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 at any price. It's not a premium question, it's a network question, and it's the fastest way for a good cost decision to become a bad employee experience. 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.
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 (44%) |
| POS | Yes, with a referral | Yes, from their primary-care doctor | 389 more (12%) |
| 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 |
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.
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 anywhere. 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?
| Answer | States | Which ones |
|---|---|---|
| A PPO in every county | 24 | AK, AL, AR, CA, CT, DC, DE, FL, HI, IL, LA, MD, ME, MI, MN, MT, ND, OK, PA, RI, SC, SD, WV, WY |
| Referral only, in every county | 1 | TX, all 254 counties. POS plans, no PPO anywhere in the state |
| Varies inside the state | 8 | GA, IA, ID, IN, NC, NE, VA, WI. Use the lookup above, the exceptions are named |
| None at any price, anywhere in the state | 18 | AZ, CO, KS, KY, MA, MO, MS, NH, NJ, NM, NV, NY, OH, OR, TN, UT, VT, WA |
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.
If the answer was none
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.
| What it is | What it changes |
|---|---|
| Level funding | Returns the surplus in a good claims year and hands over the claims data. Keep your current network. |
| 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. |
| 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. |
| A CHOICE Arrangement 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. |
| 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. |
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.
Results vary by group size, plan design, 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, from the CMS marketplace plan files and the plan files the 21 state-run marketplaces submit to CMS. Each county is classed by the strongest out-of-network option filed there: 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.
It covers marketplace plans for 2026. Group plans are a separate filing universe and are not in this data. A plan sold off the marketplace may exist in a county shown as none, and is not in these files. 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.
