Individual PPO Health Insurance on the Cigna Network — Ages 18–64
Yes, you can access PPO health coverage on the Cigna network without being employed by a
traditional employer. This plan — Patriot Ultra Cigna PPO — works differently than an
ACA marketplace plan: it's a self-funded ERISA health plan, and eligibility is provided through fractional
ownership rather than a traditional job. Below, licensed broker Clifford Grekin explains exactly how the
plan works, who qualifies, and how it compares to ACA marketplace coverage — so you can make an informed
decision before you apply.
Clifford Grekin is a licensed health insurance broker/general agent
who can help you compare available options. Call 631-963-6020 or email broker@nysmallgroupplans.com to speak with a licensed
professional.
What Exactly Is This PPO Plan?
| Product name |
Patriot Ultra Cigna PPO Available Plans Page |
| Network |
Cigna PPO Network |
| Plan type |
Self-funded ERISA PPO health plan |
| Third-party administrator |
Securus |
|
|
| Available states |
All 50 states |
| Eligible ages |
18–64 (same pricing at every age) |
| Traditional employer required |
No |
| How eligibility works |
Applicant becomes a fractional owner of the sponsoring corporation/union, which qualifies them for that entity's self-funded health plan |
| Open enrollment required |
No — apply year-round |
| Medical underwriting |
Yes — a health questionnaire is required |
| Pre-existing conditions |
Applicants with major pre-existing conditions (e.g., cancer, diabetes, recent surgery) are not accepted into the plan. If accepted, pre-existing conditions are covered like any other condition. |
| ACA-compliant major medical |
This is a self-funded ERISA plan with ACA major medical benefits. |
| Out-of-network benefits |
Yes, subject to deductible and coinsurance |
| Prescription coverage |
Covered, subject to formulary (specialty drugs excluded) |
| Maternity |
Covered |
| Mental health |
Covered |
| Annual/lifetime maximum |
No maximum benefit |
| Deductible |
$1,000–$8,000 per year per person, depending on plan selected |
| Maximum out-of-pocket |
Varies by plan selected — ask your broker for the figure on your specific plan option |
How Is This Different From an ACA Marketplace Plan?
This is not an ACA marketplace plan, and it is not "ACA-compliant major medical" in the regulatory sense
of that term. It is a self-funded ERISA health plan — a category of coverage that federal
law treats differently from individual-market insurance. Self-funded ERISA plans are specifically exempt
from ACA individual-market requirements such as guaranteed issue (accepting all applicants regardless of
health status). That's a structural feature of how ERISA
plans work, not a shortcoming specific to this plan.
Eligibility for this plan works through fractional ownership: applicants become a fractional owner, which makes them eligible to participate in that entity's
self-funded health plan on the Cigna PPO network. Because it isn't guaranteed issue, applicants complete a
health questionnaire, and those with major pre-existing conditions such as cancer, diabetes, or recent
surgery are not accepted.
Available Nationwide
This PPO plan is available to eligible individuals in all 50 states, including Alabama, Alaska, Arizona,
Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana,
Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi,
Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina,
North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee,
Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Because the plan uses the
national Cigna PPO network, coverage generally travels with you if you relocate or need care while
traveling — see "Does PPO insurance cover me outside my home state?" below.
Frequently Asked Questions
Can an individual buy PPO health insurance?
Yes. This PPO plan on the Cigna network is available to individuals directly, without a traditional
employer. Eligibility works through fractional ownership in the sponsoring entity, plus a health
questionnaire, rather than through a job or the ACA marketplace.
Can I get a PPO without an employer?
Yes. You don't need a traditional employer or business to apply. Eligibility comes from becoming a
fractional owner of the plan's sponsoring corporation/union, which qualifies you to participate in its
self-funded health plan.
Can I buy PPO insurance if I'm self-employed?
Yes. Self-employed individuals can apply the same way as any other applicant — through the fractional
ownership eligibility structure and health questionnaire. There are no additional requirements specific to
self-employment.
Can a retired person under 65 buy PPO health insurance?
Yes. Applicants ages 18–64 are eligible, and pricing is the same at every age within that range — there's
no additional cost for being closer to 65. Acceptance still depends on the health questionnaire.
Are PPO plans available in New York?
Yes, this plan is available to eligible individuals in New York. Because self-funded ERISA plans are
regulated differently than New York's individual insurance market,
Can I buy PPO insurance outside Obamacare?
Yes. This plan is not sold through the ACA marketplace —
it's a self-funded ERISA plan accessed through fractional ownership eligibility. It is not restricted to the
ACA's annual Open Enrollment Period, but unlike ACA marketplace plans, it is not guaranteed issue.
Do I have to wait for open enrollment?
No. You can apply year-round; there is no restriction to an annual open enrollment window.
Does PPO insurance cover me outside my home state?
Yes. Because the plan uses the national Cigna PPO network, you can generally receive in-network care from
participating Cigna providers in any of the 50 states, not just your home state.
