Private Health Insurance in Virginia: PPO and EPO Options for 2027
FreedInsure sells private PPO and EPO plans in Virginia that use the Cigna PPO network and are sold outside Virginia's Insurance Marketplace. They aren't insured by Cigna, a tax credit can't pay for them, and approval depends on each plan's own rules. Here's who they fit, who should use the Marketplace instead, what they cost and how applying works.
Compare Your Options ↓Can I Buy a PPO in Virginia Outside Virginia's Insurance Marketplace?
Yes. Private health insurance in Virginia includes PPO and EPO plans sold outside Virginia's Insurance Marketplace, the state's official ACA exchange. FreedInsure sells these plans in Virginia, along with short-term health plans, supplemental coverage and life insurance. We don't sell plans on Virginia's Insurance Marketplace, and we'll tell you when one of its plans is the better buy.
A note on words: Marketplace plans are private insurance too, because private insurers sell them. On this page, “private plans” means the PPO and EPO plans we sell outside the Marketplace. They are group health plans offered through a sponsoring employer or organization, with individual and family rate tiers, not individual ACA plans. They use the Cigna PPO network and are not insured by Cigna.
Quick answer (as of October 7, 2026): Yes. FreedInsure sells private PPO and EPO plans in Virginia that use the Cigna PPO network, outside Virginia's Insurance Marketplace. You can apply outside open enrollment, but approval and start dates depend on each plan's rules, and tax credits don't apply. If you qualify for financial help, the Marketplace usually wins.
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.
Last updated: October 7, 2026
Who Private Plans Fit in Virginia, and Who Should Use the Marketplace
Income comes first. A tax credit can't pay for a private PPO or EPO plan, and neither can Virginia Premium Savings, the new state program for 2027, which applies only to qualified health plans bought through Virginia's Insurance Marketplace. So the first thing we ask any Virginian is household size and income.
Straight talk: A plan sold outside the Marketplace can cost less than a full-price ACA plan if you're healthy, earn too much for a tax credit, or want a specific network. But if you qualify for a tax credit, Virginia Premium Savings or Medicaid, have a pre-existing condition, are pregnant or planning to be, or take expensive medications, an ACA plan is usually the safer buy, and the only way to get the premium tax credit is through the Marketplace. FreedInsure doesn't sell Marketplace plans in Virginia, so if that's you, we'll say so plainly and point you to Virginia's Insurance Marketplace (1-888-687-1501). Questions first? Call (844) 788-3733.
When a private plan can make sense in Virginia
- No tax credit. Your household income is above 400% of the federal poverty level (FPL): about $63,840 for one person or $132,000 for a family of four for 2027 coverage, as of fall 2026 under current law.
- Self-employed, retired early or between jobs, with income above that line. If you buy your own coverage and won't get a tax credit, price a private plan's premium, deductible and limits next to a full-price Marketplace plan. Our self-employed health insurance guide covers the tax side.
- Healthy, with predictable, low use: no ongoing specialist care, generic drugs only, no planned surgery or pregnancy.
- Network preference. You want the Cigna PPO network with an out-of-network option (PPO designs) and have checked that your doctors are in it.
- You accept the trade-offs: higher stated deductibles, pre-certification rules, visit limits and exclusions.
- You qualify through the sponsoring group. We confirm this with you; this page doesn't promise it.
- Timing. You're outside open enrollment with no Special Enrollment Period. Ask us whether a private plan can bridge to the next open enrollment; approval and start dates depend on each plan.
When Virginia's Insurance Marketplace is the better call
- You likely qualify for financial help. Federal premium tax credits apply at 100%–400% FPL, about $15,960–$63,840 for one person for 2027 coverage. Below about 250% FPL, cost-sharing reduction silver plans also cut deductibles. Virginia Premium Savings adds state help at 138%–250% FPL, about $22,025–$39,900 for one person.
