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Private PPO health plans.
Keep your doctors.
See the private PPO plans you qualify for and what they cost, in one call with a licensed agent.
Keep your doctors See any specialist Apply any month No lock-in
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Why people choose PPO plans
Skip the insurance jargon. Here's what a PPO actually gets you:
Keep the doctors you already have
Give the agent your doctors' names. They check that each one takes the plan before you enroll.
See a specialist without a referral
No gatekeeper, no permission slip. If you need a back doctor or a heart doctor, you book the visit.
Know your costs before you go
Many plans use flat copays for everyday visits, so you know the price walking in, not after the bill.
Coverage that travels with you
Broad nationwide networks work at home, across state lines, and when you move.
Plan details vary by carrier, plan, and state: a licensed agent can confirm what applies to you.
More choice within your plan's network
Choose your own doctors and specialists within the plan's network. Some private PPO options use nationwide carrier networks.
Network size varies by plan and state.
Missed open enrollment? You still have options.
Private PPO plans have no enrollment window.
When do you need coverage to start?
Already without coverage, or about to be? Ask what you may qualify for and which start dates may be available.
Coverage often starts the next day.
These private plans are medically underwritten: approval is not guaranteed, and how a plan treats pre-existing conditions varies. A licensed agent can tell you what you qualify for.
Comprehensive ACA marketplace plans are generally available only during the annual open enrollment period or a special enrollment period; visit healthcare.gov for details. Cancellation terms vary by carrier and plan.
Tell the agent when your coverage ends, or that it has already ended.
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From call to covered, minute by minute
When a plan fits, you can go from hello to enrolled in one call, in as little as 10-15 minutes.
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A licensed agent picks up. Lost coverage, missed a deadline, leaving a job: start wherever you are.
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Answer a few quick questions
Your age, zip, the doctors you want to keep, and a monthly budget that feels doable. About 3 minutes.
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A short hold while they pull up the plans you qualify for.
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Compare your options
They walk you through real plans with real prices. They can check that your exact doctors are in network, by name.
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Enroll before you hang up
E-sign from a text link on your phone. Digital ID cards often arrive by email the same day, and coverage can start as soon as the next day.
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Plans from top carriers
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Coverage is offered through licensed agents: SPARKM LLC with Champion Benefits Group, National Producer Number 20874871. View licensing details
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What is a private PPO plan?
A private PPO plan is individual health insurance sold outside the government marketplace, directly through insurance carriers and licensed agents. Applicants answer health questions during a process called medical underwriting, and approved members get access to a PPO network: a group of doctors and hospitals, with many plans allowing specialist visits without a referral.
"Off-exchange" simply means the plan is not purchased through healthcare.gov or a state marketplace. You apply directly with a carrier, usually with a licensed agent walking you through the options. Because these plans sit outside the marketplace system, they follow different rules: there is typically no fixed enrollment season, but there is also no income-based subsidy, and approval is not automatic.
The "medically underwritten" part matters most. Before a carrier approves your application, it reviews your answers to a set of health questions. Healthy applicants are often approved quickly. Applicants with significant health conditions can be declined, or offered coverage that excludes or limits those conditions. This is a real trade-off, not fine print, and it is the biggest difference between these plans and marketplace coverage.
Private individual plans also differ from employer coverage. A job-based plan is group insurance: your employer picks the carrier, typically pays part of the premium, and the coverage usually ends when the job does. A private individual plan belongs to you. You choose it, you pay for it, and it can stay with you when you change jobs, start a business, or retire before Medicare age.
Who these plans fit, and who they do not
Private underwritten plans are a strong fit for some shoppers and the wrong product for others. Here is the honest breakdown before you spend time on a call.
Often a good fit if you are:
- ✓Generally healthy, with no major ongoing conditions
- ✓Paying for coverage yourself: self-employed, a contractor, or an early retiree
- ✓Looking for PPO network breadth and the option to see specialists directly on many plans
- ✓Past the marketplace open enrollment window and not eligible for a special enrollment period
- ✓Between jobs and weighing alternatives to continuing your old employer plan
Probably not the right fit if you:
- ✗Have significant pre-existing conditions that need covered treatment now
- ✗Qualify for income-based subsidies that would lower a marketplace premium
- ✗Need coverage that cannot turn you down based on health history
If any of those describe you, the honest answer is an ACA marketplace plan. Marketplace plans accept applicants regardless of health history and cover pre-existing conditions. Visit healthcare.gov or your state's marketplace to see your options and enrollment dates.
Telling you this up front saves everyone a phone call. If a private plan is not the right tool for your situation, an agent will say so.
How medical underwriting works
When you apply for a medically underwritten plan, the carrier asks a series of health questions: your height and weight, tobacco use, current medications, recent diagnoses, hospitalizations, and planned procedures. The questions exist so the carrier can decide whether to offer you coverage and on what terms. Answer them accurately; misstatements can lead a carrier to rescind coverage later.
Approval is not guaranteed. Depending on your answers, a carrier may approve the application, approve it with exclusions or limitations on specific conditions, or decline it. Pre-existing conditions are generally not covered the way marketplace plans cover them, and some conditions can make approval unlikely. That is the trade-off for a product that typically enrolls year-round and prices for a healthier pool.
The process itself is usually simpler than people expect. For many applicants the health questions take a few minutes on the phone, decisions often come back within days rather than weeks, and approved coverage can frequently start soon after. Timelines vary by carrier and by how much review your answers trigger. A licensed agent walks through the questions with you on the call, tells you which carriers are realistic for your history, and helps you avoid applying somewhere likely to decline you.
