PPO Health Insurance for Individuals: How to Find One

By Heather Sprague, licensed Agent of Record (NPN 19086819)·Updated November 1, 2026·8 min read

PPO health insurance lets you see specialists without a referral and use out-of-network doctors at a higher cost. That freedom makes PPOs popular. However, they are harder to find on the individual market than HMOs and EPOs. This guide explains why, what PPOs cost, and how to get similar flexibility.

How PPO Health Insurance Works

PPO stands for preferred provider organization. With PPO health insurance, you pay the least when you use in-network doctors. Still, the plan pays part of the bill if you go out of network.

You also do not need a primary care referral. So you can book a dermatologist or cardiologist directly. That flexibility is why many people ask for a PPO by name.

To see which network types sell near you, compare health insurance quotes or call 888-730-6031.

PPO vs HMO vs EPO

In short, a PPO buys freedom at a higher price. For a full breakdown, read HMO vs PPO plans and EPO vs POS plans.

Why Individual PPO Plans Are Hard to Find

Many carriers have pulled PPOs from the individual market. PPOs cost more to run because carriers have less control over prices. As a result, HMO and EPO plans dominate most Marketplaces.

Availability changes by county. In some areas, you may still find a PPO on the Marketplace. Elsewhere, none are offered at all.

Because of this, check your ZIP code before you set your heart on a PPO. An agent can tell you in minutes at 888-730-6031.

How Much Does PPO Health Insurance Cost?

PPO premiums usually run higher than HMO or EPO plans at the same metal tier. The gap depends on the carrier and county.

For context, KFF puts the average benchmark silver premium at $704 a month for a 40-year-old for 2027 coverage. A PPO at the same tier may cost more. Meanwhile, out-of-network care adds its own deductible and coinsurance.

So ask what you would pay for out-of-network care before choosing. See in-network vs out-of-network costs to understand the math.

Alternatives That Offer PPO-Like Flexibility

• EPO plans with large networks. No referrals, but in-network only.
• POS plans. Some out-of-network coverage with a referral system.
• Short-term plans with PPO networks. Some use a UnitedHealthcare network, while others use PHCS or First Health.
• Employer PPO plans. Still common in job-based coverage.

Keep in mind, short-term plans are not ACA plans and can exclude pre-existing conditions. Learn more about short-term health insurance.

How Out-of-Network Care Works on a PPO

Out-of-network care usually has its own deductible. In addition, your coinsurance share is higher. Some doctors may also bill you the difference between their charge and the plan's payment.

Federal law limits surprise bills in many emergency cases. Still, planned care out of network can cost much more. So ask for an estimate first.

For details, read how networks affect health insurance costs. Then call 888-730-6031 to compare.

Questions to Ask Before Choosing a PPO

• Are my doctors in network? In-network care still costs least.
• What is the out-of-network deductible?
• Is there a separate out-of-pocket cap for out-of-network care?
• How much more is the premium than an EPO?

These answers show whether the extra flexibility is worth it. Above all, compare the yearly total, not just the premium.

PPO Plans for Families and Travelers

Families with a student away at school often need broad coverage. Likewise, people who split time between two states benefit from a national network.

If a PPO is not offered, a large EPO may still work. Otherwise, a short-term plan with a national network can bridge the gap in approved states. See family health insurance plans and health insurance for students.

How to Check if a Doctor Is in a PPO Network

1. Get the exact plan name, since one carrier can run several networks.
2. Search the carrier directory for each doctor and hospital.
3. Call the office to confirm they take that specific plan.
4. Save proof of the network listing in case of a billing dispute.

Our find a doctor in my network page links to every major carrier directory. Prefer help? Call 888-730-6031.

When an HMO or EPO Beats a PPO

• All your doctors are in network on a cheaper plan.
• You rarely see specialists, so referrals are not a burden.
• Your budget is tight and premiums matter most.
• You stay close to home for nearly all care.

In those cases, the extra PPO premium buys little. Instead, put the savings toward your deductible. An agent can show the price gap at 888-730-6031.

Who Should Look for PPO Health Insurance

• People with specialists who are out of local HMO networks.
• Frequent travelers who need care in many places.
• Families in two states, such as a student away at school.
• Anyone who values choice over the lowest premium.

If none of these fit, an EPO or HMO may save money. An agent can compare both at 888-730-6031.

PPO Health Insurance FAQs

Next Steps to Find a PPO

List your doctors first, then check which network types include them.

Call a licensed Vivna agent at 888-730-6031, Monday through Friday, 9 a.m. to 6 p.m. Eastern. Or compare individual health insurance online.

Sources

• HealthCare.gov: Health insurance plan and network types
• KFF: Marketplace average monthly benchmark premiums

Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641) appointed with 50+ carriers. Plans, prices, benefits, and availability vary by state and carrier. Short-term and Tri-Term plans are not ACA-compliant. They may exclude pre-existing conditions and sell only in approved states. Vivna is not affiliated with HealthCare.gov or any government agency. Cited figures come from the sources listed above.

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