South Dakota still has nationwide PPO options. Around Aberdeen, marketplace HMOs and PPOs have a sizable price difference. Here's how plumbers whose income changes between winter and summer can decide.
Hi, I'm Sam Jaber. I sell health insurance exclusively, I'm licensed in South Dakota, and I take care of my clients by phone.
Picture a two-truck plumbing business in Aberdeen. During January and February, the owner gets calls about frozen farmhouse supply pipes, broken lines in empty lake cabins and water heaters failing during bitter cold nights. Spring thaw changes the schedule. Now he's installing yard hydrants, livestock waterers and farm service lines throughout Brown and Edmunds counties, along with rough-ins for houses outside town. Things settle down again in late fall. He and his wife have a teenager on their health plan, and what they earn in March barely resembles their August income.
First, nationwide PPO insurance is still an option in South Dakota, and I can arrange that coverage for an Aberdeen household.
Brown County residents can choose among 41 marketplace medical plans in 2026, offered by two insurers. The selection includes 20 HMOs and 21 PPOs. For a 40-year-old buying silver coverage without credits, the lowest-priced PPO costs 29% more than the lowest-priced HMO. HMOs generally limit nonemergency benefits to participating providers. PPOs also contribute toward outside-network visits without requiring referrals, although your share of the bill is higher. That additional flexibility explains the premium difference. You can also compare a private nationwide PPO, with rates determined through medical underwriting.
Your marketplace credit is based on expected household net income for the coverage year. For a plumbing business, subtract costs such as trucks, fuel, pipe, fittings, the drain machine, camera, licenses and liability insurance from receipts. Seasonal earnings make it easy to underestimate a strong year, and that could mean repaying credits when you file taxes. Look at your previous two or three years, then update your HealthCare.gov estimate as the current season develops.
Most households in this situation qualify for help. Since credits apply only through HealthCare.gov, that's usually the more affordable choice. Brown County HMOs cost considerably less than PPOs. If your family doctor and preferred hospital are in the same HMO network and you rarely seek care elsewhere, I'd lean toward the HMO. But a teenager traveling for sports or a specialist in Sioux Falls or Fargo outside that network could make the PPO worth its higher premium.
Next step: Send over last year's tax return and your family's doctor list. I'll compare Brown County HMOs and PPOs with your credit included.
Combine a winter full of frozen-pipe calls with a packed summer, and your household might exceed the income limit for credits. Brown County marketplace plans would then cost full price. If everyone is healthy, I'd quote a medically underwritten nationwide PPO. The insurer asks each person about their health and can approve coverage, exclude a previous condition, or decline the application. Healthy families can often pay less than full marketplace rates while using a network beyond South Dakota.
Next step: Call me with each person's birth year and relevant medical history. I'll compare nationwide PPO pricing with Brown County plans without subsidies.
Sometimes winter doesn't bring enough emergency work. South Dakota voters approved Medicaid expansion in November 2022, and the state constitution has required it since July 1, 2023. KFF puts adult eligibility at 138% of the federal poverty level. Beginning January 1, 2027, expansion adults ages 19 through 64 must document 80 hours monthly of employment, training, community service or education unless exempt. Renewals will happen every 6 months. Since working counts, keep track of your job hours.
Next step: Tell me what you've earned over the past few months. We'll compare Medicaid eligibility with a Brown County plan reduced by tax credits.
Straight answers, no sales pitch.
Yes. Before tax credits, a 40-year-old buying silver coverage pays 29% more for the lowest-priced PPO than the lowest-priced HMO.
Yes. South Dakota voters passed expansion in November 2022, with coverage starting July 1, 2023. KFF lists eligibility up to 138% of the federal poverty level.
On January 1, 2027, expansion adults ages 19 through 64 begin having to document 80 hours of qualifying monthly activity unless exempt.
You may need to repay part of your tax credit. As soon as your income outlook changes, revise the estimate on HealthCare.gov.
Let me know your county, everyone who needs coverage, and what the business earns during slower and busier months. I'll compare Brown County PPOs and HMOs after your credit and see whether Medicaid is an option.
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