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PPO Health Insurance in California: Who Sells an Individual PPO in 2026, What It Costs, and Can You Buy Private Coverage?
Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published September 18, 2026
Quick answer Yes, you can buy a PPO in California, but in 2026 only two carriers sell one to individuals and families: Blue Shield of California in all 58 counties, and Health Net in 6 of the 19 rating regions (Sacramento Valley, both Los Angeles regions, the Inland Empire, Orange, and San Diego). Anthem Blue Cross sells no individual PPO this year, only EPO or HMO plans depending on the region, per its own rate filing. That leaves 13 of 19 regions with exactly one individual PPO. For a 40-year-old in Los Angeles, that PPO runs $689 to $788 a month for Silver, against $392 to $415 for the lowest-cost HMO. "Private" plans bought off the exchange are the same plans at the same price. The broad, nationwide PPO lives on the group side. I educate, you decide.
I'm Dick Tracy, an independent health insurance broker. I'm licensed in California (NPN 20414610), one of 25 states I hold a license in, and I work with 80+ carriers. My office is in Buffalo, New York, and I work with Californians on the phone or on Zoom with the documents on the screen. I came from the healthcare side of this business, so there is no gag clause on me. You get the tips, the tricks, and the traps, and the first trap is on this page: plenty of websites still tell you Anthem sells an individual PPO in California. In 2026 it does not.
PPO in California in 2026
one individual PPO
are in a PPO (my tally)
Source: my tally of Covered California's March 2026 Active Member Profile ("Product by Region" sheet, data as of June 1, 2026, cells rounded to the nearest 10), listed on its active member profiles page.
Who sells individual PPO health insurance in California in 2026?
Two carriers. That is the whole list, checked region by region against Covered California's own enrollment file and the carriers' filings.
| Carrier | Individual PPO in 2026? | Where |
|---|---|---|
| Blue Shield of California | Yes | Statewide. All 58 counties, and PPO enrollees in all 19 rating regions. |
| Health Net (Ambetter from Health Net) | Yes, in 6 regions | Region 3 (Sacramento Valley), 15 and 16 (Los Angeles), 17 (Inland Empire), 18 (Orange), 19 (San Diego). Not in every ZIP code in San Bernardino County. HMO only in regions 13 and 14. |
| Anthem Blue Cross | No | EPO plans in regions 1 through 10 and 12 through 14. HMO plans in region 11 and regions 15 through 19. |
| Every other carrier (Kaiser, L.A. Care, Molina, Sharp, and the rest) | No | No other carrier has a single PPO enrollee in the March 2026 file. |
Sources: Covered California Active Member Profile, March 2026; Blue Shield of California, individual and family plans; Centene, Ambetter from Health Net 2026 release; Anthem's 2026 rate filing as quoted by ACA Signups; Covered California 2026 plan rates by county for the ZIP code note.
Anthem's filing says it in plain words: it "will continue to participate in its 2025 marketplace footprint consisting of rating areas 1-10 and 12-14 with EPO plans and rating areas 11 and 15-19 with HMO plans," and the filing applies to plans both on and off the exchange. So there is no secret Anthem PPO hiding off-exchange either.
Put the two lists together and here is the map. Thirteen of the 19 regions have exactly one individual PPO, Blue Shield. That covers the far north, the whole Bay Area, the Monterey coast, the San Joaquin Valley including Fresno, the Central Coast, the eastern counties, and Kern. Six regions have two. No region has zero, because Blue Shield is everywhere, with what it says is more than 71,000 doctors, 325 hospitals and 1,000 urgent care centers in its individual PPO network. One choice is still one choice, though.
How much does a PPO cost in California compared with an HMO?
Here is what Covered California's own 2026 rate decks show for a 40-year-old single person buying a Silver plan, full price, before any subsidy. One warning first: these are the preliminary rates as of August 1, 2025, which Covered California labeled as still under regulatory review. Treat them as a close map, not a quote.
| Area (rating region) | Lowest-cost Silver | Blue Shield PPO Silver | PPO costs more by | Health Net PPO Silver |
|---|---|---|---|---|
| East Los Angeles (15) | L.A. Care HMO $392 | $689 | $297 a month | $587 |
| West Los Angeles (16) | L.A. Care HMO $415 | $788 | $373 a month | $740 |
| Orange (18) | Anthem HMO $516 | $752 | $236 a month | $765 |
| San Diego (19) | Sharp $475 | $843 | $368 a month | $794 |
| Riverside and San Bernardino (17) | Health Net HMO $453 | $706 | $253 a month | $607 |
| Sacramento (3) | Western Health Advantage $611 | $1,001 | $390 a month | $858 |
| San Francisco (4) | Kaiser HMO $710 | $979 | $269 a month | Not sold |
| Alameda (6) | Kaiser $649 | $844 | $195 a month | Not sold |
| Sonoma (2) | Western Health Advantage $632 | $1,009 | $377 a month | Not sold |
| Monterey (9) | Kaiser $637 | $1,032 | $395 a month | Not sold |
| San Joaquin (10) | Kaiser $587 | $911 | $324 a month | Not sold |
| Ventura (12) | Blue Shield HMO $626 | $723 | $97 a month | Not sold |
| Imperial (13) | Molina $533 | $889 | $356 a month | Not sold |
Sources: Covered California, 2026 Regional Bronze and Silver Rates and 2026 Plan Rates by County (San Francisco row). Monthly gross premium, 40-year-old single individual, preliminary rates as of August 1, 2025, "currently undergoing regulatory review with the Department of Managed Health Care." The difference column is my subtraction.
