Service
Customized Private PPO & White-Glove Health Insurance
For individuals who want more than a plan off a shelf: nationwide access, no referrals, tailored benefits, and a local advocate who picks up the phone when you need them.
Built for individuals who want more than the marketplace offers
The ACA marketplace works well for many people, but it isn’t the right fit for everyone. For those who earn above the subsidy threshold, frequently travel outside their home state, see specialists regularly, or simply want a higher-touch experience, a customized private PPO offers a level of flexibility and access that standard marketplace plans can’t match.
This is also the right path for anyone who missed the Open Enrollment window and needs coverage now. Many private, off-exchange plans are available year-round with no enrollment deadline required.
Who typically chooses a private PPO
- High earners who don’t qualify for ACA subsidies
- Frequent travelers and second-home owners
- Those who missed Open Enrollment
- Professionals who want specific specialist access
- Anyone who values direct, personal service over an automated process
What a customized private PPO actually gives you
Nationwide network access
See specialists anywhere in the country through premier networks like Anthem Blue Cross Blue Shield and Aetna. No referrals, no HMO gatekeepers.
Unrestricted provider choice
Access Boulder Community Health, UCHealth, and Boulder Medical Center without needing a referral and with strong out-of-network coverage when you need it.
Coverage that travels with you
Whether you’re working from a second home, skiing in Utah, or visiting family across the country, your coverage goes wherever you go.
Tailored to your risk profile
We customize your deductible, out-of-pocket maximums, and supplemental gap coverage to match how you actually live, rather than following a template.
Private PPO vs. ACA marketplace: an honest comparison
The right choice depends almost entirely on your income, how you use healthcare, and how much flexibility you need. Here’s how the two paths compare for Boulder residents:
| Feature | Private off-exchange PPO | ACA marketplace plan |
|---|---|---|
| Government subsidies | Not available | Available if income qualifies |
| Enrollment window | Available year-round | Open Enrollment or SEP only |
| Provider network | Broad national PPO network | Varies; often Colorado-focused |
| Referrals required | No; direct specialist access | Depends on plan type |
| Out-of-state coverage | Strong nationwide coverage | Often emergency-only outside Colorado |
| Plan customization | High; tailored deductibles and benefits | Limited to metal tier selection |
| Pre-existing conditions | Some plans medically underwritten. For Short-Term Limited Duration Insurance (STLDI) or Fixed Indemnity plans, they can underwrite. However, if they are "Off-Exchange ACA-Compliant" plans, they cannot underwrite. John can help with these nuances. | All conditions covered, no exceptions |
| Best for | High earners, travelers, those needing flexibility | Those who qualify for subsidies |
Not sure which path fits your situation? John runs the full comparison for your specific income and needs before making any recommendation.
Boulder Community Health and private PPO plans
As of 2026, Boulder Community Health (BCH) remains in-network with most major private PPO carriers, including Aetna and Anthem. Network contracts change annually. John verifies the current status of every local facility before recommending a plan, so you’re never surprised at the billing desk.
Supplemental & gap coverage: filling the holes in your plan
Even the best private PPO leaves some exposure. John often pairs primary coverage with targeted supplemental policies that cover costs your main plan doesn’t turning good coverage into complete protection.
| Coverage type | What it covers | Best for |
|---|---|---|
| Accident coverage | Cash benefit paid directly to you after a covered accident like fractures, dislocations, ER visits | Active Boulder residents, trail runners, cyclists, skiers |
| Critical illness | Lump-sum benefit upon diagnosis of cancer, heart attack, stroke, or other major conditions | Those with family history of serious illness |
| Hospital indemnity | Daily cash benefit for each day spent in the hospital, regardless of other coverage | High-deductible plan holders who want income protection |
| Dental & vision | Standalone plans for routine dental, orthodontics, glasses, and contacts | Most adults — rarely included in private medical plans |
Common questions about private PPO health insurance in Boulder
Is private PPO insurance more expensive than the ACA marketplace in Boulder?
It depends on your income. If you qualify for ACA subsidies on Connect for Health Colorado, the marketplace will almost always be less expensive. But if your income is above the subsidy threshold — roughly $60,000 for a single person in 2026 — a private off-exchange PPO can actually offer more value: a broader network of doctors, more customizable benefits, and stronger out-of-state coverage at a comparable price point.
Can I get a private health insurance plan outside of Open Enrollment in Colorado?
Yes, and this is one of the biggest advantages of private off-exchange plans. Unlike ACA marketplace plans, many medically underwritten private PPOs are available year-round. If you missed the January 15th enrollment deadline and don’t qualify for a Special Enrollment Period, John can help you secure private coverage immediately, provided you meet standard health qualifications.
Does Boulder Community Health accept private PPO plans?
As of early 2026, Boulder Community Health (BCH) is in-network with most major private PPO carriers, including Aetna and Anthem Blue Cross Blue Shield. However, network contracts are renegotiated annually. John verifies the current contract status of BCH and any other local facilities before recommending a plan, not just what’s listed in last year’s directory.
Do private PPO plans cover pre-existing conditions?
It depends on the specific plan type. ACA marketplace plans must cover all pre-existing conditions without exception. Some private off-exchange plans are medically underwritten, meaning your health history may affect your eligibility or premium. John conducts a preliminary health review before recommending any medically underwritten plan to ensure you’re placed in coverage that fully protects your situation.
What is gap coverage and should I add it to my private PPO plan?
Gap coverage, including accident, critical illness, and hospital indemnity policies, pays cash benefits directly to you when something major happens, helping offset your deductible or out-of-pocket costs. For Boulder’s active residents who ski, cycle, run trails, or simply want financial protection against a serious diagnosis, supplemental gap coverage is often one of the most cost-effective additions to a private PPO plan.
What does “no referrals required” actually mean on a PPO plan?
With a PPO, you can schedule an appointment directly with any specialist, a cardiologist, orthopedic surgeon, dermatologist, without first visiting your primary care doctor for a referral. This is a significant advantage over HMO plans, which require referrals and limit you to a specific local network. For Boulder professionals who see specialists regularly or travel frequently, this flexibility is one of the most valuable features of a private PPO.
How is working with John different from buying a plan directly from a carrier?
When you buy directly from a carrier, you get that carrier’s options only, and you’re on your own if a claim gets denied or a bill looks wrong. John is independent, meaning he compares plans across all major carriers to find your best option. More importantly, he stays involved after enrollment advocating on your behalf for claims issues, conducting annual plan reviews, and serving as your direct point of contact for anything coverage-related. The cost is identical either way; the carrier pays John’s fee.
Can I switch from my current ACA plan to a private PPO mid-year?
In most cases, yes, with some planning. Voluntarily dropping an ACA plan mid-year doesn’t trigger a Special Enrollment Period for another marketplace plan, but private off-exchange plans don’t have the same restrictions. John walks through the timing and any implications for tax credits before making any mid-year switch to ensure there are no gaps in coverage or unexpected tax consequences.
You’ve worked hard to build your life in Boulder.
Schedule a private portfolio review and find out if a customized PPO is the right fit. No pressure, just a real conversation with a local expert.
Local Expertise. Real Coverage. Zero Confusion.
Nationwide health insurance guidance without the confusion. Just straightforward advice from a trusted independent advisor.
