more house and more land: new builds outside Ranson, older homes in Shepherdstown, a few places near Harpers Ferry with a view of the rivers. Many of them still commute toward Washington. She moved from Virginia herself a couple of years ago, and the first thing she heard about West Virginia health insurance was that it costs a fortune. That's partly true, and her corner of the state is where it's least true.
Every county in West Virginia gets the same marketplace menu for 2026: 37 individual medical plans from two insurers, with all 15 PPOs coming from one company and all 22 HMOs from the other. On price the PPO comes out ahead. In every county, the least expensive silver PPO is 3.5% below the least expensive silver HMO for a 40-year-old before any subsidy.
You can still get a nationwide PPO in West Virginia through me as well, sold privately and priced on your health. Its network isn't tied to one state, which suits an agent whose doctors may still be on the Virginia side of the line.
Statewide, prices are steep. KFF's average benchmark silver premium for a 40-year-old in West Virginia is the third highest among the states and DC for 2026, and it rose 16.8% from 2025. Location matters a lot, though. The least expensive silver plan in Jefferson and Berkeley counties is as low as anywhere in the state; the same plan costs 24% more in Cabell County.
The credit itself depends on household income for the coverage year. For an agent that's commission after the brokerage split, MLS and board dues, lockbox fees, photography and the miles between Charles Town and the Virginia line. It stops above four times the federal poverty level.
The credit is tied to the second-lowest-cost silver plan and doesn't grow if you choose something pricier. Here that helps you. Because the least expensive silver plan is a PPO, you get out-of-network coverage without paying extra for it. An HMO generally pays only inside its network outside an emergency, while a PPO still pays for providers outside it, at a higher cost to you.
So for most agents in the credit range, the silver PPO is the better buy. Pick the HMO only if your own doctors are in its network and not the PPO's, since in West Virginia the choice of plan type is also a choice between the two companies.
Next step: Send me your doctors and an estimate of this year's net commissions, and I'll show you the Jefferson County PPO and HMO after the credit.
Above four times the poverty line you pay the full price, and in West Virginia that's a large number even in the Panhandle. That's where a private nationwide PPO deserves a look. The insurer reviews your medical history and approves you, approves you with one condition excluded, or declines. A healthy agent often comes in under the marketplace's unsubsidized price, and I'll walk you through each plan's benefits before you commit.
Next step: Call me when you can see most of the year's closings, and I'll put a private PPO quote next to the full-price Jefferson County plans.
That person stays on a marketplace plan, whether or not you get a credit, because those plans accept everyone and can't charge more for health history. With two companies in the market, the real decision is which network has your specialists and the hospital you'd use, in West Virginia or across the line.
Next step: List your family's doctors and prescriptions, and I'll check which Jefferson County plans keep them.
If the whole year comes in very low, KFF lists West Virginia's Medicaid limit for adults at 138% of the federal poverty level. The state says that from January 1, 2027, certain adults 19 through 64 in the Adult Expansion Group must log 80 hours a month of qualifying activities, and seasonal workers may qualify based on their six-month average income. Ask how that applies to a commission year before you count on it.
Next step: If the year looks thin, talk to me before renewal, and we'll work out where your household lands.
Straight answers, no sales pitch.
Yes, compared with the rest of West Virginia. The least expensive silver plan in Jefferson and Berkeley counties is as low as anywhere in the state, and Cabell County's costs 24% more.
The PPO. In every county the least expensive silver PPO costs 3.5% less than the least expensive silver HMO.
KFF ranks the state's 2026 average benchmark premium for a 40-year-old third highest among the states and DC.
Yes. If you're in good health, I can set one up privately, outside the marketplace.
Tell me your county, who you're covering and a rough number for this year's commissions after your split. I'll price the Jefferson County marketplace and a private nationwide PPO and tell you which I'd choose.
The guide for every state, and other work I help with