Read the table the way I would. In these 13 areas the Blue Shield PPO costs anywhere from $97 a month more than the cheapest Silver (Ventura) to $395 a month more (Monterey). I am not going to hand you a statewide average, because nobody official publishes one and I will not make one up. And then there is Fresno, which breaks the pattern: in Region 11 the Blue Shield PPO Silver at $558 is the lowest-priced Silver plan, a dollar under Kaiser at $559 and under Anthem's HMO at $568. Where you live decides whether a PPO is a luxury or the default.
Prices across all plan types are on my California monthly cost page.
HMO vs EPO vs PPO in California: what is the difference?
Three letters decide whether your doctor is covered. Here they are in plain English, using the state's own definitions.
| Question | HMO | EPO | PPO |
|---|---|---|---|
| Can I go out of network? | No, except emergencies. You must use providers in the HMO network. | No. The Department of Insurance says: "If you do go out-of-network, your EPO will not pay for any services." | Yes. You can see preferred or out-of-network providers, and you pay less with preferred ones. |
| Do I need a primary care doctor and referrals? | Usually yes. You see your primary care physician before getting a referral to a specialist. | It combines features of both: an exclusive network like an HMO. | No gatekeeper built into the definition. You pick the doctor. |
| Price, per Covered California | "Typically cheaper than PPOs," with smaller networks. | "Usually less expensive than PPOs." | "Usually more expensive." In exchange you likely get a larger network. |
Sources: Covered California, plan and network types; California Department of Insurance, Health Insurance Guide.
The trap is the EPO. People hear "Anthem Blue Cross" and assume PPO. An EPO has no out-of-network benefit at all. If your specialist is not in that network, the plan pays nothing, and you find out when the bill arrives.
Can you buy private health insurance in California, and what does off-exchange really mean?
Yes, you can buy coverage directly from a carrier without touching the marketplace. But "private" in California does not mean what it means in Texas or Florida. Here is what the law actually says.
- Same plans. A carrier that sells on the exchange and also sells outside it must "fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange" (California Government Code 100503(f)(1)(A)).
- Same price. Federal law requires a carrier to charge the same premium for a qualified health plan whether it is sold through an exchange, directly from the carrier, or through an agent (42 U.S.C. 18021(a)(1)(C)(iii)). Going direct does not get you a discount.
- Guaranteed issue, no health questions. California Insurance Code 10965.3 requires insurers to offer and sell all of their individual plans to everyone in the service area, bars eligibility rules based on health status or medical history, bars health questionnaires before enrollment, and bars preexisting condition provisions. You still have to enroll during open enrollment or a special enrollment period.
- No price break for being healthy. The Department of Insurance puts it this way: "Insurers can no longer charge you more based on your health status." It cuts both ways. They cannot charge you less either.
- Subsidies only through the exchange. Same page: "If you qualify for a subsidy, you have to purchase your coverage through Covered California to take advantage of it."
- Short-term plans are banned. SB 910 has prohibited insurers from issuing, selling, or renewing short-term limited duration health insurance in California since January 1, 2019 (Insurance Code 10123.61).
- Fixed indemnity is legal only as a supplement. Insurance Code 10198.61 requires this wording on hospital indemnity and specified disease policies: "This is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law." That matches how I write them: as a second layer on top of a real base plan, never as the only coverage.
So if you searched "private health insurance California" hoping for a cheaper, underwritten PPO, the honest answer is that it does not exist in the individual market. Buying direct mostly saves paperwork when no subsidy is coming. Not sure? Check the Covered California income limits for 2026 first.
How narrow are marketplace networks, really?
The best study I know is from KFF, and I want to be clear that these are national figures using 2021 data, not California figures. On average, marketplace enrollees had access to 40% of the doctors near their home through their plan's network. About 70% of enrollees were in a plan that included half or fewer of the local doctors, 23% were in a plan KFF classed as narrow, and only 4% were in a plan that included at least three quarters of local doctors.
