You can still get a nationwide PPO in Iowa through me, and the Iowa Great Lakes are one of the few places where the marketplace sells a PPO, priced below its HMOs. Here is how local owners choose.
Hi, I'm Sam Jaber. I run my brokerage from Tampa, I'm licensed in 36 states, and I help Iowa business owners cover their families over the phone.
Imagine a couple in Spirit Lake who run a boat service and storage business on the Iowa Great Lakes as an LLC: spring launches, summer repairs, fall winterizing, and indoor storage that pays the bills through the cold months. They have two kids in grade school. When the family needs a specialist, they usually drive to Sioux Falls, about ninety minutes away in South Dakota. No one in the house has a job with benefits, so they buy coverage on HealthCare.gov, and Dickinson County gives them something most Iowans don't get: a marketplace PPO that's priced below the HMOs.
Dickinson County has 28 individual medical plans for 2026 from three insurers: 12 PPOs, 9 EPOs and 7 HMOs. Statewide, marketplace PPOs show up in only 7 of Iowa's 99 counties, and this is one of them. Here the PPO is the bargain: compare silver plans for a 40-year-old without a subsidy, and the most affordable PPO comes in 9% under the most affordable HMO.
Outside the marketplace, you can still get a nationwide PPO in Iowa through me, underwritten person by person, with a network that reaches across the country. For this family, the comparison is between two PPOs.
The marketplace credit follows household income for the coverage year: the business's profit after parts, fuel, storage-building costs, insurance and seasonal help, plus any other household income. Help continues until income passes four times the federal poverty level, and that ceiling grows with every person in the house.
In a very lean year, adults may qualify for the Iowa Health and Wellness Plan, the state's Medicaid expansion, at incomes up to 138% of the poverty level, per KFF. Owners whose estimate climbs during a strong summer should update it; for tax years after 2025, there's no cap on repaying excess credit.
Buy on HealthCare.gov, the only place the credit applies. Normally a PPO costs extra, but in Dickinson County the silver PPO is less expensive than the HMOs. An HMO or EPO generally pays outside its network only in emergencies, while a PPO keeps paying at a higher share for you. For a family that travels to Sioux Falls for specialists, a credit-backed marketplace PPO is very likely the best value in the county; check that your Sioux Falls doctors are covered on the terms you expect.
Next step: Share each family member's doctors, Sioux Falls specialists included, with last year's return, and you'll see Dickinson County's plans after the credit.
Above the credit line, all four of you pay full price. Compare the marketplace PPO with a private nationwide one. On the private side, each person answers health questions, and each comes back approved, approved minus one listed condition, or declined. Healthy families often pay below the marketplace's full rate. We compare benefits before you pick.
Next step: Phone me, and I'll set a nationwide PPO quote for the family against Dickinson County's full-price PPO.
A first non-family employee who owns no share of the business can open the door to SHOP, the small-business marketplace, and a group plan. It's worth pricing, but it doesn't automatically beat the family's own coverage.
Next step: Before the new hire starts, call me and we'll weigh a group plan against what the family has now.
Straight answers, no sales pitch.
Yes, 12 of them in Dickinson County, and at the silver level the PPO undercuts the HMOs by 9%.
In 7 of Iowa's 99 counties, all in the northwest.
Through SHOP, after it employs at least one person who is neither an owner nor a relative.
Yes. If the family is healthy, I can arrange one outside the marketplace.
Tell me where you live, how old each family member is, roughly what the business made and where you travel for specialists. I'll price both PPO routes and tell you which I'd buy.
The guide for every state, and other work I help with