- Income under 138% FPL. Virginia Medicaid (Cardinal Care) covers adults ages 19–64 with income under 138% FPL who don't have Medicare. We'll tell you and point you to the state application.
- Pre-existing conditions or ongoing treatment. All Marketplace plans must cover treatment for pre-existing medical conditions. For the private plans on this page, ask us to confirm in writing how the plan handles pre-existing conditions before you apply.
- Pregnant or planning a pregnancy. On a Marketplace plan, pregnancy and childbirth are covered from the day your plan starts. The private plans' own coverage examples show a member paying about $6,050–$6,960 of a normal delivery, before any gap benefit.
- You need guaranteed acceptance. Open enrollment and Special Enrollment Periods are the guaranteed routes. The private plan documents we reviewed are silent on acceptance.
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.” In Virginia, that Marketplace is Virginia's Insurance Marketplace: Virginia left HealthCare.gov for its own platform starting with open enrollment for plan year 2024.
Virginia's Insurance Marketplace vs Private PPO Plans vs Virginia Medicaid
Three routes cover most Virginians who buy their own health insurance, and they work very differently. If you're shopping for individual health insurance in Virginia, start with the column your income points to. Facts come from the official sources listed below and, for private plans, from the plan documents we reviewed, as of fall 2026.
| What to Compare | Virginia's Insurance Marketplace (ACA Plans) | Private PPO/EPO Plans Using the Cigna PPO Network | Virginia Medicaid (Cardinal Care) |
|---|---|---|---|
| Where you get it | Virginia's official ACA exchange, run by the Virginia Health Benefit Exchange, a division of the State Corporation Commission | Group health plans offered through a sponsoring employer or organization, sold outside the Marketplace; FreedInsure helps you apply | Virginia's Medicaid program; apply through CommonHelp, Cover Virginia (1-855-242-8282) or Virginia's Insurance Marketplace |
| Who it fits | Anyone eligible to buy a Marketplace plan; financial help depends on income | Can fit people who get no tax credit, such as incomes above 400% FPL; eligibility is set by each plan document | Adults 19–64 with income under 138% FPL who don't have Medicare; children can be covered through Medicaid or FAMIS |
| Financial help | Federal tax credits at 100%–400% FPL; cost-sharing reductions on silver plans at or below 250% FPL; Virginia Premium Savings at 138%–250% FPL, new for 2027 | None: no tax credit, cost-sharing reduction or Virginia Premium Savings | A public program, separate from Marketplace tax credits |
| Pre-existing conditions | Must cover treatment for pre-existing medical conditions | Not confirmed in the plan documents we reviewed; ask us to confirm in writing | Eligibility is based on income and program rules |
| Pregnancy | Covered from the day your plan starts | Childbirth is 30% after the deductible; the plans' coverage examples show a member paying about $6,050–$6,960 of a normal delivery, before any gap benefit | Pregnant non-citizens with qualifying income can get coverage regardless of immigration status |
| Network | Each insurer's own network | Uses the Cigna PPO network; the plan, not Cigna, sets benefits and pays claims. EPO designs cover in-network care only, except emergencies | Providers that participate in Virginia Medicaid |
| Deductible and out-of-pocket limit | Varies by plan; the 2027 out-of-pocket maximum is $12,000 for one person ($24,000 for a family) | Stated in-network deductibles of about $5,000–$9,000 for one person in the plans we reviewed; premiums, penalties, balance billing and non-covered care don't count toward the out-of-pocket limit | Set by Virginia Medicaid; ask Cover Virginia |
| When you can enroll | Open enrollment Nov 1, 2026 – Jan 29, 2027; otherwise you need a Special Enrollment Period | You can apply outside open enrollment; approval depends on eligibility and any underwriting, and the start date depends on the plan | Apply through CommonHelp or Cover Virginia; the Marketplace also makes Medicaid eligibility decisions |
| What changes in 2027 | Virginia Premium Savings is new, funded for plan year 2027 and first-come, first-served | Prices on this page are fall 2026 ranges; rates aren't guaranteed and can change | From January 2027, expansion adults must work or do qualifying activities at least 80 hours a month unless exempt, with reviews every 6 months |
Virginia Premium Savings is a new state-funded program applied on top of any federal premium tax credit, from a Virginia Health Insurance Affordability Fund the General Assembly created in a 2026 special session. The marketplace says “Some may save as much as 70%,” that you may still qualify if you're ineligible for federal tax credits, and that the savings aren't a tax credit. Catastrophic plans and stand-alone dental plans don't qualify. Lawfully present immigrants who lose federal tax credits on January 1, 2027 may qualify for additional Virginia Premium Savings, according to the marketplace.
