I can still arrange a nationwide PPO for you in South Dakota. Brookings County has an interesting pricing difference: its marketplace PPO actually costs less than the EPO. Here's how a married couple operating a repair business can use that information when choosing coverage for themselves.
Hi, I'm Sam Jaber. I hold broker licenses in 36 states, and I help South Dakota business owners figure out their health insurance over the phone.
Consider this couple running a welding and farm machinery repair business just outside Brookings, only minutes from I-29. The husband repairs combines and grain carts arriving during harvest. His wife manages accounting, orders replacement parts and handles payroll for their two mechanics. Their workload rises and falls with the surrounding farms' planting and harvesting seasons. If spring is unusually wet or crops come in short, the financial effects can appear months afterward. Because the business doesn't provide group health benefits, the husband and wife purchase their own insurance.
In 2026, Brookings County residents can choose among 28 marketplace individual medical plans from three insurers. Those include 21 PPOs and 7 EPOs. Unlike the usual pricing relationship, the PPO is cheaper here. For a 40-year-old paying before subsidies, the lowest-priced silver PPO comes in 6% below the lowest-priced silver EPO. Across South Dakota, PPOs have that price advantage in 22 of the 49 counties offering both types of coverage.
I can also get you a nationwide PPO privately in South Dakota. The insurer reviews your health information to determine pricing, and the provider network extends beyond Minnesota's border. That can be useful when your doctor refers you to a specialist farther east.
The marketplace bases your credit on household income during the year your policy covers you. For a business owner, that generally means net earnings after paying for parts, steel, rent for the shop, insurance, employee wages and equipment expenses. It's not the total amount customers were billed. Once household income exceeds four times the federal poverty level, the assistance ends.
South Dakota saw a relatively small premium increase heading into 2026. KFF reports that the average benchmark silver premium for someone age 40 increased 5.8%. Your personal premium, however, still depends on where you live, how old you are and what your household earns.
The marketplace calculates your credit using the second-lowest-cost silver plan. Selecting a higher-priced policy doesn't increase that credit. In Brookings County, that's good news for PPO shoppers because the lowest-priced silver PPO already costs 6% less than the lowest-priced silver EPO. Once the credit is applied, the PPO is generally the stronger value. It provides some out-of-network benefits at a lower premium, whereas EPO coverage usually stays within its network except for emergencies. I'd consider the EPO instead if your physicians participate there but aren't included in the PPO network.
Next step: Tell me which doctors you see and how much net income the business produced last year. I'll compare the Brookings County PPO and EPO premiums after applying the marketplace credit.
If your household income goes above four times the poverty level, the marketplace credit disappears and you're responsible for the entire premium. At that point, I'd compare the marketplace against a private nationwide PPO. Each applicant goes through a health review, after which the insurer can approve coverage, approve it with one condition excluded, or reject the application. Many couples in good health find private premiums below the marketplace's full rates. I'll also review what each policy actually covers before you commit to anything.
Next step: Once you've finished the year's bookkeeping, call me. I'll compare a nationwide PPO quote with Brookings County marketplace coverage at its full, unsubsidized price.
When farmers delay machinery repairs, your shop's net earnings can fall sharply. If that brings household income to 138% of the federal poverty level or less, KFF identifies that as the adult Medicaid eligibility threshold in South Dakota. The state also reports that beginning January 1, 2027, most adults ages 19 through 64 covered through expansion must document 80 monthly hours of employment, education, training or service. You'll want to understand whether that requirement applies to your situation. As business activity improves, revise your income information and move back to marketplace coverage.
Next step: If business has been slower this year, give me a call before renewing. We'll review the numbers and determine where your household fits for coverage.
Straight answers, no sales pitch.
Yes. Before subsidies, Brookings County's lowest-priced silver PPO is 6% cheaper than its lowest-priced silver EPO.
Generally, it's the net amount. Marketplace eligibility uses household income, which for business owners reflects what remains after business expenses.
The increase was fairly modest. KFF reports that South Dakota's benchmark silver premium for a 40-year-old rose 5.8% between 2025 and 2026.
Yes. Provided you qualify through medical underwriting, I can arrange a private nationwide PPO outside the marketplace.
Give me your county, tell me who needs to be insured, and estimate what the business paid you both last year. I'll compare Brookings County marketplace plans with a private nationwide PPO and explain which one I'd choose.
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