PPO Health Insurance
Plans, Costs & Networks for 2027
A PPO (preferred provider organization) plan usually lets you see specialists without a referral and pay less in its network, and many PPO plans also pay something out of network. Compare both kinds side by side: ACA Marketplace PPOs, where offered, and private PPO and EPO plans sold outside the Marketplace that use the Cigna PPO network but aren’t insured by Cigna.
ACA PPO Plans vs. Private PPO Plans
Both kinds use a PPO-style network, but the rules behind them are very different. Here’s how they compare, using federal rules for 2027 and figures from the private plan documents we reviewed.
| Feature | ACA Marketplace PPO | Private PPO / EPO (Cigna PPO network) |
|---|---|---|
| Where you buy | HealthCare.gov or your state’s exchange, where PPOs are offered in your area | Outside the Marketplace; some are group health plans offered through a sponsoring employer or organization, not individual ACA plans |
| Premium tax credit | Yes, if you qualify (100%–400% of the federal poverty level for 2027 coverage, under current law) | No. The only way to get the premium tax credit is through the Marketplace |
| Pre-existing conditions | Must be covered | Ask us to confirm in writing how a plan handles pre-existing conditions |
| When you can enroll | Open Enrollment (Nov 1, 2026 – Jan 15, 2027 on HealthCare.gov; state exchanges may differ) or a Special Enrollment Period | You can apply outside Open Enrollment; approval depends on each plan’s eligibility and underwriting rules, and the start date depends on the plan |
| Network | The insurer’s own PPO network for that plan | The Cigna PPO network; the network doesn’t insure the plan or pay claims |
| Out-of-network care | Generally covered at a higher cost (HealthCare.gov’s PPO definition); check the plan | PPO designs we reviewed: 50% after a separate, higher deductible, plus possible balance billing. EPO designs: not covered except emergencies |
| In-network deductible | Varies by plan and metal level | About $5,000–$9,000 for one person, stated in the plan documents we reviewed |
| Out-of-pocket limit | No more than $12,000 for one person or $24,000 for a family in 2027 (in-network essential health benefits) | About $6,000–$9,000 for one person, stated in the plan documents we reviewed; premiums, balance billing, penalties and non-covered care don’t count toward it |
| Pregnancy | Covered from the day your plan starts | Childbirth is typically 30% after the deductible; the plans’ own examples show a member paying about $6,050–$6,960 of a normal delivery, before any gap benefit |
| Monthly premium | Varies by age, ZIP code and metal level; a premium tax credit lowers it if you qualify | Roughly $500–$950/month for a healthy single adult, depending on age, state, network and underwriting (as of fall 2026) |
| Usually the better fit | You qualify for a tax credit or Medicaid, have a pre-existing condition, are pregnant or planning to be, or take expensive brand-name or specialty drugs | You’re healthy, earn above 400% of the poverty level (about $63,840 for one person for 2027 coverage), want the Cigna PPO network, accept a higher deductible, and qualify through the plan’s sponsoring group, which we confirm |
About these prices: Price ranges are examples of monthly quotes we commonly see as of fall 2026, not offers or guarantees. Your rate depends on age, state, household size, network, plan design and each plan’s eligibility and underwriting rules. Premiums are separate from what you pay when you get care (deductibles, copays and coinsurance). Some quotes in this range include a separate hospital and accident gap policy. A premium tax credit may lower an ACA plan’s price: estimate yours with the 2027 subsidy calculator.
Network: The Cigna PPO network is a provider network, not an insurance company, and it doesn’t pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan’s own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.
Before you buy a private PPO, check four things
- The real deductible. Some brochures advertise a lower figure that depends on a gap benefit. The plan’s Summary of Benefits and Coverage controls, so ask us for it before you enroll.
- Out-of-network rules. A “PPO” label doesn’t guarantee out-of-network coverage. Some plans that use a PPO network cover in-network care only, except emergencies.
- Prescriptions. Some designs cover generic drugs at $0 before the deductible; others put all drugs behind the deductible; limited-benefit plans may cover generics only, with brand-name drugs through patient-assistance programs.
- Pre-certification. Imaging, surgery and hospital stays typically need it. The plans we reviewed charge a $500 penalty if you skip it, and penalties don’t count toward the out-of-pocket limit.
Not every plan sold with a PPO network works like the plans in this table. Lower-priced limited-benefit plans can use a PPO network, such as the Cigna or First Health network, but they pay a set list of services with copays and hard caps: in the plans we reviewed, 3 lab/X-ray/imaging services a year and 2 ICU plus 2 non-ICU hospital stays of up to 5 days each. Some are in-network only even though the network is called a PPO. See the plan disclosures under the comparison tool below, and our private health plan price report for ranges by plan type.
