South Dakota residents can still obtain nationwide PPO coverage. But in Sioux Falls, marketplace HMOs are considerably less expensive than PPOs. Here's how electricians supporting families can weigh those costs.
Hi, I'm Sam Jaber. Health insurance is the only thing I broker, and I'm licensed in South Dakota. We can take care of everything by phone between your electrical service appointments.
Picture a Sioux Falls electrician running his own shop with one apprentice. His schedule includes wiring new homes in Brandon, Tea and Harrisburg, finishing commercial spaces near the interstate, upgrading electrical service in older downtown neighborhoods, and occasionally taking jobs over the border in Minnesota or Iowa. His wife manages appointments and billing. They have three children, including one with asthma who needs a pediatric specialist several times each year. Business is profitable enough to support the family comfortably, but their household income generally remains within the premium tax credit range.
First, nationwide PPO coverage is still an option in South Dakota, and I can quote it for your family in Sioux Falls.
Minnehaha County does offer marketplace PPOs, although its HMOs are substantially less expensive. For 2026, 2 insurance companies offer 41 medical plans: 20 HMOs and 21 PPOs. Looking at silver coverage for a 40-year-old before tax credits, the lowest-priced PPO costs 30% more than the lowest-priced HMO. All 7 silver HMOs are priced below even the least expensive silver PPO. That extra PPO premium buys out-of-network access without referrals. A private nationwide PPO is another category, priced through a medical review and not restricted to a South Dakota network.
Before comparing premiums, let's identify your family's essential providers. That includes the pediatric specialist, your regular physician and the hospital you prefer. In Sioux Falls, finding the network that includes those providers can make the decision much easier than looking at prices alone.
Next comes household income. Your tax credit is based on projected net earnings for the coverage year. For an electrical business, take total billings and subtract the apprentice's pay, truck expenses, tools, wire, equipment, licensing and insurance. Revise the projection when contracts change.
For the typical Sioux Falls household I'm describing, I'd usually lean toward an HMO. The premium tax credit is based on the second-lowest-priced silver plan, regardless of which one you select. It won't fully offset a PPO premium that's 30% higher. If the HMO network includes your child's specialist, family doctor and preferred hospital, that's likely the better value. HMOs generally exclude nonemergency out-of-network care and may require members to live or work within their service area, which suits a household based in Minnehaha County.
Next step: Share the names of your family's doctors and your most recent tax return. I'll check Minnehaha County HMO networks and calculate prices with your credit.
An HMO gets more complicated when your child's specialist isn't in the same network as the rest of the family's doctors, or when you want care across the state border. In that situation, paying extra for a marketplace PPO may be worthwhile. If everyone is healthy, we should also quote a nationwide PPO. I'll show you the costs for both before you choose.
Next step: Let me know which providers your family visits and where they're located. I'll price both a Minnehaha County PPO and a nationwide PPO.
A particularly busy construction year can raise your household income beyond the premium credit limit. That means paying full marketplace rates in Sioux Falls. For a healthy family, it's worth comparing a medically underwritten nationwide PPO. Everyone applying answers health questions, after which the insurer may approve coverage, exclude a prior condition or decline the application. Your son's asthma will be part of that review. Tell me how his condition is managed, and I'll get family quotes before drawing conclusions.
Next step: Give me a call with everyone's birth year and medical history. I'll explain whether a medically underwritten plan makes sense for your household.
Straight answers, no sales pitch.
Yes. For unsubsidized silver coverage at age 40, the lowest-priced PPO premium is 30% higher than the lowest-priced HMO.
There are two insurers offering a combined 41 medical plans for 2026.
Usually only for emergencies, unless the doctor participates in that HMO's network.
No. Your credit is calculated using the second-lowest-priced silver plan, leaving you responsible for the PPO's additional premium.
Give me your county, everyone needing insurance, the doctors you want to keep and your previous year's net income. I'll compare Minnehaha County HMOs and PPOs after your credit, plus a nationwide PPO quote.
The guide for every state, and other work I help with