Medicaid work rules for 2027 don't apply to children, pregnant and postpartum people, adults with a disability, or adults over 64. Our Medicaid work requirements guide covers the federal rules. The marketplace also warns that failing to report work will make you ineligible for an Advance Premium Tax Credit. Estimate your federal credit with our 2027 ACA subsidy calculator; Virginia Premium Savings would come on top of it.
What Do Private PPO and EPO Plans Cost in Virginia?
Group-style PPO and EPO plans we see often run roughly $500–$950/month for a healthy single adult, depending on age, state, network and underwriting, as of fall 2026. These ranges come from FreedInsure's broker plan catalog and cover both categories below combined. They are not Virginia-only quotes; your quote depends on your age, household, plan design and each plan's eligibility rules.
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.
| Categories 1 + 2: Group-Style PPO/EPO Plans | Monthly Premium, Fall 2026 |
|---|---|
| Single adult | $500–$950 |
| Couple | $1,000–$1,800 |
| One adult + child(ren) | $950–$1,700 |
| Family | $1,600–$2,300 |
Plans in these two categories we see often run roughly $500–$950/month for a healthy single adult, roughly $1,000–$1,800/month for a couple, roughly $950–$1,700/month for one adult plus children and roughly $1,600–$2,300/month for a family, depending on age, state, network and underwriting.
Pricing note: 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. Full-price Marketplace premiums vary by age, location and plan, so we don't print them here; see our health insurance cost guide and our private health plan price report for the national picture.
Category 1: group PPO plans with standard cost sharing
Some private PPO plans we offer are group health plans offered through a sponsoring employer or organization, not individual ACA plans. Their Summaries of Benefits and Coverage state that they provide minimum essential coverage and meet the federal minimum value standard. In the plan documents we reviewed, in-network deductibles ran about $5,000–$6,000 for one person ($10,000–$12,000 for a family), with out-of-pocket limits of about $7,000–$8,700 ($14,000–$17,400 for a family).
Some designs let you see a primary care doctor or specialist for a flat copay before the deductible (for example $40 and $80), with generic drugs at $0. ER visits, imaging, surgery, hospital stays and childbirth are typically 30% after the deductible. PPO plans with out-of-network benefits typically charge more out of network. In the plans we reviewed, that meant 50% coinsurance after a separate, higher deductible.
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.
Services have yearly limits, for example 60 home-health visits, 35 rehab visits and 25 skilled-nursing days. Common exclusions include adult dental and vision, hearing aids, infertility treatment, bariatric surgery and acupuncture. The plans' own coverage examples show a member paying roughly $6,400–$7,000 of a $12,700 normal delivery.
Category 2: group EPO and PPO plans with an integrated gap benefit
Some group plans pair a high stated deductible with an “integrated gap benefit” that may pay down eligible in-network deductible and coinsurance costs, subject to the plan's terms and limits. In the documents we reviewed, the stated in-network deductible and out-of-pocket limit were the same figure: $6,000–$9,000 for one person ($12,000–$18,000 for a family). Copays, penalties, balance billing and non-covered services may not be eligible for the gap benefit.
