Private PPO Health Insurance Plans
For many shoppers, the biggest selling point of private PPO or open-access plans is provider freedom. PPO and open-access structures are built around the ability to use any doctor you choose, while still allowing you to save money by staying within the plan’s network whenever possible. With these types of plans, you have the option to go in or out of network, with lower costs in network.
That network flexibility is real, but the product category behind the label is where shoppers should pay attention. In many private-market sales discussions, the phrases “private PPO health insurance plan” and “open-access coverage” are often being used to describe Short-Term Medical plans or Fixed Indemnity / fixed-benefit plans. Short-term medical plans and fixed-indemnity plans are common private-market offerings and many of those products explicitly market doctor-choice features and PPO-style access.
These plans are generally purchased through the private market, meaning you can’t find these plans by going to HealthCare.gov or other state-based exchanges. The private market can sometimes feel like the Wild West, since plans vary tremendously from company to company. Moreover, plans offered through the private market do not have to follow all the essential coverage benefits mandated by the Affordable Care Act. This means that Private PPO and Open Access plans could contain limitations and exclusions on items that may be important to you, including pre-existing conditions, pregnancy, preventive care, and more.
So if your priority is broad doctor access, the “private PPO” or “open-access” label may be part of the appeal — but in many private-market settings, the plan being discussed often has some pitfalls that you need to be on the lookout for.
Compare Private PPO & Open Access Plans
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