If you have been searching for a PPO and coming up short, you are not imagining it. Only about 14% of plans on the ACA marketplace are PPOs. More than eight in ten are HMOs or EPOs built around narrow local networks, and in a number of states the exchange offers no PPO at all.
This is a relatively recent change, and it happened quietly. Broad networks are expensive to offer under community-rated pricing, so carriers narrowed their products to control costs. The withdrawals have continued year over year.
According to research on the individual market, some of the strongest remaining individual PPO options are now sold off the exchange rather than on it — and off-exchange plans do not qualify for premium tax credits.
So if you want a genuine broad-network PPO, the marketplace is frequently the wrong place to look, and searching harder on it will not change that. The plan you want may exist; it is just not sold where you are looking.
What a PPO actually buys you
| Plan type | Out of network | Referrals |
|---|---|---|
| PPO | Covered at a higher cost share | Generally not required |
| EPO | Not covered except emergencies | Generally not required |
| HMO | Not covered except emergencies | Usually required |
For plenty of people an HMO is genuinely the better buy. If you see a local primary care doctor, use a nearby hospital and stay in your area, you would be paying a PPO premium for freedom you never use.
A PPO starts earning its cost in specific circumstances:
- You travel for work or split the year between states — see remote workers and owner-operators
- You work on contracts in different cities, like travel nurses
- You see a specialist outside your plan’s health system, or want to keep the option
- You are managing a condition across more than one system
- Your nearest in-network facility is a long drive, and the next-nearest is not in network
Where PPOs still exist
There are three routes, and most people only know about the first.
| Route | What to expect |
|---|---|
| On the marketplace | A minority of plans in some states and counties. Subsidy-eligible. In Florida, for example, one major carrier accounts for essentially all of the true PPO options despite sixteen carriers participating. |
| Off-exchange, direct from a carrier | Sold outside the marketplace. Often broader networks than the on-exchange equivalents. No premium tax credits, so this only makes sense if you were not going to receive meaningful subsidies anyway. |
| Medically underwritten private plans | Frequently the broadest nationwide networks available to an individual buyer, priced on your own health rather than the community pool. You have to pass underwriting. |
It is not a coincidence that the widest networks tend to sit outside the exchange. Community-rated marketplace plans have to accept everyone at the same price, which pushes carriers toward narrow networks to control cost. An underwritten plan starts from a healthier pool, and that is what makes a broad network affordable to offer.
The practical upshot for a healthy buyer who is not drawing large subsidies: you can often get a wider network and a lower premium at the same time. How the two routes compare covers when that applies to you and when it does not.
Checking a PPO properly
“PPO” describes how out-of-network care is handled. It says nothing about how far the network reaches, and the two get conflated constantly.
- Get the network name, not just the carrier name. A single insurer runs several networks and a provider can be in one and outside another.
- Ask whether it is national or regional. A regional PPO is still a PPO, and still of little use in another state.
- Check your own doctors against that specific plan, then call the billing office to confirm — directories lag reality. More on that in how to keep your doctor.
- Understand the out-of-network cost share. Covered at a higher share is not the same as covered well; check the coinsurance and whether out-of-network spending counts toward your out-of-pocket maximum.
If a PPO is what you actually need
The honest summary is that individual PPO coverage still exists, it is just no longer where most people look for it, and finding it usually means comparing on-exchange, off-exchange and underwritten options at the same time rather than one at a time.
That comparison is what we do, and it costs nothing — carriers pay broker commissions, so the premium on any given plan is the same whether you find it yourself or not.
General information as of September 2026. Not a quote, an offer of coverage, or a guarantee of eligibility. PPO availability, network footprints, pricing and underwriting criteria vary by state, county, carrier and product, and change annually.
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