Before the deductible, office visits run $25–$40 for primary care and $50–$60 for a specialist, and generic drugs are $0. Diagnostic tests, imaging, surgery, hospital stays and childbirth are 30% after the deductible. The plans' own coverage examples, before the gap benefit, show a member paying about $6,050 for a normal delivery. The EPO plans we reviewed cover in-network care only; out-of-network care isn't covered except for emergencies.
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.
Group plan notice (Categories 1 and 2): 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.
Pre-certification: 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.
Why the network matters
Both categories use the Cigna PPO network. Some private plans rent access to the Cigna PPO network. Your plan administrator, not Cigna, may process your claims. 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.
A “PPO” label doesn't guarantee out-of-network coverage. Some plans that use a PPO network cover in-network care only, except emergencies. Read the out-of-network column before you buy; our EPO vs PPO guide and PPO health insurance guide explain the difference.
How Applying for a Private Plan in Virginia Works
You can apply for these plans outside open enrollment, but approval isn't automatic and no one can promise you a start date. Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan's own eligibility rules. Here's how we handle a Virginia application, step by step.
- Income first. We ask about household size and income before recommending anything. If you'd likely qualify for a federal tax credit, Virginia Premium Savings or Medicaid, we'll tell you and point you to Virginia's Insurance Marketplace or CommonHelp.
- Documents before decisions. We send the plan's Summary of Benefits and Coverage so you can check the deductible, out-of-pocket limit, network, visit limits and exclusions. Ask us to confirm in writing how this plan handles pre-existing conditions. Marketplace plans must cover them.
- Eligibility and approval. These are group health plans, and eligibility is set by the plan document. We confirm with you whether you qualify through the sponsoring group. Approval depends on each plan's eligibility rules and any underwriting it uses.
- Start date. If you're approved, your effective date comes from the plan's enrollment materials, not from this page. Keep any current coverage in place until the new plan confirms your coverage in writing.
- Read what arrives. Review the plan document when you get it, and ask whether a free-look or cancellation period applies (see Virginia's rules below).
Before you drop other coverage: If you have a Marketplace plan, Medicaid or job-based coverage, know two things before you cancel it for a private plan. Once you cancel Marketplace coverage, you generally can't re-enroll until the next open enrollment unless you qualify for a Special Enrollment Period. And voluntarily dropping coverage doesn't create a Special Enrollment Period (45 CFR 155.420(e)).
Lost a job, or retiring before Medicare? Losing minimum essential coverage, such as a job-based plan, can open a Special Enrollment Period on Virginia's Insurance Marketplace. Our guides to health insurance after losing your job and early retirement health insurance walk through the options.
Virginia Open Enrollment 2027: Dates and Deadlines
Open enrollment for 2027 coverage on Virginia's Insurance Marketplace runs November 1, 2026 – January 29, 2027, according to the marketplace's Federal Changes page.
- November 1, 2026: open enrollment opens on Virginia's Insurance Marketplace.
- January 2027: Medicaid work requirements begin for expansion adults, and Virginia Premium Savings applies to plan year 2027 coverage.
- January 29, 2027: open enrollment ends. After that, a Marketplace plan needs a Special Enrollment Period.
- Coverage start dates: the marketplace hasn't posted its 2027 start-date cutoffs. Check its How to Enroll page or call 1-888-687-1501.
Virginia Premium Savings isn't limited to open enrollment, according to the marketplace's Virginia Premium Savings FAQ, but the savings are available on a first-come, first-served basis, and the marketplace says that “for most Virginians, open enrollment” is “the only chance to get the savings on a plan this year.” Lawmakers funded the program for plan year 2027; no funding beyond 2027 has been announced. For other states' dates, see our open enrollment deadlines by state.
