Private PPO options
A PPO is a plan structure built around a preferred provider network, generally allowing you to see out-of-network providers at a higher cost and often without requiring a referral to see a specialist. Some PPO-style plans are sold privately, outside the Health Insurance Marketplace.
Who commonly considers it
- People who want to keep specific doctors or specialists
- People who travel or split time between states
- People who did not qualify for Marketplace financial help
- People exploring options outside an Open Enrollment window
Potential advantages
- Network flexibility, including out-of-network access at a higher cost on many PPO plans
- Specialist access without a referral on many PPO plans
- Some private products have different enrollment timing than Marketplace plans
Important considerations
- Not every plan sold outside the Marketplace is ACA-compliant, and coverage rules can differ significantly
- Some private products apply medical underwriting, exclusions or waiting periods
- Benefits, exclusions and availability vary by carrier, product and state — read what is and is not covered
Questions worth asking
- Is this plan ACA-compliant, and what does that mean for what it covers?
- Does this product apply medical underwriting or pre-existing condition limits?
- Which providers are in network, and what happens if I go out of network?
- What is specifically excluded?
How Dave helps
Dave is direct about what a private product does and does not cover, so the flexibility is weighed against the exclusions rather than discovered later. [INSURANCE COMPLIANCE REVIEW]
Related reading
Plan availability, eligibility, benefits, exclusions, underwriting requirements, enrollment periods and coverage vary by carrier, product and state.