A PPO when you are self-employed: where one exists in 2027

A PPO pays something out of network and needs no referral; for a 1099 worker who works across county lines that is the difference between a plan and a plan that travels. In 2027 it exists on the marketplace in 13 of the 24 states here, and not at all in 11.

States with a marketplace PPO in 2027

Alabama, Arkansas, Delaware, Florida, Louisiana, Michigan, Montana, North Carolina, Oklahoma, South Dakota, West Virginia, Wisconsin, Wyoming.

States with no marketplace PPO in 2027

Indiana, Iowa, Kansas, Mississippi, Missouri, Nebraska, Ohio, South Carolina, Tennessee, Texas, Utah. Every marketplace plan in these states is an HMO, EPO or POS, which pay nothing out of network outside an emergency.

CMS Plan Year 2027 plan files; a PPO filed somewhere in the state, not necessarily in every county. The state pages list the counties.

What to check before the letters

• The network itself. Two PPOs can differ more than a PPO and an EPO; look up your doctors and the hospital in the plan’s own directory (Plans By City reads the insurers’ files).
• Out-of-network terms. A separate, higher deductible and coinsurance, and balance billing above the allowed amount; the out-of-network side of a PPO is a backstop, not a plan.
• Price. Where a PPO is filed it usually costs more than the EPO or HMO next to it, and the credit, if you qualify, is set by the benchmark Silver, not by the PPO.

Where no PPO is filed

Two routes. An EPO or HMO with a wide in-state network, chosen for the hospital you actually use; or, for a healthy person over the credit line, a private plan with access to a national PPO network, priced on age and health answers, from $180 a month at 40 in the cheapest priced state. Private plans are medically underwritten: your health history decides whether you qualify and the final price, and some applicants pay more or are declined. They are not ACA marketplace plans, they do not cover pre-existing conditions the way a marketplace plan does, and no premium tax credit applies. If you are not in good health, the marketplace is usually the better route.

Who this matters for

Truck drivers, travelling nurses and locum clinicians, consultants on client sites, trades crews working across a metro, snowbirds with two homes. Networks for 1099 workers who travel has the rest.

Common questions

Run my own numbersBack to the ZIP box near the top of this page.