You can still get a nationwide PPO in Florida. Here is how owners of Florida LLCs, S-corps and small shops are covering themselves and their families after a steep price jump.
Hi, I'm Sam Jaber, a licensed broker based in Tampa. I help people who run their own companies, and plenty of them are right here in Florida: single-member LLCs, S-corps with a spouse on payroll, small shops with a few employees. I'm licensed in 36 states and I handle everything by phone.
A Florida owner shopping for coverage this year runs into a market that changed fast. Prices for individual plans jumped, the marketplace's PPO is priced far above its other plans, and the state's safety net has a gap at the bottom that can catch a startup year. Here's how owners are working through it.
Before anything else: you can still get a nationwide PPO in Florida, through me, and for a healthy owner and family it can fit a business budget.
Owners tend to assume otherwise after a look at HealthCare.gov. One insurer offers the PPO statewide, and its price stands far above the rest. In Broward County the marketplace PPO runs 137% more than the least expensive silver plan on another network, in Seminole 151% more, and in Palm Beach 120% more. For a family at full price, that difference adds up fast.
Medically underwritten private plans are the other path to a PPO. They're built on national networks and priced on the health of the people applying, which is where a healthy family can come out ahead.
Does your household qualify for the premium tax credit? In Florida you buy individual coverage through HealthCare.gov, and the credit is figured from household income for the coverage year. For a sole proprietor or single-member LLC, that starts from net profit. For an S-corp owner, your salary and the profit that passes through to your return both count.
The answer carries more weight than usual right now. Approved increases for Florida's 2026 individual plans averaged 34.1%, by the regulator's enrollment-weighted count, before subsidies. If you get the credit, much of that is cushioned. If the business earns too much for the credit, you absorb it.
Pick the scenario that fits.
Early years, reinvestment years and slim years often land here. When they do, a marketplace plan with the credit is generally the most economical way for a Florida owner to cover the household, since no plan outside HealthCare.gov can use the credit.
Look closely at networks. Of the 410 plans in Florida's marketplace file, 316 are HMOs, so most choices will use a set local network and referrals. Make sure the doctors your family uses are inside it. And revisit your profit estimate during the year. A strong second half can push income past what you reported, and the extra credit is settled on your return.
Next step: Bring last year's return and a sense of this year's profit, and we'll choose a plan that fits both the estimate and your family's doctors.
Past the credit range, Florida's price jump lands on the business owner in full. Covering a spouse and kids at those rates, and paying roughly double for the marketplace's only PPO, is where many owners start looking elsewhere.
An underwritten nationwide PPO asks everyone being covered to answer health questions. The insurer then approves the application, declines it, or approves it with a condition excluded. When the household is healthy, the price can fall well below the full marketplace rate, and the network isn't confined to one part of Florida. Benefits are set plan by plan, so we read each one closely.
Next step: Call me and I'll price a nationwide PPO for your household against the marketplace plans sold in your county.
If a spouse or child lives with a chronic condition, keep that person's coverage on the marketplace, full price or not. Marketplace plans can't refuse anyone or charge more for health history. Underwritten plans can.
In Florida, the real decision becomes which marketplace network covers the care your family relies on, and whether the PPO's higher price buys access to a doctor the HMOs don't include.
Next step: Send me the doctors and prescriptions that matter, and I'll show you which Florida plans in your county include them.
A new company often takes a while to pay its owner. In Florida, a very low year has a hidden risk. The state has not expanded Medicaid, and the marketplace credit generally starts at 100% of the federal poverty level, so a household whose income lands below that line may qualify for neither.
The fix is planning, not guessing. We look at what the business is likely to net across the whole year before you apply, so you know where you stand.
Next step: Call me before you enroll, and we'll work through what your household qualifies for in a startup year.
If you have at least one employee who isn't an owner or a family member, the small-business marketplace, called SHOP, may be open to you for a group plan. Contractors you pay on a 1099 don't count. Whether a group plan beats each person buying individual coverage depends on your team, and in Florida's current market it's worth pricing both ways.
Straight answers, no sales pitch.
Yes, if your household income for the year falls in the credit range. In Florida you apply through HealthCare.gov, and your income starts from the business's net profit.
Only one insurer sells it, and in most counties it costs about twice the least expensive plan on another network. Healthy owners often price a nationwide PPO outside the marketplace instead.
Be careful. Florida hasn't expanded Medicaid, and the tax credit generally isn't available below the poverty level, so a very low year can leave you in a gap. Talk to me before you apply.
If you have at least one employee who isn't an owner or family member, you may be able to use SHOP. A business with no employees buys individual coverage.
Your county, how the business is set up, roughly what it netted, and who needs coverage. I'll explain which route fits and price it for where you live, and if what you have now is already the smart choice, you'll hear that from me.
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