Reviewed by BeneHub's licensed advisor team · Agency NPN 21324782 · Updated October 2026
What a private PPO is
A private PPO is health insurance you buy straight from a carrier, outside HealthCare.gov. You can see any doctor in a large network without a referral.
Most are medically underwritten. The carrier asks health questions and sets your price or eligibility from the answers.
How it differs from an exchange PPO
- Networks: many private PPOs use national networks, while exchange plans are often local HMOs or EPOs.
- Enrollment: apply in any month instead of waiting for open enrollment.
- Subsidies: private plans don't qualify for ACA tax credits.
- Approval: health questions apply, so not everyone is accepted.
What's typically covered
Plans vary by carrier and level. Most cover the everyday care people use, with clear copays.
- Primary care and specialist visits
- Urgent care, emergency room and hospital stays
- Lab work and imaging
- Generic and some brand-name prescriptions
- Telehealth on many plans
Types of private PPO plans
Medically underwritten PPOs are the most common. They look and feel like traditional insurance.
Level-funded PPOs are built for business owners and the self-employed. They often use a large carrier network, such as Cigna's.
Some PPO options are HSA-eligible, which lets you save pre-tax for medical costs.
Who usually saves
- Healthy adults who earn too much for a meaningful subsidy
- Families who want one national network for kids at college or away
- Self-employed people and early retirees
- Anyone whose doctor isn't in their local exchange network
How to check your doctors
Ask for the network name before you apply. Then search your doctors and nearest hospital in that directory.
A licensed advisor can do this with you, including checking your prescriptions against the drug list.
Applying
The application takes about 15 minutes. Expect questions about recent diagnoses, treatment and medications.
Answer honestly. Incorrect answers can lead to a cancelled policy or denied claims later.
Comparing private PPO plans side by side
Two plans with similar premiums can behave very differently when you actually use them. Look past the monthly price.
Line up each plan's costs for a normal year and a bad year, then pick the one you could live with in both.
- Deductible and out-of-pocket maximum
- Copays for visits, urgent care and the ER
- How prescriptions are covered, by tier
- Any annual or per-condition benefit limits
- Whether rates are guaranteed for a period
Private PPO costs: what drives your price
Private PPO prices are set per person. Your quote reflects your age, where you live, tobacco use and your answers to health questions.
The plan level matters too. A lower deductible raises the monthly premium, while a higher deductible lowers it.
- Age of each person on the plan
- State and ZIP code
- Tobacco use
- Health history and current medications
- Deductible and copay level you choose
Private PPO vs hospital and indemnity plans
A private PPO is built to be your main coverage. Indemnity and hospital plans pay set cash amounts and work best alongside other insurance.
If you're healthy and want a familiar card with copays, start with a PPO. If budget comes first, an advisor can show what layered cash-benefit plans would and wouldn't pay.
Who this is NOT for
- People with serious ongoing health conditions — health questions apply
- Anyone who gets a large ACA subsidy
- Anyone who is pregnant or has surgery scheduled
- People who need guaranteed acceptance regardless of health