A nationwide PPO is still available through me in South Dakota. Let's look at how a Rapid City worker starting her own business can weigh her former employer's coverage against marketplace options and a private PPO.
Hi, I'm Sam Jaber. I hold health insurance licenses in 36 states and regularly help people earning 1099 income. If you're in South Dakota, we can handle your coverage together entirely by phone.
Picture a Rapid City graphic designer who worked at a small downtown marketing company for six years. This spring, she decided to go solo. Now she designs for Black Hills businesses, including campgrounds around Custer, Keystone gift shops, and trail outfitters near Hill City. Business is booming from Memorial Day until summer ends, then slows as tourists leave. Her employer's health coverage expires at the end of her final paycheck month. With that deadline approaching, she needs to choose between three coverage routes.
For 2026, three insurers offer 28 individual marketplace medical plans in Pennington County. Of those, 21 are PPOs and 7 are EPOs. That means Rapid City residents do have marketplace PPO choices without a big price difference. Comparing the lowest-priced silver plans for a 40-year-old before subsidies, the PPO premium is just 6% higher than the EPO.
I can also help you enroll in a private nationwide PPO outside South Dakota's marketplace. Your health determines eligibility and pricing, and its network extends beyond state lines for family travel or projects with clients elsewhere.
One route is to stay with your former employer's insurance. Under South Dakota law, departing workers can maintain group coverage for as long as eighteen months. The catch is that you become responsible for the entire premium, including what your employer previously contributed.
Another option is HealthCare.gov, where losing employer insurance generally opens a 60-day enrollment period. Or, if you're healthy and earn too much to receive financial assistance, you can consider a private nationwide PPO.
Your projected earnings are what drive the decision. When you start contracting, estimate your annual net self-employment income after deducting software, equipment, home office expenses, and mileage to Black Hills clients. As your actual earnings become clearer, revise that projection.
When projected income falls within 100% to 400% of the poverty line, marketplace credits generally make that coverage more economical than paying the full continuation premium. The PPO costs 6% more than the EPO but includes out-of-network benefits. EPOs typically restrict coverage to network providers except for emergencies. If you stay around Rapid City and your doctors participate, the EPO likely makes more sense. But if you need access to specialists outside that network, paying extra for the PPO could be worthwhile.
Next step: Give me your doctor list and an estimate of your first-year earnings. I'll compare Pennington County PPO and EPO prices after your credit.
Once income exceeds four times the poverty level, the credit disappears. Then you're comparing continuation coverage with a private nationwide PPO. Let me price the PPO before you choose continuation. The insurer asks medical questions and can approve you, approve you with one condition excluded, or decline. Healthy contractors may pay less than full marketplace premiums. I'll lay out all three figures: the private PPO, the unsubsidized marketplace plan and your continuation premium. Then we'll compare the benefits carefully.
Next step: Get in touch before the deadline to elect continuation. I'll compare its premium with a private PPO quote.
Tourist-season earnings can make a new contractor's first year look stronger than it finishes. If annual income ends up at or below 138% of the poverty level, KFF identifies that as South Dakota's adult Medicaid threshold. State guidance also says that beginning January 1, 2027, most expansion adults ages 19 through 64 must complete 80 hours monthly of employment, education, training, or volunteer activities. Their expansion coverage renewals will also occur every 6 months.
Next step: If business slows and your earnings fall short of expectations, call me before applying. We'll check where your income falls relative to that cutoff.
Already receiving treatment? Continuing your employer plan may preserve access to your existing network while you make the transition. Your next choice depends on the care involved. Explain your treatment situation, and I'll compare private coverage with Pennington County plans while checking the specialists you're currently seeing.
Next step: Share your medications and treating providers with me. I'll find out which Rapid City plans include that care in their networks.
Straight answers, no sales pitch.
In most cases, yes. South Dakota permits continuation for up to eighteen months, provided you cover the entire premium yourself.
Yes. There are 21 PPO options on Pennington County's marketplace. Its lowest-priced silver PPO carries a premium 6% higher than the lowest-priced silver EPO.
You generally have 60 days after your existing insurance ends to enroll through HealthCare.gov.
Yes. If you're a healthy contractor, I can help you purchase a private nationwide PPO.
Let me know when your employer coverage ends, who needs insurance, and your projected net earnings from 1099 jobs this year. I'll compare your existing coverage, Pennington County marketplace plans, and a private nationwide PPO.
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