Sources
- HealthCare.gov: Preferred Provider Organization (PPO)
- HealthCare.gov: Health insurance plan & network types
- HealthCare.gov: Premium tax credit — the only way to get the premium tax credit is through the Marketplace.
- HealthCare.gov: Pre-existing conditions — Marketplace plans must cover pre-existing conditions, and pregnancy is covered from the day your plan starts.
- HealthCare.gov: Dates and deadlines — Open Enrollment for 2027 coverage.
- CMS: 2027 cost-sharing limits — $12,000 self-only / $24,000 other than self-only.
- HHS ASPE: Poverty guidelines — the 2026 guideline of $15,960 for one person, used for 2027 coverage (400% = $63,840).
Compare PPO Plans & Pricing
Select your age range and household size to see example monthly rates for private plans that use the Cigna PPO network or the First Health network. These are not Marketplace plans: you can apply outside Open Enrollment, but approval depends on each plan’s eligibility rules and the start date depends on the plan.
Rates shown are monthly premiums before any employer contribution. Plans use the Cigna PPO network or the First Health network and are not insured by Cigna or First Health. Rates subject to change. Call (844) 788-3733 for exact quotes and to confirm availability in your state.
Plan disclosures
Prices: Price ranges are examples of monthly quotes we commonly see as of fall 2026, not offers or guarantees. Your rate depends on age, state, household size, network, plan design and each plan’s eligibility and underwriting rules. Premiums are separate from what you pay when you get care (deductibles, copays and coinsurance). Some quotes in this range include a separate hospital and accident gap policy.
Monthly rates for some plans include a separate hospital and accident gap plan. Gap benefits are subject to that policy’s own terms, limits and exclusions. The medical plan’s deductible and cost sharing are shown before any gap benefit.
Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan’s own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.
These plans are not sold through the ACA Health Insurance Marketplace (HealthCare.gov or your state’s exchange) and are not individual-market ACA plans. You can’t use a premium tax credit or cost-sharing reduction to pay for them. As HealthCare.gov puts it, “the only way to get the premium tax credit is through the Marketplace.”
Networks: The Cigna PPO network is a provider network, not an insurance company, and it doesn’t pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
The First Health network is a provider network, not an insurance company, and it doesn’t pay claims. A plan that uses the First Health network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
Group-style and gap-benefit plans: This is a group health plan offered through a sponsoring employer or organization, not an individual ACA plan. Its Summary of Benefits and Coverage states that it provides minimum essential coverage and meets the minimum value standard. If you are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit. Eligibility is set by the plan document.
Some services, such as imaging, surgery and hospital stays, need pre-certification before you get them. If you skip it, the plan may charge a penalty ($500 in the plans we reviewed), and in most of those plans the penalty doesn’t count toward your out-of-pocket limit.
PPO designs with out-of-network benefits: Out-of-network providers may bill you for the difference between their charge and what the plan pays. That amount doesn’t count toward your out-of-pocket limit. Out-of-network preventive care and prescriptions are not covered.
Gap-benefit plans: How the “integrated gap benefit” works: The plan’s stated in-network deductible and out-of-pocket limit are higher than the reduced amount you may see advertised. The plan’s integrated gap benefit may offset eligible in-network deductible and coinsurance amounts, subject to the terms and limits of the plan. Copayments, non-covered services, penalties, balance billing and other excluded charges may not be eligible. Ask us for the plan’s Summary of Benefits and Coverage and the gap benefit’s terms before you enroll.
HSA-labeled plans: An “HSA” plan label doesn’t guarantee you can open or contribute to a Health Savings Account. That depends on whether the plan is an HSA-qualified high-deductible health plan and on your own situation. Confirm with the plan administrator and a tax professional; FreedInsure doesn’t give tax advice. No HSA account or employer HSA contribution is included unless your plan materials say so.
Limited-benefit plans: This is a limited-benefit plan. It pays for a defined list of services, with copays, visit and day limits, and caps on hospital stays, and it excludes some major treatments. Its plan materials don’t state that it meets ACA coverage standards or that it counts as minimum essential coverage. Costs above the plan’s limits are yours to pay. Benefits are subject to the governing plan document. Copays apply after the deductible unless the plan says otherwise. Coverage is in-network only, even though the network is called a PPO. Out-of-network care isn’t covered except under the plan’s emergency-care protections.
FreedInsure LLC is an independent insurance broker; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states. Our help is free to you, and we’ll show you your ACA Marketplace options, including any tax credit you qualify for, next to any private plan. We don’t sell ACA Marketplace plans in Maine, Maryland, Nevada, Pennsylvania, Virginia or Washington, DC; see private plans by state.
We Compare PPO Plans. You Choose.
Plans that look alike can have very different premiums, networks, deductibles and limits — and a PPO label alone doesn’t tell you what’s covered out of network. Picking the wrong one can cost thousands.
