EVERY PLAN FILED IN EVERY COUNTY · 2026 MARKETPLACE · CMS FILINGS
If you change your health plan, can your people keep their doctors?
1,359 of 3,143 counties have no PPO or POS plan on the marketplace in 2026.
That's 43% of the country where out-of-network coverage isn't purchasable on the marketplace at any price. In 5 of those states you can still buy one off the marketplace, and a CHOICE Arrangement can pay for it. It's not a premium question, it's a network question. Pick your state below.
The lookup
What's filed where your people live?
Three possible answers, and the difference decides whether an employee can keep the specialist they've had for 6 years. Where the marketplace answer is none, the lookup also tells you if a PPO is sold off the marketplace.
What the three answers mean
Why does the plan type decide whether your people stay with their doctor?
This is about out-of-network coverage, not network size. An EPO can have a broad network and still cover nothing outside it. Go by what the plan covers, not by the label on the brochure.
| Plan type | Can they see a doctor outside the network? | Do they need a referral? | Counties where it's filed |
|---|---|---|---|
| PPO | Yes, in or out of network | No | 1,395 of 3,143 |
| POS | Yes, with a referral | Yes, from their primary-care doctor | 389 more, where no PPO is filed |
| EPO | No, emergencies only | No, inside the network | 1,359 counties (43%) have only EPO and HMO plans |
| HMO | No, emergencies only | Yes, from their primary-care doctor |
1,395 plus 389 plus 1,359 is 3,143, so every county is accounted for. Built from every marketplace plan filed for 2026 in all 51 jurisdictions, joined to the counties each plan actually serves.
The 18 states where no county has a PPO or POS plan
Arizona, Colorado, Kansas, Kentucky, Massachusetts, Missouri, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, New York, Ohio, Oregon, Tennessee, Utah, Vermont, Washington.
If your people live in any of them and you move to a marketplace-based design, every one of them moves to a network-only plan. That shows up in month 2, not at renewal.
Before you write those 18 off, check outside the marketplace. A CHOICE Arrangement can pay for a plan bought off the marketplace, and in 5 of the 18 a PPO is sold there: Mississippi, Arizona, Massachusetts, Oregon and Missouri. Those aren't paper filings. Between 115 and 11,578 people were enrolled in one going into 2026, depending on the state. The state table below splits the 18 on exactly this line.
The trade is that buying off the marketplace costs the employee any premium tax credit. Under an affordable CHOICE Arrangement they weren't eligible for one anyway, so for most employers this is a real option rather than a sacrifice.
The flip side, and it's real: in 22 states, marketplace plans cost less per member per month than group plans. 9 states are on both lists: Colorado, Kentucky, Massachusetts, Missouri, New Hampshire, New Jersey, New Mexico, New York and Ohio. Cheaper, and no out-of-network coverage on the marketplace anywhere in the state. That's the trade to put in front of your CFO before anyone signs.
Every state, at a glance
Where does out-of-network coverage still exist?
All 50 states and the District of Columbia, counted once each, from the 2026 marketplace plan filings across 3,143 counties.
| Answer | States | Which ones |
|---|---|---|
| A PPO in every county | 24 | Alabama, Alaska, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Montana, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, West Virginia, Wyoming |
| Referral only, in every county | 1 | Texas, all 254 counties. POS plans, no PPO anywhere in the state |
| Varies inside the state | 8 | Georgia, Idaho, Indiana, Iowa, Nebraska, North Carolina, Virginia, Wisconsin. Use the lookup above, the exception counties are named |
| None on the marketplace, but a PPO off it | 5 | Mississippi (11,578 people enrolled in one), Arizona (9,034), Massachusetts (8,959), Oregon (2,457), Missouri (115). A CHOICE Arrangement can pay for these |
| None on the marketplace, and none you can actually buy off it | 13 | Colorado, Kansas, Kentucky, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Tennessee, Utah, Vermont, Washington |
Virginia is the sharpest example. 7 counties out of 133 have a PPO, all of them in Northern Virginia. The rest of the state has none.
24 plus 1 plus 8 plus 5 plus 13 is 51, so every jurisdiction is counted once. The last 2 rows are the 18 states with nothing on the marketplace, split by whether there's a real option outside it. Nevada and New York sit in the bottom row because their off-marketplace filings had 1 person and 0 people enrolled going into 2026, which is a filing rather than a product. Idaho sits in the varies row because the answer changes type inside the state: a PPO in 33 counties, referral-only in the other 11.