Narrow is not automatically bad. If your doctors are in and you rarely leave your county, a narrow HMO can be the smart buy. It is bad when you travel or your specialist is two counties over. Then the math doesn't math.
How does a self-employed Californian or a small business get a true nationwide PPO?
This is what I actually do. The individual market gives you one or two regional PPOs at individual prices. The group market is a different building, and federal law holds the door open.
The pre-established ERISA group plan
ERISA is the 1974 federal law that governs employer benefit plans. There are group plans that already exist under it, and a solo owner or a small business's people can be merged into one. You get group rates, a true nationwide PPO network of the PHCS type, and a policy the person owns. The employer can be the payer. No employees required, and one simple compliance step I walk you through. Here is the full breakdown of the ERISA cheat code.
How big is "nationwide"? The company behind PHCS described it in May 2023 this way: "The PHCS Network includes more than one million health care providers nationwide: 920,000 practitioners, 4,800 acute care hospitals and 87,000 ancillary facilities" (Claritev, May 4, 2023). If you know that company as MultiPlan, it is the same one. MultiPlan renamed itself Claritev on February 17, 2025.
Fits: a healthy self-employed Californian or small business owner earning too much for a subsidy, who wants a broad PPO and travels or has doctors in more than one place. Does not fit: anyone with a serious diagnosis in the last five years, and anyone counting on a subsidy, because the subsidy only lives on the exchange.
Traditional small group PPO, if you have employees
Here is the part that surprises people. Carriers that will not sell you an individual PPO still sell PPOs to groups. CaliforniaChoice lists Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp, Sutter Health Plan, UnitedHealthcare, and Western Health Advantage, with PPO and HMO options, and it references Anthem's Prudent Buyer PPO small group plans (CaliforniaChoice). Blue Shield says its small business Full PPO network "is among the largest in California and includes more than 80,000 physicians and over 380 hospitals," and its Tandem PPO is a smaller statewide subset with 55,000 providers and 350 hospitals (Blue Shield of California, small business).
For a business I lay three options side by side: a traditional fully insured small group plan, the pre-established ERISA group merge, or no group plan at all. Sometimes you do not need one. I customize the plan based on the situation, and that is often cost-effective customized individual plans instead of a one-size-fits-all group plan. If you do contribute, pick a flat dollar amount per person. More on my California small business health insurance page.
Which situation are you in?
Healthy, self-employed or a small business owner, income too high for a subsidy
Price the pre-established ERISA group plan first. Group rates, a nationwide PHCS type PPO, a policy you own, no employees required. Then I put it next to the Blue Shield PPO for your region so you see both numbers. All four California doors are here, in order.
Income under the subsidy lines
A subsidized plan or Medi-Cal may be your best deal, and I will tell you so. The trade-offs are real: mostly HMO and EPO networks, an income estimate you have to get right, and paying credits back at tax time if you guess low. Run the 2026 subsidy calculator, preset for California, then bring me the number.
A serious diagnosis in the last five years
Guaranteed-issue coverage, for now. California individual plans cannot ask health questions, on or off the exchange. If you need out-of-network freedom, the individual PPO in your region is the tool. Take that protection, get well, and we revisit the other doors later.
A business with employees who want a PPO
Small group opens PPOs the individual market closed. I compare traditional small group, the ERISA group merge, and customized individual plans, and show you the cost of each with a flat dollar contribution.
Check your doctors first: the checklist I use before anyone picks a PPO
- Write the list. Every doctor, specialist, hospital, and lab you would be upset to lose. Include the ones your spouse and kids use, and any out-of-state ones.
- Get the exact network name. "Blue Shield" is not a network. Blue Shield's individual PPO network, its Trio HMO (28 counties), and its small business Full PPO and Tandem PPO are four different lists of doctors.
- Call the billing office, not the front desk. Ask: "Are you in network with this exact plan name for 2026?" Remember the KFF note above: directories are wrong often enough to matter.
- Ask the EPO question. If the plan is an EPO or HMO, there is no out-of-network benefit outside of emergencies. Decide now whether you can live with that.
- Think about where you will be, not just where you live. Travel, a second home, a student away at school. A regional network stops at the region. A nationwide PPO does not.
- Price the whole year. Premium times twelve, plus the deductible and out-of-pocket maximum you could actually hit. The cheapest plan is the one that costs least on the day nothing happens. What kind of tank should we build?
- Bring the list to a call with me. Thirty minutes, phone or Zoom. I check the networks with you on the screen and put the individual PPO, the HMO, and the group PPO options side by side. Nothing gets signed on that call. I educate, you decide.
Common questions about PPO and private health insurance in California
Can you buy private health insurance in California?
