You can still get a nationwide PPO anywhere in Virginia, even where the marketplace sells none. Here is how owners of Virginia LLCs, S-corps and small shops are covering themselves and their families.
Hi, I'm Sam Jaber. I'm licensed in 36 states, I work out of Tampa, and Virginia owners reach me by phone whether they run a consulting LLC in Herndon, a family S-corp in Richmond or a contracting crew in the Shenandoah Valley.
Running a company in Virginia means shopping a market the state manages itself. Virginia's Insurance Marketplace replaces HealthCare.gov, a state reinsurance program works in the background on premiums, and the one PPO on the marketplace never leaves Northern Virginia. Medicaid, meanwhile, reaches adults up to 138% of the poverty line. Each of those shapes what an owner should buy.
Count the shelf and the picture is clear: 83 individual medical plans for this year, of which 60 are HMOs and 19 are EPOs. Only 4 are PPOs, and those are limited to Northern Virginia, where the least expensive silver PPO is priced 131% above the least expensive silver plan using a different network.
You can still get a nationwide PPO anywhere in Virginia, from Winchester to Wise County, through me. It's a private plan with medical underwriting. Every family member answers health questions, the price follows from those answers, and the network stretches across the country. A healthy family should see that quote before signing up for anything.
Owners usually ask about a group plan first. If the company is just you, co-owners and relatives, the answer is individual coverage, bought on Virginia's Insurance Marketplace or privately. SHOP, the small-business marketplace, becomes possible once you hire someone who isn't an owner or family member, and even then it's worth pricing against individual plans.
The premium tax credit runs off household income for the coverage year. A sole proprietorship or single-member LLC counts net profit. An S-corp owner counts the salary drawn plus the profit passed through to the personal return.
Virginia layers two things around that credit. At the bottom, its Medicaid expansion covers adults up to 138% of the federal poverty level. At the top, the Commonwealth Health Reinsurance Program pays insurers back for part of their most expensive claims, a design meant to keep full-price premiums from climbing as high as they otherwise would.
That's the case where buying on Virginia's marketplace almost always wins, because the credit can't be spent anywhere else. Check pediatricians and specialists against each HMO or EPO network, and revise your profit figure during the year if a contract lands or falls through.
Next step: Walk me through last year's return and this year's outlook, and I'll match an estimate to a plan your family's doctors take.
Above the credit range, you're buying HMOs or EPOs at full price per person, or, in Northern Virginia, a PPO at more than double. That's the usual moment an owner prices a private nationwide PPO.
Each applicant's health history goes to the underwriter, who issues the policy, declines it, or issues it minus coverage for a stated condition. Healthy households often land below the full marketplace price, and kids away at an out-of-state college stay in network. Policies differ in what they pay, so we'll go through them line by line.
Next step: Phone me, and I'll set a nationwide PPO quote for the family against the marketplace options where you live.
New owners often draw almost nothing at first. In Virginia that can mean Medicaid, which covers adults up to 138% of the poverty level. Once profit carries you past that line, move to a marketplace plan with the credit and report the change.
Next step: Before enrolling in a startup year, call me and we'll sort out which program fits the household right now.
A smaller employer that isn't subject to federal COBRA may still owe you continuation under Virginia law: up to 12 months, if you were covered for at least three months. Larger employers offer COBRA instead. Losing job coverage also opens a special window on Virginia's marketplace.
Next step: Call a few weeks before your last day, and I'll price continuation, a marketplace plan and a private PPO for you side by side.
Straight answers, no sales pitch.
Only in Northern Virginia, from one insurer, at a steep price. Elsewhere in the state there's none. A healthy owner anywhere in Virginia can get a nationwide PPO privately through me.
Not through SHOP until you employ someone who isn't an owner or relative. Until then you buy individual coverage.
Yes, if household income is up to 138% of the poverty level, through Virginia's expansion.
A state program, approved under a federal waiver, that reimburses insurers for part of their high-cost claims to lower individual-market premiums.
How is the business organized, roughly what did it clear, which locality is home, and who in the family needs a plan? Those four answers are enough for me to recommend a route and quote it.
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