Our licensed advisors compare plans side by side, including your ACA Marketplace options, verify your preferred doctors are in-network, check your prescriptions, and handle your enrollment — all at no cost to you.
Unlike online quote engines, we’re real licensed advisors available by phone. We stay with you throughout your plan year for any billing, claims, or network questions. Two of our licensed advisors speak Spanish, so you can get help in Spanish (hablamos español).
Compare PPO Plans Free →What Is a PPO Health Insurance Plan?
PPO stands for Preferred Provider Organization — a plan that balances network savings with the freedom to go outside it.
A PPO gives you access to a network of preferred providers at the lowest cost, and unlike an HMO, many PPOs also pay for out-of-network care at a higher cost to you (HealthCare.gov). Not every plan does: some plans that use a PPO network cover in-network care only, except emergencies.
There’s usually no requirement for a primary care physician and no referral process. If you want to see a cardiologist, dermatologist, or orthopedic surgeon, you can usually make the appointment directly. Some services, such as imaging, surgery and hospital stays, may still need pre-certification.
PPO premiums are typically higher than HMO premiums. Marketplace plans come in several network types, including PPOs in some areas (HealthCare.gov plan types). ACA premium tax credits can lower the cost of Marketplace plans, including Marketplace PPOs where they’re offered, but they can’t be used on private plans sold outside the Marketplace. Our advisors check every available subsidy when comparing plans for you. See the carriers and networks we work with.
PPO Insurance — What You Need to Know
Straight answers to the most common PPO questions — no jargon.
PPO vs. HMO vs. EPO vs. HDHP
Not all health plans work the same way. Here’s how the most common plan types compare.
| Feature | PPO Most Flexible | HMO | EPO | HDHP |
|---|---|---|---|---|
| Referral to see specialist | ✓ Usually not required | ✗ Required | ✓ Not required | Depends on the network type |
| Out-of-network coverage | ✓ Often (higher cost); check the plan | ✗ Usually none | ✗ Emergency only | Varies by plan |
| Must choose a PCP | ✓ Not required | ✗ Required | ✓ Not required | Depends on the network type |
| Monthly premium | Higher | Lower | Moderate | Lowest |
| Deductible | Moderate | Low–Moderate | Moderate | High (IRS 2027 minimum: $1,750) |
| HSA eligible | Only if the plan is an HSA-qualified HDHP | Only if the plan is an HSA-qualified HDHP | Only if the plan is an HSA-qualified HDHP | ✓ Yes, if it meets IRS HDHP rules |
| Best for | Flexibility, if your doctors are in network | Low cost, simple care | No referrals, in-network only | Healthy, want HSA savings |
Deductible, Copay & Coinsurance — Simplified
Three terms explain how you and your PPO plan split the cost of care.
Is a PPO Plan Right for You?
PPO plans can be the right choice in several common situations.
When a private plan can make sense: your household income is above 400% of the federal poverty level (about $63,840 for a single person for 2027 coverage, under current law), so you get no tax credit; you’re healthy with predictable, low use; you want the Cigna PPO network and have confirmed your doctors are in it; and you accept higher deductibles, caps or exclusions. Outside Open Enrollment with no Special Enrollment Period, ask us whether a private plan can bridge to the next Open Enrollment.
When an ACA plan is the better call: you likely qualify for a tax credit (100%–400% of the poverty level) or Medicaid; you have a pre-existing condition or ongoing treatment; you’re pregnant or planning to be; you take expensive brand-name or specialty drugs; or you want a firm out-of-pocket ceiling ($12,000 for one person in 2027). Marketplace plans must cover pre-existing conditions, and the only way to get the premium tax credit is through the Marketplace. See if you qualify →
Private Plans by State
In these five states we sell private health plans, but not ACA Marketplace plans. For an ACA plan with a premium tax credit there, apply through your state’s ACA Marketplace.
Washington, DC: we don’t sell ACA Marketplace plans there (DC residents use DC Health Link), but we can help with life and supplemental coverage.
The Cigna PPO network is a provider network, not an insurance company, and it doesn’t pay claims. A plan that uses the Cigna PPO network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
PPO Health Insurance — Frequently Asked Questions
What Our Members Say
Thousands of families in the 42 states where our agent is licensed trust FreedInsure to find the right coverage.
Related Coverage & Resources
Find the Right PPO Plan — Free
A licensed FreedInsure advisor compares the private PPO plans available in your area with your ACA Marketplace options (in the states where we sell them), applies any tax credit you qualify for, and explains the real cost difference between plans — at zero cost to you. Help is available in English and Spanish.
Agent NPN: 20230457 · Licensed in 42 states · Free service · Info never sold · Not affiliated with Healthcare.gov or any government agency