Iowa residents can still obtain nationwide PPO coverage, even though the HealthCare.gov plans around Des Moines don't include any PPOs. Here's how I'd help builders across the metro compare their insurance choices.
Hi, I'm Sam Jaber. I'm licensed to sell health insurance in Iowa, it's the only insurance I work with, and I help all my clients by phone.
Imagine a home builder operating out of Ankeny. His crews build houses in Ankeny and Altoona, work on townhomes in Waukee and Grimes across into Dallas County, and handle older Des Moines home renovations as temperatures fall. Framing slows during Iowa's winter, leaving April through November as the busiest stretch. He's purchased family insurance himself since departing a larger construction company. This fall, he started searching for PPO coverage.
The good news is that nationwide PPO coverage is still available in Iowa. I can help you get one set up.
Around Des Moines, HealthCare.gov doesn't offer PPO coverage. Polk County's 2026 options include 26 HMOs and 32 EPOs from 4 insurers. Dallas County has 10 HMOs and 32 EPOs from 3 insurers. The state's marketplace PPOs come from just one company and are restricted to seven counties in northwest Iowa, nowhere near Des Moines. HMOs and EPOs typically cover out-of-network treatment only for emergencies. PPOs contribute toward care outside the network without referrals, though you pay a greater share. Nationwide PPO plans are available privately, with premiums based on medical underwriting.
Everything starts with whether your household can receive a premium tax credit. For construction business owners, eligibility depends on projected net self-employment earnings during the coverage year. That's the money left after lumber, concrete, subcontractors, equipment, permits, insurance and vehicle expenses. Submit an estimate at enrollment, then revise it when a major project starts or a closing gets delayed.
Consider our Ankeny contractor during a profitable year. Without premium assistance, he's responsible for the full cost of an HMO or EPO, and the marketplace offers no PPO regardless of what he's willing to pay.
That's when I'd price a nationwide PPO using medical underwriting. The insurance company reviews your family's medical information and may approve the policy, decline it, or issue coverage excluding one prior condition. That screening often lets healthy families pay less than unsubsidized marketplace premiums. The nationwide network also follows you to Okoboji for a lake vacation, Kansas City for a tournament, or another destination. Because coverage terms vary, I'll walk you through the benefits before you commit.
Next step: Call me with your county and the ages of everyone on the application. I'll compare nationwide PPO premiums against the marketplace plans around Des Moines.
When winter brings fewer construction starts and reduces your household profit into the qualifying range, HealthCare.gov generally becomes the better-priced choice. Premium credits cannot be applied to private plans. In the Des Moines area, that leaves dozens of HMO and EPO options, so we'd focus on which ones include your doctors and preferred hospital. Keep track of signed projects and expected closing dates, then adjust your income estimate whenever the spring workload increases or slows.
If household earnings drop substantially more, Iowa offers another option. Its Medicaid expansion, called the Iowa Health and Wellness Plan, covers qualifying adults whose income is no higher than 138% of the federal poverty level.
Next step: Send over your prior year's tax return and upcoming project starts. We'll work out an income projection and choose a suitable plan in Polk or Dallas County.
Straight answers, no sales pitch.
No. For 2026, the Polk and Dallas County marketplaces offer only HMOs and EPOs. Healthy families can still obtain nationwide PPO insurance outside the marketplace.
For 2026, one insurer offers it, and only in these counties: Clay, Dickinson, Emmet, Lyon, O'Brien, Osceola and Sioux.
Use your projected net business profit for the coverage year, after subtracting expenses, and revise that figure when circumstances change.
Yes, potentially. Iowa adopted Medicaid expansion, allowing qualifying adults with income at or below 138% of the federal poverty level to receive coverage.
Tell me your county, who needs to be insured, and approximately how much business profit you made last year. I'll compare priced marketplace choices around Des Moines with a nationwide PPO and give you my recommendation.
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