I can still help you purchase a nationwide PPO in West Virginia. To explain the choices, let's look at a Parkersburg couple running a print shop. Their premium increase looks very different depending on whether their household receives a tax credit or pays the entire premium itself.
Hi, I'm Sam Jaber. As a health insurance broker licensed in 36 states, I work with West Virginia business owners by phone to help them find and arrange their coverage.
Picture a husband and wife operating a print and sign business in Parkersburg. Their work includes banners for Friday night games, restaurant menus for places along the river, campaign yard signs during election seasons, and shirts for plants and contractors throughout the Mid-Ohio Valley. She oversees the printing equipment and four employees, while he manages sales and bookkeeping. They don't offer group insurance, so they purchase their own coverage through HealthCare.gov. This year's renewal showed a substantial premium jump. Naturally, they started wondering whether to cancel their insurance or simply choose the lowest-priced plan available.
For 2026, Wood County residents can choose from the same 37 individual medical plans available throughout West Virginia. Two insurers provide them: one offers all 15 PPO plans, and the other offers all 22 HMOs. When comparing silver coverage for a 40-year-old before tax credits, the PPO actually costs 3.5% less than the HMO.
There's another option I can help you explore: a privately underwritten nationwide PPO available in West Virginia. If your print shop has been profitable and both of you are healthy, I'd want you to see that price before deciding.
According to KFF, West Virginia's average benchmark silver premium for a 40-year-old increased 16.8% between 2025 and 2026. Prices also vary considerably by location. In Wood County, the lowest-priced silver plan is 23% more expensive than the comparable lowest-priced plans in Berkeley and Jefferson counties, putting the Mid-Ohio Valley well above the state's least expensive areas.
The advertised premium increase doesn't tell you what you'll actually owe. Your tax credit is calculated using the benchmark silver premium, with a required household contribution determined by income subtracted from it. If that benchmark rises while your income remains unchanged, your credit will generally rise too. That means qualifying households may experience a much smaller increase in their final premium. Households earning too much for the credit, however, have to cover the entire increase themselves.
For business owners, the relevant income is generally the net amount the company contributes to the household. Start with business revenue and account for paper, ink, vinyl, equipment leases, rent and payroll, then estimate the result for the coverage year. If your household falls between 100% and 400% of the poverty line, don't cancel insurance because of the advertised premium. First, find out what remains after your tax credit.
Next, compare the networks. Wood County's lowest-priced silver option is a PPO. It provides some benefits for out-of-network treatment, although your share of the bill is higher. An HMO generally provides no out-of-network coverage except for emergencies. That's why I usually favor the silver PPO for business owners who qualify for tax credits. I'd reconsider if the doctors you need participate only in the HMO insurer's network.
Next step: Share your business figures from last year along with the doctors you use. I'll calculate your current premium after the tax credit and compare Wood County's PPO and HMO choices for you.
If household income exceeds four times the poverty line, the entire premium increase becomes your responsibility. Before accepting Wood County's unsubsidized rates, ask me for a private nationwide PPO quote. The insurance company examines both applicants' medical histories and may approve coverage, approve it with a particular condition excluded or deny the application. Healthy couples frequently find private premiums below the marketplace's full price. I'll also explain the benefits of each option before you make your final decision.
Next step: Once your accountant has completed last year's tax return, give me a call. I'll compare the cost of a nationwide PPO with the marketplace plans you'd pay for without subsidies.
Both premiums and available insurance plans change from year to year. When HealthCare.gov publishes its 2027 offerings this fall, take another look at the insurers, their provider networks and your actual premium after credits. Don't automatically renew last year's coverage without making that comparison.
Straight answers, no sales pitch.
Yes, premiums increased across West Virginia. KFF reports that the average benchmark silver premium for a 40-year-old went up 16.8% between 2025 and 2026.
Generally, yes. Your credit uses the benchmark silver premium minus the contribution required based on household income. When that benchmark premium increases, the available credit usually increases as well.
Yes. Compared with the Eastern Panhandle, Wood County is more expensive. Its lowest-priced silver plan costs 23% more than the least expensive silver plans in Berkeley and Jefferson counties.
Yes. If you're healthy, I can help you purchase a private nationwide PPO outside HealthCare.gov.
Let me know which county you're in, how old everyone is and approximately how much business profit reached your household. I'll calculate your Wood County marketplace price after any available credit, then compare it with the cost of a private nationwide PPO.
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