Does PPO insurance cover out-of-network doctors?
Yes. Out-of-network care is covered, subject to the plan's deductible and coinsurance, which are higher
than in-network cost-sharing.
Are pre-existing conditions covered?
If you're accepted into the plan, pre-existing conditions are covered the same as any other condition.
However, applicants with major pre-existing conditions — such as cancer, diabetes, or recent surgery — are
generally not accepted, since this plan uses medical underwriting rather than guaranteed issue.
This page is for general informational purposes and does not constitute a description of any specific
insurance contract. This plan is a self-funded ERISA health plan, not ACA marketplace or individual-market
major medical insurance. Plan details, availability, and pricing vary by plan option and eligibility.
Contact 631-963-6020 to speak with a licensed broker and review the official plan documents before
enrolling.
Private PPO vs. ACA Marketplace Health Insurance
These are two fundamentally different types of coverage, and the right one depends on your
health and your subsidy eligibility — not just price. Below, licensed broker Clifford Grekin
compares the Patriot Ultra Cigna PPO plan to ACA Marketplace
coverage honestly, including where the PPO plan isn't the better choice, so you can decide with full
information before you apply.
Side-by-Side Comparison
|
ACA Marketplace |
Patriot Ultra Cigna PPO |
| Guaranteed issue |
Yes — everyone is accepted regardless of health |
No — medical underwriting via health questionnaire |
| Pre-existing conditions |
Always covered |
Covered if accepted; major conditions (cancer, diabetes, recent surgery) generally result in decline |
| Enrollment window |
Annual Open Enrollment Period (plus qualifying life events) |
Year-round — apply anytime |
| Subsidies available |
Yes, income-based premium tax credits for those who qualify |
No subsidies — this is private coverage |
| Network |
Varies by insurer and metal tier, often regional |
Cigna PPO — national network |
| Out-of-network coverage |
Varies — often limited or unavailable on HMO/EPO plans |
Yes, subject to deductible and coinsurance |
| Deductible |
Varies widely by metal tier [ADD A REAL COMPARISON FIGURE IF YOU HAVE ONE, e.g., typical Bronze/Silver deductible in your state] |
$1,000–$8,000 per year, depending on plan selected |
| Annual/lifetime maximum |
None (ACA requirement) |
None |
| Prescription coverage |
Required essential health benefit |
Covered, subject to formulary (specialty drugs excluded) |
| Maternity |
Required essential health benefit |
Covered |
| Mental health |
Required essential health benefit |
Covered |
| Pricing by age |
Varies by age band (most states, except NY) |
Same price at every age, 18–64 |
Who the PPO Plan Is a Good Fit For
- Generally healthy individuals who don't have major conditions like cancer, diabetes, or a recent
surgery that would affect underwriting
- People who don't qualify for ACA premium subsidies and are paying full price on the Marketplace
- Self-employed individuals and retirees under 65 who want a national PPO network and don't need to wait
for open enrollment
- Anyone who wants out-of-network flexibility that many Marketplace HMO/EPO plans don't offer
Who Should Stay on the ACA Marketplace
- Anyone with a major pre-existing condition who may not pass medical underwriting for this plan
- Anyone who qualifies for income-based premium tax credits, since a subsidized Marketplace plan is often
cheaper than private coverage even before comparing benefits
- Anyone who wants a guaranteed-issue plan and doesn't want underwriting risk
Because these are different types of coverage for different situations, the honest answer to "which is
better" is: it depends on your health and your subsidy eligibility. Clifford
Grekin can review both options with you and tell you plainly which one actually makes sense — including
telling you to stay on the Marketplace if that's the better call for your situation.
Frequently Asked Questions
Is private PPO insurance cheaper than ACA Marketplace coverage?
It depends on your subsidy eligibility. If you don't qualify for a premium tax credit, private PPO
coverage can be significantly cheaper for healthy applicants. If you do qualify for a subsidy, a Marketplace
plan is often the lower-cost option once the subsidy is applied — an advisor can run both numbers for you.
Can I be denied private PPO coverage?
Yes. Unlike ACA Marketplace plans, this PPO plan uses medical underwriting. Applicants with major
pre-existing conditions such as cancer, diabetes, or recent surgery are generally not accepted.
Do I have to wait for open enrollment to buy a PPO plan?
No. This PPO plan can be purchased year-round. ACA Marketplace plans, by contrast, generally require
enrollment during the annual Open Enrollment Period unless you have a qualifying life event.
Which plan has a better network?
This PPO plan uses Cigna's national PPO network with out-of-network benefits included. Marketplace plans
vary — many are HMO or EPO plans with narrower, regional networks and limited or no out-of-network coverage.
This page is for general informational purposes and does not constitute a description of any specific
insurance contract or a recommendation for your individual situation. Contact
a licensed broker to review your options, including whether the ACA Marketplace may
be a better fit for you.