A nationwide PPO is still available in South Dakota, and I can help you get one. Around Sioux Falls, the marketplace PPO costs noticeably more than the HMO. Let's look at how real estate agents who earn their money at closing figure out whether paying that difference makes sense.
Hi, I'm Sam Jaber. I hold health insurance broker licenses in 36 states, and I work with South Dakota real estate agents over the phone to help them choose coverage that makes sense for their situation.
Consider a real estate agent working through her second full year in the Sioux Falls market. One day she's showing newly built homes in subdivisions near Harrisburg and Tea, and the next she's handling a split-level on the east side or a piece of acreage beyond Brandon. Her first year consisted largely of open houses with only a few completed sales. Now her calendar is packed with potential deals, and the income projection she entered on HealthCare.gov last fall no longer reflects what she's likely to earn. She's trying to answer two important questions. Does paying extra for a PPO make financial sense, and could underestimating her income create a problem when she files her taxes?
For 2026, residents of Minnehaha and Lincoln counties can choose among 41 individual medical plans on the marketplace, offered by two insurance companies. Those choices include 21 PPO plans and 20 HMOs. The price gap is substantial rather than minor. Looking at premiums before subsidies for a 40-year-old, the lowest-priced silver PPO costs 30% more than the lowest-priced silver HMO available in those counties.
There's another route if you want PPO coverage across the country. I can arrange a private nationwide PPO in South Dakota without going through the marketplace. Instead of using the county's standard pricing, the insurer bases the price on your health. That broader network can be useful when your relatives live outside South Dakota or you might want to visit doctors beyond Sioux Falls.
What determines your premium credit is your household's income across the coverage year, not the size of any particular real estate commission. For agents, you need to look at what's left after brokerage splits, desk charges, MLS membership, signage, photography, and driving expenses along I-29. Once household income exceeds four times the federal poverty level, that financial assistance ends.
Premiums increased, but the change was relatively gradual this year. According to KFF, South Dakota's average benchmark silver premium for someone age 40 increased 5.8% between 2025 and 2026.
Your premium tax credit doesn't increase simply because you select a more expensive policy. It's calculated using the second-lowest-cost silver plan, and you pay whatever additional premium your chosen plan carries. That's why the 30% difference for a Sioux Falls PPO matters. You're responsible for that added cost. With an HMO, care outside the network is generally covered only for emergencies. A PPO can still cover out-of-network treatment, although you'll usually pay a larger portion yourself.
Before spending more for the PPO, look at the providers your family already uses. If your physician, your children's pediatrician, and your preferred hospital all participate in the HMO network, that HMO will generally give you better value once the credit is applied. Paying more for the PPO makes the most sense when you need access to providers the HMO leaves out.
Next step: Let me know which doctors you use and approximately what your net commissions should be this year. I'll compare the Sioux Falls PPO and HMO premiums after applying your available credit, so you can see what each actually costs.
This is where an agent in year two can run into trouble. Suppose you received advance premium credits based on an income estimate, but your actual commissions leave you earning more than expected. When you file your return, you'll have to repay the credit you received beyond your eligibility. Starting with the 2026 tax year, there's no maximum repayment limit. If your closings make it clear that you'll exceed your original projection, change your income on HealthCare.gov then. Don't leave that adjustment until April.
When your annual household income goes beyond four times the federal poverty level, you no longer qualify for the premium credit. At that stage, it's worth putting the marketplace's full premium beside the price of a private nationwide PPO. Private coverage involves health underwriting. The company might accept your application, accept it while excluding one specified condition, or decline coverage. Agents in good health frequently find private premiums below the marketplace's full price. I'll also compare what each policy covers so you understand the benefits before making your decision.
Next step: Once you've got a fairly clear picture of the closings you'll complete this year, give me a call. We'll use your revised income projection to compare the marketplace and private coverage routes.
Closings in the Sioux Falls area often slow down during the colder months. If annual income ends up particularly low, Medicaid may become relevant. KFF reports South Dakota's adult income limit at 138% of the federal poverty level. Starting January 1, 2027, the state says most expansion adults ages 19 through 64 must complete 80 hours each month in work, education, volunteering or training, so those requirements matter too. Review eligibility before renewing coverage, and consider moving back to a marketplace plan when spring brings more closings.
Next step: Expecting a slower year with less commission income? Call me before your coverage renews. We'll calculate a realistic household income figure and see what that means for your choices.
Straight answers, no sales pitch.
Yes, there is a meaningful price difference. Across Minnehaha and Lincoln counties, the lowest-priced silver PPO carries a premium 30% higher than the lowest-priced silver HMO, before subsidies are considered.
It could happen. Your advance premium credit is reconciled when you file taxes, and beginning with the 2026 tax year, there's no maximum repayment limit.
According to KFF, the average benchmark silver premium for someone age 40 increased 5.8% between 2025 and 2026.
Yes. If you're an agent in good health, I can arrange private coverage for you outside the marketplace.
Tell me which county you're in, who needs coverage, and approximately how much commission you expect to keep this year after your splits. I'll compare Sioux Falls HMOs, marketplace PPOs, and a private nationwide PPO, then explain which one I'd recommend and why.
The guide for every state, and other work I help with