A private PPO is a medically underwritten plan built on a nationwide PPO network. For a healthy person who earns too much for a subsidy, it is often the better fit. Here is how to tell whether that is you.
Hi, I'm Sam Jaber, a licensed health insurance broker in Tampa. Most of the people I help work for themselves, and many of them want the same thing: a PPO. They looked on the marketplace, and either there wasn't one or the price made them close the tab.
That is the gap a private PPO fills. I'm licensed in 36 states and I do this by phone, so where you live matters less than you'd think. This page explains what a private PPO is, who it's built for, and who is better off staying on the marketplace.
If the marketplace in your state has no PPO, or prices its PPO out of reach, that is not the end of the road. I can get you a private PPO with a nationwide network in every state where I hold a license. For a healthy person who pays full price, it is usually the first thing worth pricing.
Start with the PPO part. A PPO pays for care from doctors and hospitals in its network and also pays something when you go outside it, just at a higher cost. You can see a specialist without asking a primary doctor for a referral first. An HMO or EPO, by contrast, generally keeps you inside its own network except for emergencies.
Now the private part. A private PPO is sold outside the marketplace and is medically underwritten. The application asks about your medical history, and based on what you tell it the insurer can approve you as is, turn you down, or approve you while carving out one particular condition. Because the plan chooses who it covers, a healthy applicant can often get a price below what the marketplace charges at full price.
The network on these plans is national. The same card works with doctors in your home town and in the city you fly to for a job next month.
PPOs have been disappearing from the individual marketplace for years. Many insurers swapped them for HMO and EPO plans to keep premiums competitive, and in plan-year 2025 about 37% of people in the U.S. lived in a state where the marketplace sold no PPO at all.
The 2026 picture in the states I serve looks the same. Indiana, Kansas, Mississippi, Missouri, Ohio, Tennessee, Texas and Utah have no PPO medical plan on HealthCare.gov, and the state-run marketplaces in Colorado, Kentucky and Nevada list none either. And where one does exist it can be steep. Florida is the clearest case: comparing plans inside the same county, its marketplace PPO costs a median of 110% more than the least expensive silver plan with another network type.
So the honest answer to "can I get a PPO?" is usually "yes, just not on the marketplace." Which way you should go depends on two things, and the scenarios below walk through them.
If your household income sits in the range where the marketplace tax credit applies, start there. The credit only works on marketplace plans, and it can bring the monthly cost down further than any private plan can match. For most people in this spot, the marketplace is where the money is, even if the network is narrower than you'd like.
The work is in choosing the right marketplace plan and setting an honest income estimate, so the credit doesn't come back to bite you at tax time.
Next step: Talk to me before you enroll, and we'll set an income estimate you can stand behind and choose a plan your doctors take.
This is who a private PPO is built for. You pay full price on the marketplace either way, so the question is simply which full-price option gives you more for the money. For a healthy person, an underwritten nationwide PPO often comes in under the full marketplace price and comes with a network that isn't fenced in by county lines.
Go in with your eyes open. The health questions are real, and an honest answer about something in your history can mean an exclusion. Each plan spells out its own benefits, so we read them before you choose instead of after.
Next step: Call and I'll put real numbers on it: a private PPO quote for your household beside what the marketplace would charge you at full price.
If you take a maintenance medication, see a specialist regularly, or are being treated for something now, the marketplace is usually the safer home. A marketplace plan has to accept you and cannot raise your price because of your health. A private PPO can decline you or leave that condition out, which would defeat the point.
That doesn't mean settling for a bad fit. It means picking, from what the marketplace sells where you live, the plan that already includes your doctors and covers your prescriptions.
Next step: Give me the names of your doctors and the medications you take, and I'll find the marketplace plans that cover both.
Some people need a wide network more than anyone: drivers, traveling nurses, consultants, anyone with a second home, and families with a kid at school in another state. A local HMO handles emergencies on the road, but routine care far from home is where it falls short.
If you are healthy and over the subsidy line, a private nationwide PPO is the natural fit here. If you qualify for a subsidy or have an ongoing condition, we look for the marketplace plan with the widest network you can get and plan around it.
Next step: Tell me where you spend your time and I'll show you which option keeps your care covered in each place.
I start with the two questions on this page: where your income lands against the subsidy line, and how your health looks. That usually settles the direction in a few minutes.
From there I price the options that actually fit, explain what the underwriting will ask, and walk you through the application. If the marketplace is the better answer, I'll tell you and help you pick the plan. None of this costs you anything: the insurer pays me, and you pay the same premium you would on your own.
Straight answers, no sales pitch.
A marketplace PPO must accept everyone and can be paired with a tax credit, but many states don't sell one. A private PPO is medically underwritten, sold outside the marketplace, and can cost less for a healthy person who pays full price.
Anyone whose income qualifies for a marketplace subsidy, and anyone managing an ongoing health condition. The subsidy only works on marketplace plans, and an underwritten plan can decline you or exclude a condition.
Yes. These plans are built on nationwide PPO networks, so routine care is in network across the country, not only near home. That is a big part of why people who travel for work choose them.
Yes. The marketplace and the private market are separate. I can price a private nationwide PPO in every state I'm licensed in, whether or not the marketplace there sells a PPO.
Tell me your state, who needs coverage, and roughly what your household earns. I'll tell you whether a private PPO or a marketplace plan is the better fit, price it, and say so plainly if the marketplace wins.
Guides by line of work and by state