Want a PPO, not a narrow HMO? Licensed broker in 29 states comparing PPO options for self-employed households above the subsidy threshold.
Most people asking for a PPO already know why they want one. They have a specialist they intend to keep, they travel or work across state lines, or they've been burned by a referral requirement at exactly the wrong moment.
The problem is that PPOs have quietly become harder to find where most people look.
When the exchanges launched, PPOs were common on them. Over the following decade carriers narrowed networks to control cost, and on-exchange menus shifted heavily toward HMOs and EPOs — tighter local networks, referrals required for specialists, and little to no coverage outside the service area except for emergencies.
In a lot of counties, particularly in states using healthcare.gov, a true individual PPO simply isn't on the exchange menu anymore. That's not a conspiracy, it's cost containment. But it means "I want a PPO" and "I'll shop on healthcare.gov" are increasingly incompatible.
An HMO is built around the assumption that you live, work, and receive care in one metro. Contract work, client sites, seasonal relocation, and multi-state operations all break that assumption. A PPO's out-of-area coverage isn't a luxury in that situation, it's the point.
Accepting a narrow network is a reasonable trade when a subsidy makes the plan cheap. For 2026, premium tax credits end above $62,600 for an individual and $128,600 for a household of four. Above that line you're paying full retail — and there's no financial logic to paying full retail for a restricted network.
For a healthy household in that position, a non-Marketplace PPO frequently costs less per month than the unsubsidized on-exchange plan and gives broader access. That's the rare case where the cheaper option is also the less restrictive one.
An employee with a network problem calls HR. You call the carrier, on hold, between client calls. Getting the network right the first time is worth more to you than to almost anyone else.
Vague descriptions are how people end up surprised, so here it is directly. The non-Marketplace plans I work with are medically underwritten — the application asks about your health history, and coverage can be declined, limited, or priced based on what it says. They are not ACA-compliant, which means pre-existing conditions may be excluded and the essential health benefits guaranteed on every Marketplace plan are not automatic.
What you get in exchange is a materially lower premium, a real maximum out-of-pocket, and usually a broader network. Term length and renewal rules vary by plan and by state, and I'll tell you precisely what applies to yours before you sign anything.
Whether that trade favors you comes down almost entirely to your health. That's why it's the first thing I ask about, before I quote a number. If you have an ongoing condition, an ACA plan's guaranteed coverage is frequently worth more than the premium difference — and I'll tell you that even though it's the less profitable answer for me. A plan sold to someone it doesn't fit comes back as a denied claim, and neither of us wants that phone call.
Nothing. Brokers are paid a commission by the carrier, built into the premium whether you use a broker or not. Enroll direct and the carrier keeps it. The plan price is identical either way — there's a fuller explanation, plus my NPN, on the licensing page.
Yes, though availability varies by state and county. On-exchange menus have shifted heavily toward HMOs and EPOs, so a true individual PPO is often unavailable on the Marketplace. Off-exchange and non-Marketplace plans more frequently offer PPO network access, and many use large rented national networks.
Carriers narrowed networks over the past decade to control costs, shifting on-exchange offerings toward HMOs and EPOs. In many counties, particularly in states using healthcare.gov, no individual PPO is available on the exchange. Off-exchange options are more likely to include PPO access.
It depends on whether your care stays inside one network area. If you travel for work, operate across state lines, or want to keep a specialist outside a narrow local network, a PPO addresses something an HMO structurally cannot. Above 400% FPL, where no subsidy applies, a non-Marketplace PPO is often less expensive than the unsubsidized on-exchange plan as well as less restrictive.
Verify your specific doctors by name rather than trusting the directory, confirm your prescriptions are on the formulary, ask what percentage out-of-network care is covered at and against what allowed amount, and confirm whether the maximum out-of-pocket applies to out-of-network care. Also ask which network the plan actually uses so you can verify providers independently.
Rohr Health Advisors LLC — Cavin Rohr, licensed in 29 states, NPN 21388659. Verify that before you call me.
Twenty minutes. Unsubsidized Marketplace and non-Marketplace, priced side by side for your household.
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