Paying over $1,000 a month? Learn why — and what to do about it.
A plain-English guide to private PPO coverage for people who don't get a subsidy — how it works, who it actually fits, and how to see what you may qualify for.
The whole guide in 2 minutes.
Every part of this guide — why premiums run high, what a private PPO plan actually changes, and who it isn't for — in one video with straight answers.
Why your premium got this high.
Marketplace plans are priced around everyone who enrolls: your rate is the same whether you're healthy or not. That system works well when a subsidy absorbs part of the cost. If you don't get one, you're paying the full sticker price for a plan that wasn't priced around you.
Those last two rows are why this isn't for everyone — Part 4 below spells out who it isn't for.
What a private PPO plan actually is.
Four things make these plans different from the marketplace default — worth understanding before you compare anything.
A PPO network
You can see any doctor in the PPO network — these networks are typically broad, and Tonya confirms your providers are in-network before anything is decided.
You answer health questions
These plans are medically underwritten: your answers affect both approval and price. That's how healthy applicants often qualify for lower premiums. It also means many plans don't cover pre-existing conditions.
Year-round enrollment
There's no open-enrollment window. If your situation changes in March, you can compare plans in March — no waiting for the end of the year.
Built around your situation
The plan is chosen around who needs coverage, the deductible you're comfortable with, and your monthly budget. Nothing is assigned to you.
What actually determines your price.
No honest quiz can hand you a final number. Anyone who promises one is guessing. Here's what your real rate is built from:
The 60-second quiz narrows the field to what you're likely to qualify for. The real numbers come from Tonya, a licensed advisor, on a short call.
See what I may qualify for →Who this fits — and who it doesn't.
Private PPO coverage isn't for everyone, and it's better you know that in the next 30 seconds than on a call.
A strong fit if you're…
- Paying over $1,000 a month without a subsidySelf-employed, 1099, small-business owner, or early retiree buying your own coverage at sticker price.
- In generally good healthUnderwriting rewards it — that's how healthy applicants can qualify for lower rates.
- Attached to your doctorsYou want a PPO network broad enough to keep the providers you already use.
Probably not, if…
- A subsidy covers most of your premiumThen the marketplace is likely your best value — keep it.
- You're managing serious ongoing conditionsMarketplace plans must cover pre-existing conditions; many private plans don't. That protection may matter more than the premium.
- You qualify for Medicare or MedicaidDifferent system, different rules — start there first.
Sound like a fit? Then it's worth 60 seconds to see where you land.
See what I may qualify for →How it works from here.
Three steps, and you decide at every one of them.
Tell Tonya your situation
Your ZIP, who needs coverage, and a few quick details. About 60 seconds, no paperwork.
Tonya matches the plans
Your answers point to the private PPO plans you're likely to qualify for — across the carriers Tonya works with.
Decide on a quick call
Tonya walks you through what fits and what it costs. No pressure — you decide, or you don't.
Tonya Whipple
You work with Tonya directly — one licensed advisor, start to finish, no call-center handoffs. Tonya compares what's available in your state, explains the tradeoffs in plain English, and only recommends a plan that actually fits. The decision stays yours.
Prefer to talk now? Call or text Tonya at (260) 366-4519Common questions, straight answers.
Is there any cost to compare?
None. Both the quiz and the call with Tonya are free, with no obligation. If nothing's a fit, Tonya will say so.
Will I be able to keep my doctor?
These are PPO-network plans, so in most cases you can keep the doctors and hospitals you already use. Tonya confirms your providers before anything is decided.
Is this the Health Insurance Marketplace?
No. These are private plans offered by licensed insurance carriers — this isn't the government Marketplace, and this site isn't affiliated with any government agency. If a subsidy covers most of your premium, the Marketplace is likely still your best value.
Does my health history affect what I qualify for?
Yes — that's the tradeoff at the heart of these plans. You'll answer health questions, and your answers help determine which plans you qualify for, whether you're approved, and at what rate. Tonya goes over exactly where you stand.
What about pre-existing conditions?
Many private plans don't cover pre-existing conditions. That's part of why premiums can run lower for healthy applicants. If ongoing conditions are a big part of your picture, a marketplace plan's protections may serve you better, and Tonya will tell you so.
Can I enroll any time of year?
Generally, yes — these private plans are available year-round, so you're not stuck waiting for a once-a-year window. What's offered varies by state and carrier, and Tonya will confirm what's available where you live.
What happens after the quiz?
One short call with Tonya. Most people grab a time on the calendar right after the quiz; otherwise Tonya reaches out by phone or text. That call is where you'll see what you may qualify for and what it would actually cost. No pressure, no obligation. You decide from there.
See what you may qualify for.
You've read the guide. The quiz takes 60 seconds and shows Tonya enough to find what may fit — no cost, no obligation, no pressure.
See what I may qualify for →This is a private insurance marketing website, not a government website or the Health Insurance Marketplace, and is not affiliated with or endorsed by any government agency. Plans are offered by licensed insurance carriers; availability, benefits, eligibility, and costs vary by state and carrier and are subject to the terms of the actual policy. This page is for general information and is not medical, legal, or tax advice. This is a solicitation of insurance; coverage is offered through licensed insurance agents/producers. These private plans may not be Qualified Health Plans under the Affordable Care Act and may not cover pre-existing conditions. By submitting the form you agree to be contacted as described in the consent you provide.