I can still arrange nationwide PPO coverage for you in South Carolina. If your family's income comes entirely from a small business around Columbia, here's how other owners in that situation are choosing health insurance for their households.
Hi, I'm Sam Jaber. I work as a health insurance broker and carry licenses in 36 states. South Carolina business owners can call me to review and sort through their family's health coverage.
Imagine a married couple operating a printing and promotional merchandise business in West Columbia. Their LLC produces football banners in the fall, church-group T-shirts and signage for real estate offices. They have two middle-school children. For eight years, this business has supported the household, but revenue arrives unevenly. September and October bring substantial sales, while January can be difficult. Since the company doesn't offer group health insurance, the family purchases its own coverage through HealthCare.gov, using its Lexington County address.
For 2026, Lexington County has 52 individual medical plans offered by three insurance companies. You'll find 30 HMOs, 13 EPOs and 9 PPOs. PPO pricing is relatively high compared with a typical county. Consider a 40-year-old purchasing silver coverage without a subsidy. In both Lexington and Richland counties, the lowest-priced PPO costs 33% more than the lowest-priced silver HMO. Across the state's counties, the median difference is 28%.
I can help your family obtain a nationwide PPO in South Carolina through the private market. Each person is medically underwritten separately, and the provider network extends across state lines, whether you're visiting grandparents, touring colleges or taking a family vacation.
Marketplace assistance is calculated using the household's income for the year of coverage. For this printing shop, that's the profit left after paying for ink, blank materials, leased equipment, rent and any employee wages, plus whatever other income the household receives. The credit is available up to four times the federal poverty level. That translates into a considerably higher income cutoff for a family of four than for someone applying alone.
South Carolina has a particular problem for households at the lowest income levels. Medicaid hasn't been expanded in the state. According to KFF, parents face an eligibility ceiling of just 67% of the federal poverty level, while marketplace credits generally start at 100%. A family experiencing an exceptionally bad business year could fall into the gap between those limits.
Individual-market premiums increased substantially for 2026. According to figures reported by the South Carolina Department of Insurance, the weighted average rate increase was 19.49%.
I'd begin at HealthCare.gov, since marketplace credits can only be applied there. The credit is calculated from a benchmark silver policy, and choosing a more expensive PPO doesn't increase that assistance. So the PPO's additional 33% would have to come from your business income. For most households, I'd lean toward an HMO or EPO that includes both the family doctor and pediatrician. But if having a wider provider network matters more to you, we'll compare that option and its actual price too.
Next step: Give me last year's tax return and the names of the doctors your family uses. I'll compare Lexington County plans after the credit and show you which ones include those providers.
When household income exceeds the credit limit, all four family members pay the full marketplace price. For healthy families, private coverage can often be a better value. The insurer requires a separate health questionnaire for each person, then may approve the application, approve it while excluding one condition, or decline it. Because coverage details vary from policy to policy, I'll compare those benefits with you before you make a decision.
During a strong business year, make sure your income projection stays accurate. If you've received advance credits and a profitable fall pushes earnings higher, you'll owe back the excess when filing your taxes. For years after 2025, there's no maximum repayment amount.
Next step: Give me a call, and I'll compare a nationwide PPO quote for your family with the unsubsidized HealthCare.gov premiums offered in Lexington County.
If you hire an employee who isn't family and has no ownership in the business, your company could become eligible for SHOP, the small-business marketplace, and a group health plan. Whether that option costs less than individual family coverage will depend on your employee situation and available budget.
Next step: Call me before that employee joins the payroll. We'll compare what group insurance would cost against the coverage your family already carries.
Straight answers, no sales pitch.
The lowest-priced silver PPO in Lexington and Richland counties is 33% more expensive than the lowest-priced silver HMO.
Eligibility is limited to people with very low incomes. South Carolina has not expanded Medicaid, and KFF puts the income threshold for parents at just 67% of the federal poverty level.
SHOP becomes an option after the business hires someone who isn't a relative and has no ownership interest in the company.
Yes. For a family in good health, I can arrange private PPO coverage with a nationwide provider network.
Let me know your county, the ages of everyone needing coverage, approximately how much profit the business made, and whether anyone has employer coverage available. I'll price both approaches and give you my straightforward recommendation.
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