Yes. You can buy an individual or family plan directly from a carrier without using the marketplace. Under California Government Code 100503, a carrier that sells on the exchange and outside it must offer its exchange products to people buying outside it, and federal law (42 U.S.C. 18021) requires the same premium either way. Insurance Code 10965.3 makes coverage guaranteed issue with no health questions. The catch: subsidies are only available through Covered California, and short-term plans have been banned since January 1, 2019 under SB 910.
Which companies sell individual PPO health insurance in California in 2026?
Two. Blue Shield of California sells an individual PPO in all 58 counties. Health Net, under the Ambetter from Health Net name, sells a PPO in 6 of the 19 rating regions: Sacramento Valley, both Los Angeles regions, the Inland Empire, Orange, and San Diego. Anthem Blue Cross sells no individual PPO in 2026. Its rate filing lists EPO plans in rating areas 1 through 10 and 12 through 14 and HMO plans in areas 11 and 15 through 19. By my tally of Covered California's March 2026 Active Member Profile, 13 of 19 regions have exactly one individual PPO.
What is the average cost of PPO health insurance in California?
No official source publishes a statewide average for PPO plans, so I will not invent one. What Covered California's preliminary 2026 rates (as of August 1, 2025) show for a 40-year-old buying Silver: the Blue Shield PPO runs $689 in East Los Angeles, $752 in Orange County, $843 in San Diego, $979 in San Francisco, and $1,001 in Sacramento per month before any subsidy. The lowest-cost Silver HMO in those same areas runs $392 to $710. Fresno is the exception, where the Blue Shield PPO at $558 is the cheapest Silver plan.
How much does private health insurance cost in California?
The same as the marketplace price for the same plan, because federal law requires a carrier to charge one premium on and off the exchange. As an example from Covered California's preliminary 2026 rates, a 40-year-old in San Francisco would pay $793 a month for the Blue Shield PPO Bronze, $979 for Silver, $1,184 for Gold, and $1,610 for Platinum, while the Kaiser HMO Silver there is $710. Your price depends on age, rating region, metal tier, and network. It does not depend on your health.
What is the best PPO health insurance in California?
It depends on where you live and whether you can use group coverage. In 13 of California's 19 rating regions the only individual PPO in 2026 is Blue Shield, whose individual PPO network includes more than 71,000 doctors and 325 hospitals, according to Blue Shield. In six regions Health Net also sells one. For a healthy self-employed person or a business owner paying full price, a pre-established ERISA group plan with a nationwide PHCS type network is often the broader PPO. The best one is the one your doctors actually take, so check them first.
How do I get PPO health insurance in California if I am self-employed?
Two routes. You can buy the individual PPO sold in your region, which is Blue Shield everywhere and Health Net in six regions, with no health questions. Or, if you are healthy and earn too much for a subsidy, you can be merged into a pre-established ERISA group plan as a solo owner: group rates, a policy you own, no employees required, and a nationwide PPO network of the PHCS type. In May 2023 Claritev (formerly MultiPlan) put the PHCS Network at more than one million providers, including 920,000 practitioners and 4,800 acute care hospitals.
What is the difference between an HMO, an EPO, and a PPO in California?
An HMO requires you to use its network and usually to have a primary care doctor who refers you to specialists. An EPO also has an exclusive network, and the California Department of Insurance warns that if you go out of network, the EPO will not pay for any services. A PPO lets you see preferred or out-of-network providers, and you pay less with preferred ones. Covered California describes HMOs as typically cheaper with smaller networks and PPOs as usually more expensive with larger networks.
Does Anthem Blue Cross sell a PPO in California?
Not to individuals and families in 2026. Anthem's 2026 rate filing says it participates with EPO plans in rating areas 1 through 10 and 12 through 14 and HMO plans in areas 11 and 15 through 19, on and off the exchange. Covered California's March 2026 enrollment file shows zero Anthem PPO members. Small group is different: CaliforniaChoice lists Anthem Blue Cross among its carriers and references Anthem Prudent Buyer PPO small group plans. So a business may be able to get an Anthem PPO when an individual cannot.
Are most Covered California plans HMOs?
By enrollment, yes. By my tally of Covered California's March 2026 Active Member Profile, about 75.6% of 1,786,310 enrollees are in an HMO, 19.9% are in a PPO, and 4.5% are in an EPO. Only two carriers have any PPO members: Blue Shield of California with 315,760 and Health Net with 39,070. Nationally, KFF found that marketplace enrollees had access to an average of 40% of the doctors near their home through their plan's network, based on 2021 data.
Thirty minutes on the phone or Zoom, no fee, no hard sell. Bring your county, your age, a rough income number, and your list of doctors. I put the individual PPO, the HMO, and the group PPO options side by side with the networks on the screen. I educate, you decide.
Grab a time right here
Pick a slot below and it lands on both our calendars. Phone or Zoom, plan documents on the screen, real numbers side by side. I educate, you decide.