PPO Plans
How to Get Private PPO Health Insurance Without an Employer
Most people assume PPO plans only exist through employers. That's wrong — and it's costing them. Private PPO plans from major carriers are available to individuals and families. You just need to know where to look.
This guide explains what a private PPO is, why most people miss it, and exactly how to get one in 2026 — step by step.
What Is a Private PPO Plan?
A PPO — Preferred Provider Organization — is a type of health insurance plan where:
- You can see any licensed doctor or specialist without a referral
- Staying in-network costs less; going out-of-network is more expensive but covered
- You don't need a primary care physician to coordinate your care
- You have nationwide coverage — especially important if you travel, live in multiple cities, or want flexibility
Compare that to an HMO, where you choose a primary care doctor who manages all referrals, your care is largely limited to one local network, and going out-of-network is typically not covered at all (except emergencies).
PPOs cost more than HMOs — but they give you control.
PPO vs. HMO in plain terms: With a PPO, you call any cardiologist in the country and make an appointment. With an HMO, you call your primary care doctor, explain your symptoms, wait for a referral, and then see the cardiologist your plan has on its local list.
Why Most People Think You Can't Get a PPO on Your Own
When people shop for insurance on healthcare.gov, they mostly see HMO and EPO plans. PPO options on the ACA marketplace have shrunk significantly since 2014 — many carriers pulled their PPO products from the marketplace entirely.
But those same carriers — United Healthcare, Aetna, Cigna — still sell PPO plans off the marketplace. They don't show up on healthcare.gov. They aren't advertised directly to consumers. They're distributed exclusively through licensed independent brokers who have carrier contracts.
This is Ryder's specialty. These plans are the same quality (and often the same exact products) as what large employers offer their employees — they're just not visible to people shopping on their own.
How to Buy a Private PPO Plan — Step by Step
Step 1 — Know What You Need
Before you compare plans, get clear on your priorities:
- Your doctors: Are there specific physicians or specialists you need to stay with? Get their names and practice addresses — we'll confirm they're in-network.
- Your prescriptions: List every medication you take. Formularies (drug coverage lists) vary by plan, and this can matter more than the premium.
- Your budget: What monthly premium can you comfortably afford? And what deductible/out-of-pocket maximum is acceptable if something happens?
- Geography: Do you travel frequently? Work in multiple states? A national PPO network is especially valuable if you're not always in one location.
Step 2 — Compare PPO Options Off-Marketplace
This is where a broker earns their value. An independent advisor with carrier contracts can pull private PPO plans from United Healthcare, Aetna, and other carriers — plans you cannot find by searching online — and compare them against ACA marketplace options side by side.
For self-employed individuals above the ACA subsidy threshold (roughly $55,000+/year for a single person), private PPOs are often competitive on price with the same or broader network coverage.
Step 3 — Work With an Independent Advisor
Here's something most people don't realize: using a licensed broker costs you nothing extra. The broker is paid by the carrier — the same premium you'd pay if you called the carrier directly. You pay the same price either way, but a broker:
- Shows you plans across multiple carriers (not just one)
- Has access to off-marketplace plans healthcare.gov doesn't list
- Confirms your doctors are in-network before you enroll
- Handles paperwork and answers questions after you're enrolled
Step 4 — Enroll and Confirm Your Network
Once you've selected a plan, the broker submits your enrollment directly to the carrier. Before your first appointment:
- Get your member ID card and confirm your effective date in writing
- Call your doctors' offices to verify they accept your new plan (use your plan name and insurance company, not just "PPO")
- Download your carrier's mobile app — most have provider directories and claims tracking
- Review your formulary (drug list) at the carrier's website to confirm your prescriptions are covered
Private PPO vs. ACA Marketplace Plans
| Feature | Private PPO (Off-Marketplace) | ACA Marketplace HMO | ACA Marketplace PPO |
|---|---|---|---|
| Typical monthly premium | $250–$500 | $200–$450 (unsubsidized) | $300–$600 (unsubsidized) |
| Network size | Large national | Local/regional | Large (varies) |
| Referrals required | No | Yes | No |
| Out-of-network coverage | Yes (higher cost) | Emergency only | Yes (higher cost) |
| Subsidies available | No | Yes (income-based) | Yes (income-based) |
| Pre-existing conditions | Covered (ACA-compliant) | Covered | Covered |
| Where to buy | Licensed independent broker | healthcare.gov or state exchange | healthcare.gov or state exchange |
Who Should Consider a Private PPO?
Private PPOs aren't for everyone. Here's who gets the most value from them:
- High earners above the subsidy threshold — if you earn too much for ACA subsidies, you're already paying full price. A private PPO may offer the same or better coverage at a lower unsubsidized premium.
- People with specific doctors they want to keep — specialists, surgeons, or primary care physicians who don't participate in local HMO networks are often in major PPO networks.
- Frequent travelers and remote workers — a national PPO network means you're covered whether you're in Phoenix, New York, or Denver.
- Families wanting consistent coverage — one national plan for the whole family, regardless of where kids are in college or a spouse works.
- Anyone coming off COBRA — private PPOs are often 30–50% cheaper than COBRA continuation coverage with similar networks.
Frequently Asked Questions
Can I buy a PPO plan without an employer?
Yes. Private PPO plans are available through licensed independent brokers — not on healthcare.gov. Major carriers like United Healthcare and Aetna sell them directly to individuals and families. The broker fee is zero; the carrier pays the broker from your premium.
Are private PPO plans more expensive than ACA plans?
With subsidies, ACA plans are almost always cheaper. Without subsidies (higher income), private PPO plans are often comparable to — or cheaper than — unsubsidized ACA marketplace plans, and typically offer broader networks.
What's the difference between PPO and HMO?
A PPO lets you see any doctor without a referral — in-network for lower cost, out-of-network at higher cost. An HMO requires choosing a primary care physician who coordinates all referrals; out-of-network care is usually not covered except in emergencies. PPOs cost more but give more flexibility.
Do private PPO plans cover pre-existing conditions?
ACA-compliant private plans — which includes most individual and family PPO plans sold by major carriers — must cover pre-existing conditions without exception. Ask your broker explicitly whether any plan is ACA-compliant before enrolling.
How do I find PPO plans in my state?
Work with a licensed independent broker who has carrier contracts for your state. Healthcare.gov only shows marketplace plans — off-marketplace private PPOs require a broker. Ryder is licensed in 32 states and can pull private PPO options and compare them to ACA plans in one conversation.
Ryder has access to private PPO plans in 32 states.
See your options — takes 2 minutes, costs nothing. Carriers pay Ryder, not you.
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