Why Being Healthy Gives You More Options (and Better Health Insurance)

As we roll into summer, I’ve been talking a lot about wellness and healthy living—and there’s a good reason for it. Yes, eating better, moving more, and reducing stress are great for your body and mind—but they also open the door to better health insurance options and lower medical costs. That’s a win-win.

Why Your Health Matters for Insurance Options

When you’re in good health, you’re more likely to qualify for private PPO health insurance plans—and those offer flexibility you just can’t get with most marketplace plans. If you’ve ever said, “I want a PPO,” you’re not alone. It’s one of the most common requests I hear. But here’s the truth:

👉 Currently, the Health Insurance Marketplace does not offer PPO options.

Instead, it offers HMOs and EPOs, which require you to stay in-network with no out-of-network benefits. That can be a big limitation for folks who want freedom to see providers nationwide.

But there is another way.

How to Get a PPO Health Insurance Plan in 2025

I work with individual PPO plans that operate a little differently. Here’s how they work:

✅ You join a group plan by answering about 10–12 health screening questions.

✅ If you can answer “no” to all the medical questions, you’re eligible to join the group.

✅ Once in the group, you can choose from multiple nationwide PPO plans—with major medical coverage and out-of-network benefits.

That’s why I keep emphasizing health and wellness tips. If you take good care of yourself throughout the year, you increase your chances of qualifying for these more flexible options.

Key Benefits of These PPO Plans

💡 Nationwide PPO Networks

These include trusted names like Anthem Blue Cross, First Health, and PHCS—networks that allow you to see doctors outside of your zip code.

💡 Out-of-Network Reimbursement

If your provider isn’t in-network, many of these plans will reimburse a portion of your out-of-pocket costs.

💡 Major Medical Coverage

These plans cover preventive care, wellness visits, and more—just like traditional insurance.

💡 Flexible Enrollment

The best part? You don’t have to wait for open enrollment to join. You can enroll any time of the year if you qualify. However, once you’re in, changes to your plan can only be made during open enrollment.

Is This Plan Right for You?

These plans are ideal for:

• Healthy individuals who are not receiving a government subsidy

• People currently on COBRA or coming off COBRA coverage

• Anyone frustrated with a limited HMO or EPO plan

• Self-employed professionals who want national PPO access

If you’re currently receiving a tax credit through the Marketplace, that still might be your most cost-effective option. But if nationwide provider access and more flexibility are your top priorities, it’s definitely worth exploring these PPO plans.

Now’s the Time to Prep for Open Enrollment

Later this year, open enrollment will bring big changes due to administrative updates, including:

🚨 Tax credit eligibility changes

🚨 Plan and pricing shifts

🚨 New plan structures

Getting healthier now isn’t just good for your well-being—it sets you up for more insurance choices when these changes roll out.

Bonus Tip: Review Your Medications

If you’re taking a brand-name prescription, now is a great time to talk to your doctor about alternatives. Coverage for brand-name drugs is becoming harder to find without meeting a high deductible.

If there’s a generic option or an alternative treatment that works for you, it could save you a lot of money and make qualifying for a PPO group plan easier.

Let’s Talk About Your Options

I’d love to help you find a plan that meets your needs and supports your health goals. Whether you’re ready to switch now or just want to plan ahead for open enrollment, we can start the conversation today.

👉 Schedule your free consultation at jkappconsulting.com

Let’s find a health plan that works for you—not the other way around.

Here’s to staying healthy and empowered with your insurance choices.