8/21/2025
Private PPO Plan Basics
Private PPOs are available off the ACA Marketplace and often through brokers. Key features:
- Nationwide Network – Access to providers across the country.
- Customizable – Choose deductibles, copays, and benefits.
- No Minimum Participation – Great for solo business owners or small teams.
Drawbacks:
- Underwriting – May require basic health screening.
- Not Subsidized – No premium tax credits.
Cost Comparison
Example for a business owner with two employees:
- Group Plan – $1,800/month total premium, $7,500 deductible per person.
- Private PPO – $1,250/month total premium, $2,500 deductible per person.
When Group Plans Make Sense
- You want guaranteed coverage for everyone, regardless of health.
- You can meet participation and contribution requirements.
- Your employees prefer local HMO/EPO networks.
When Private PPOs Make Sense
- You travel frequently or have employees in different states.
- You want lower deductibles and broader coverage.
- You have a very small team or are self-employed.
Hybrid Approaches
Some small business owners offer a stipend or HRA (Health Reimbursement Arrangement) so employees can buy their own private PPO coverage. This gives employees choice and can save the employer money.
Final Thought: Whether you choose a group plan or private PPO, the best option is the one that balances cost, coverage, and flexibility for your specific team.
Want to compare group and private PPO options for your business? Call (716) 503-1113 for a free consultation.