Short-term plans and open enrollment in Virginia
In Virginia, a short-term plan's term can be no longer than 3 months, renewals can't extend coverage beyond 6 months, and you can't be covered by short-term plans for more than 6 months in any 12-month period; insurers also can't issue short-term plans during the annual open enrollment period. Federal rules still on the books limit new short-term plans to 3 months, or 4 months with renewal, but federal regulators said in August 2025 they would not prioritize enforcing that limit while they write a new rule, so these limits could change. Plan terms vary by insurer, and your advisor confirms the maximum term available for your start date. More on short-term health insurance in Virginia.
Who Regulates Health Insurance in Virginia?
The Virginia State Corporation Commission's Bureau of Insurance is the state's insurance regulator. Call 1-877-310-6560 (toll-free) or Life and Health Consumer Services at 804-371-9691, file a complaint online, or look up an agent or company.
FreedInsure sells in Virginia through licensed producer Constantino Lardi, NPN 20230457, who holds a Virginia non-resident license (number 1306700) with Health and Life and Annuities lines of authority, per his NIPR Producer Database report dated September 9, 2026. You can verify it with the Bureau's agent lookup; if the state's record ever differs from this page, the state's record controls.
Your right to return a policy
Virginia law gives buyers of individual accident and sickness policies a 10-day right to return the policy (Va. Code § 38.2-3502). The private PPO and EPO plans on this page are group health plans, so that rule may not apply to them the same way. Ask us whether the plan you choose has a free-look or cancellation period, and get the answer in writing before you rely on it.
Sources
- FreedInsure broker plan catalog, fall 2026 — monthly premiums by plan and household rate tier, plus the plans' Summaries of Benefits and Coverage and brochures (internal data; product names withheld).
- Virginia's Insurance Marketplace: Federal Changes to the Marketplace — 2027 open enrollment dates, the Virginia Health Insurance Affordability Fund, Medicaid expansion eligibility, 2027 work requirements and who they don't apply to, and Virginia Premium Savings for lawfully present immigrants.
- Virginia's Insurance Marketplace: Virginia Premium Savings — income range, savings of “as much as 70%” for some, and the open enrollment timing quote.
- Virginia's Insurance Marketplace: Virginia Premium Savings FAQ — dollar income ranges, eligibility rules, not a tax credit, first-come, first-served timing and plan year 2027 funding.
- Virginia's Insurance Marketplace: How to Enroll — open enrollment for 2027 coverage.
- Cover Virginia: How to Apply — CommonHelp and the Cover Virginia Call Center for Medicaid applications.
- Va. Code § 38.2-3407.21 — Virginia's limits on short-term limited-duration plans.
- Va. Code § 38.2-3502 — 10-day right to return an individual accident and sickness policy.
- Virginia SCC Bureau of Insurance: File an Insurance Complaint — consumer phone numbers and the complaint portal.
- HealthCare.gov: pre-existing conditions — Marketplace plans must cover treatment for pre-existing medical conditions, and pregnancy and childbirth are covered from the day the plan starts.
- HealthCare.gov glossary: premium tax credit — the only way to get the premium tax credit is through the Marketplace.
- CMS 2027 benefit-year parameters (January 29, 2026) — $12,000 / $24,000 out-of-pocket maximum.
- HHS ASPE poverty guidelines — 2026 guidelines of $15,960 for one person and $33,000 for a family of four, used for 2027 Marketplace coverage.
- CMS statement on short-term limited-duration insurance (August 2025) — federal enforcement priorities for short-term plans.
- 45 CFR 155.420 — Special Enrollment Periods; voluntarily dropping coverage doesn't create one.
How FreedInsure Helps Virginians
FreedInsure LLC is an independent insurance broker; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states, including Virginia. Our help is free to you. We don't sell plans on Virginia's Insurance Marketplace, but we'll tell you when a Marketplace plan, with any tax credit or Virginia Premium Savings you qualify for, is likely the better buy than a private plan, and point you to Virginia's Insurance Marketplace to enroll.
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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.
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