What a PPO is
PPO stands for preferred provider organization. A PPO plan has a network of doctors and hospitals, but it also lets you see providers outside the network, usually at a higher cost. In most PPO plans you can see a specialist without a referral from a primary care doctor.
How private plans differ from ACA plans
Some private plans sold outside the Marketplace follow all ACA rules, but they don’t qualify for premium tax credits. Other private plans don’t follow all ACA rules. Those plans may ask health questions, may limit or exclude coverage for pre-existing conditions, and may not cover every essential health benefit.
Because the differences matter, your advisor will explain exactly what a plan covers, what it doesn’t, and how it compares to an ACA plan before you decide.
A good fit if you
- Earn too much to qualify for ACA premium savings
- Want a broader choice of doctors and specialists
- Are generally healthy and shopping for value
- Want coverage that starts outside Open Enrollment, where available
How we help
Your advisor compares private and ACA options side by side, so you can see which gives you the best value for your situation. There is no cost to use our service.
Common questions
Can I buy a private plan outside Open Enrollment?
Some private plans can be purchased year-round. Availability depends on the plan type and your state.
Will a private plan cover my pre-existing condition?
It depends on the plan. ACA-compliant plans must cover pre-existing conditions. Some other private plans may limit that coverage. Your advisor will explain the details before you apply.
Is a PPO better than an HMO?
Not always. PPOs offer more flexibility to see providers, while HMOs often cost less but require you to stay in network and get referrals. The right choice depends on your doctors and budget.