Sounds concerning? You have options.
What can you still do if there's no PPO where your people live?
A marketplace-based design is one of 12. If the network answer rules it out, the other 11 are still there, and so are the add-on layers that lower cost without touching the plan type at all.
Here's the part that isn't anyone's fault. The systems that surface plan options only surface what's already inside them. The marketplace shows you what insurers filed for the marketplace. Your broker shows you the markets their appointments reach. Both are doing their job. Neither one can show you what sits outside it. 99% of the brokers we talk to have never had visibility to our programs. They sit outside their commissioned channels.
Check off the marketplace before you rule it out. In 4 of the 18 states with no PPO or POS anywhere on the marketplace, out-of-network coverage is still sold off it, and a CHOICE Arrangement can pay for it: Mississippi 11,578 enrolled, Arizona 9,034, Massachusetts 8,959, Oregon 2,457. Missouri, Nevada and New York have plans filed off the marketplace with 115 people, 1 person and nobody in them, so those are paper options until a carrier quotes them. The other 11 states have nothing filed on the marketplace or off it.
| What it is | What it changes | Range observed |
|---|---|---|
| Level funding | Returns the surplus in a good claims year and hands over the claims data. Keep your current network. | 15 to 25% of plan cost measured on fully insured mid-market groups |
| Self funding | Opens the pharmacy contract, the hospital bill audit and paying hospitals off a public price list. None of that is available below it. | 20 to 30% of plan cost measured on plans already self-funded |
| Shelf-rated (flat-rate) plans | One published rate per tier, no medical questions, and they write groups that were declined. Trust plans A and B are PPO products with national networks. | No audited range published. The rate is published per tier, so compare it to your own renewal directly. |
| A CHOICE Arrangement (ICHRA) with the network checked first | Turns an unpredictable renewal into a budget you set. Viable where the lookup above says PPO or POS, and worth a hard look at who is actually on a PPO today before you move. | Priced per census. Whether it beats your group plan depends on the county mix in your census, not the state average. |
| Add-on layers | $0-copay pharmacy, unlimited virtual care, a supplemental wrap. They bolt onto whatever is already in place. Same card, same doctors, same broker. | $2,000+ per employee per year plus up to about $988 per employee per year in new cashflow about $100K per year for every 50 people |
Why two of those rows have no percentage next to them: nobody measured one. Every range above comes from completed client projects, grouped by what the employer was running when the work started. We don't publish a savings percentage for a product category, because a category isn't a thing you can measure. If you see one anywhere, ask what it was measured on.
A benchmark to hold it against: the average employer premium is $9,325 for single coverage and $26,993 for family per year (KFF 2025 Employer Health Benefits Survey, verified at kff.org on September 18, 2026). At family tier these arrangements have landed around 26% below that national average. At employee-only they run roughly at par.
Saying the row that doesn't win is what makes the rest credible. Your family mix decides the answer, not the brochure.
$0 upfront. Billed out of savings. Live in 30 to 45 days. Same broker, same doctors, same cards. First-year ROI has landed at 10 to 16x across completed projects.
If the lookup above came back "none" for the county most of your people live in, which of these five would you want priced first?
Ranges are what we have observed across completed engagements. They are not a guarantee, not a quote, and not an offer of coverage. Your result depends on group size, plan design, census, and utilization.
Where this comes from, and what it doesn't cover
Every medical plan filed for the 2026 plan year in all 3,143 counties across 50 states and DC. Two sources, joined: the CMS marketplace plan files for the 30 states on the federal platform, and the plan and service-area files published by each of the 21 state-run exchanges. Each plan's type is matched to the counties that plan actually serves, so a county is classed by the strongest out-of-network option a resident there can actually buy: a PPO, otherwise a POS, otherwise neither.
This is about out-of-network coverage, not network size. An EPO can have a broad network and still cover nothing outside it. Where one document labels a plan a PPO but every out-of-network column reads not covered, the coverage columns win.
On and off the marketplace. The county figures count marketplace plans, because that's the level at which plan type is published county by county. Off-marketplace plans are filed at the state level only, so we report those as a state-level answer with enrollment attached rather than guessing which counties they reach. A CHOICE Arrangement can pay for either.
Group plans are a separate filing universe and are not in this data. Plan-type availability moves once a year when filings publish, so nothing here expires mid-year into a misleading claim.
Nothing on this page is a quote. It is category-level information about what is filed, not a price for any specific group.
Last reviewed September 19, 2026.
