I can still help Utah business owners obtain a nationwide PPO, although the marketplace doesn't offer one. For families in Washington County who regularly travel to Salt Lake City or Las Vegas for specialists, here's how I'd approach choosing coverage.
Hi, I'm Sam Jaber. I'm licensed in 36 states, including Utah, and I help Utah business owners review their family's health insurance options over the phone.
Imagine a family living in Washington, just outside St. George. The parents own a pool maintenance company and operate two trucks. Last year, their son received a heart murmur diagnosis, and his referral led to a pediatric cardiologist in Las Vegas, roughly two hours away on I-15. Their daughter visits an orthodontist locally, while Grandma receives coordinated medical care in Salt Lake City. Their health care needs already extend across three cities in two states. Most Utah marketplace plans, however, are built around a much more geographically limited network.
Utah's HealthCare.gov marketplace lists 57 individual medical plans for 2026. Of those, 37 are HMOs and 20 are EPOs, with no PPOs available. Washington County residents can purchase these plans from three insurers.
I can arrange private nationwide PPO insurance for your entire Utah household. Each person completes a medical questionnaire, and the insurer uses those answers to calculate the premium. Because the network operates across state borders, a participating cardiologist in Las Vegas receives the same in-network treatment as one practicing in St. George.
HMOs and EPOs generally cover out-of-network services only during emergencies. A planned scan or return appointment with a Las Vegas specialist doesn't meet that description. When a family's doctors are spread between Utah and Nevada, I'd first check whether any of the three Washington County insurer networks include the out-of-state physician. If all three exclude that doctor, the household could be responsible for paying those visits out of pocket every month.
Start by identifying the doctors each person sees and where those physicians practice. Is anybody receiving treatment that needs to continue without a break? Then look at the business's actual net profit to determine whether marketplace credits might apply. Getting those answers upfront makes it easier to compare coverage fairly.
For families earning too much to receive marketplace credits, this year's premium increase was particularly noticeable. KFF reports that Utah's benchmark silver policy, the second-lowest-cost option, increased 17.0% for a 40-year-old between 2025 and 2026. That higher cost applies to each person the family insures.
I'd evaluate coverage separately for each member of this family. The parents and daughter, assuming they're healthy, could apply for a private PPO. The underwriter might approve them as requested, approve them while excluding a particular condition, or decline coverage. Their son's continuing treatment is the most important consideration. Depending on the networks, everyone might use the PPO, or the son could stay on a marketplace policy that includes his cardiologist while the other family members obtain private coverage.
Next step: Give me everyone's ages and the doctors each person sees. I'll compare both ways of insuring the household so you can understand the price and coverage differences.
When everyone receives care within southern Utah, the decision becomes more straightforward. We'd compare a private PPO premium with the full marketplace price for your household. Families in good health often pay less privately, and the nationwide network remains useful for college visits and travel.
Next step: Tell me which county you're in and how old everyone is. I'll compare a nationwide PPO quote with the marketplace plans available to families in Washington County.
If business profit declines, your family might qualify for marketplace credits again. In particularly difficult years, Utah's expanded Medicaid program covers eligible adults earning up to 138% of the federal poverty level. Hiring a worker who isn't related to the owners and holds no ownership interest could also make the business eligible for SHOP, the small-business marketplace, and group coverage.
Next step: If this year's income looks different from last year's, call me before renewing and we'll recalculate your coverage options.
Straight answers, no sales pitch.
Coverage generally applies only when that specialist participates in your plan's network or the visit is an emergency. Utah marketplace plans are all HMOs and EPOs.
For 2026, there are three insurers offering those plans in Washington County.
No. Healthy households can still obtain private nationwide PPO coverage in Utah, and I can help arrange it.
SHOP is the route, but the company first needs to hire an employee who isn't an owner or a relative.
Tell me which physicians your spouse and children visit, including specialists in Salt Lake or Las Vegas. Add everyone's ages and an estimate of business profit. I'll compare the policies to see which ones include those doctors.
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