Private PPO plans vs marketplace plans
Two different products built on two different sets of rules. Here is how they compare on the points that matter.
| Private PPO plans | ACA marketplace plans | |
|---|---|---|
| Enrollment window | Typically year-round | Annual open enrollment, or a special enrollment period after qualifying life events |
| Underwriting | Health questions; applicants can be declined | Guaranteed issue; no health questions affect approval |
| Pre-existing conditions | Generally excluded or limited; varies by carrier and plan | Covered |
| Subsidies | Not available | Income-based premium help for those who qualify |
| Network style | PPO options common; some use broad national carrier networks | Varies by plan and state; many areas are HMO-heavy |
| Typical fit | Generally healthy, self-pay shoppers who want network breadth or missed the window | Anyone with health conditions, subsidy eligibility, or a need for guaranteed acceptance |
Neither product is universally better. The right answer depends on your health history, your income, and your timing. A healthy freelancer who missed open enrollment is often better served by a private plan; someone managing a chronic condition or eligible for a large subsidy is almost always better served by the marketplace. Marketplace rules, covered benefits, and enrollment details are published at healthcare.gov.
When can you actually enroll?
Private underwritten plans typically have no enrollment season. You can apply in March, July, or October, and approved coverage often starts within days. A job ends in spring. A business launches in summer. For people whose lives do not line up with a government calendar, this flexibility is the main reason these plans exist.
Marketplace plans work differently. The annual open enrollment period typically begins November 1, and exact dates can change and vary by state. Outside that window, you generally need a qualifying life event, such as losing job-based coverage, moving, or a change in household, to enroll through a special enrollment period. Check current dates and special enrollment rules for your state at healthcare.gov.
Practical takeaway: if the marketplace window is open, or you qualify for a special enrollment period, compare both routes before you decide. If neither applies and you are generally healthy, a private plan may be the only path to comprehensive-style coverage that starts now rather than next year.
Frequently asked questions
What is a private PPO plan?
It is individual health insurance purchased directly from a carrier, outside the government marketplace, that uses a PPO network of doctors and hospitals. Applicants answer health questions before approval, and many of these plans can be purchased any time of year in most U.S. states.
What is the difference between private health insurance and marketplace plans?
Marketplace plans are guaranteed issue, cover pre-existing conditions, and offer income-based subsidies, but generally only enroll during set windows. Private underwritten plans typically enroll year-round and often emphasize PPO networks, but they ask health questions, can decline applicants, generally exclude or limit pre-existing conditions, and offer no subsidies.
Do private health plans have an open enrollment period?
Typically no. Because these plans are medically underwritten, carriers accept applications throughout the year. The trade-off is that approval depends on your health answers rather than being automatic.
Can I buy health insurance on my own, without an employer?
Yes. Individuals and families buy their own coverage two main ways: through the ACA marketplace during an enrollment window, or through private individual plans purchased directly from carriers with a licensed agent. Self-employed people, contractors, gig workers, and early retirees make up a large share of this market.
What is the difference between a PPO and an HMO for individuals?
An HMO usually requires you to pick a primary care doctor and get referrals to see specialists, and it typically covers care only inside its network. A PPO gives you a network of providers you can usually see without a referral, and many PPO plans pay a portion of out-of-network care as well. For self-employed people who travel or split time between states, PPO network breadth is often the deciding factor.
Can I see a specialist without a referral?
On most PPO plans, yes. PPO networks are designed for direct access: if you need a dermatologist, a cardiologist, or an orthopedist, you typically book the appointment yourself rather than waiting on a referral from a primary care doctor. HMO plans usually work the other way and require that referral before a specialist visit is covered. Referral rules are set plan by plan, so confirm how a specific plan handles specialist access before you enroll. A licensed agent can check that detail on the call.
Can I keep my doctor?
PPO plans are the plan type most often chosen by people who want to keep a specific doctor, because their networks are typically broader than HMO networks and many pay a portion of out-of-network care. Still, it depends on the specific plan's network, so do not guess. Networks vary by carrier, plan, and state. On the call, give the agent the names of the doctors you want to keep and they check each one against the specific plan's network before you enroll.
What does "medically underwritten" mean?
It means the carrier reviews your health history before deciding whether to cover you. You answer questions about conditions, medications, and recent care. Based on your answers, the carrier can approve you, approve you with exclusions on certain conditions, or decline the application. This is the opposite of the marketplace's guaranteed-issue rule.
What determines what a private PPO plan costs?
Underwritten pricing is individual, which is why this page does not quote premiums. The largest factors are typically your age, tobacco use, your state and county, how many family members you are covering, and the deductible and cost-sharing level you choose. Plan design matters too: a higher deductible generally means a lower monthly premium, and a richer plan generally costs more each month. Because carriers screen applicants through health questions, your own history also shapes what you are offered. The only way to get a real number is a quote against your own answers, which is what a licensed agent prepares on the call.
I missed open enrollment. What are my options?
You generally have three: check whether a life event, like losing job-based coverage or moving, qualifies you for a marketplace special enrollment period at healthcare.gov; see whether you qualify for Medicaid, which enrolls year-round (details at healthcare.gov); or, if you are generally healthy, apply for a private underwritten plan, which typically has no enrollment window. Which route fits depends on your health and income.
About this service
This page connects you with licensed insurance agents; calls are answered by licensed insurance agencies, not by this website's operator. You can review licensing details and the companies involved at any time. Comparing plans is free and carries no obligation.
Last reviewed: August 2026