Sarah and Mike thought they’d done everything right. Gold plan selected from the Health Insurance Marketplace. Premiums paid. Family covered. Or so they thought.
When their son’s doctor recommended a specialist at one of the Big Two Children’s Hospitals in Dallas, their heart sank. The Big Two Children's Hospital Systems were not in-network. That meant the specialist wasn’t either.
The Gold level ACA HMO plan they bought to make sure they had robust coverage was not feeling robust. The health insurance plan only covered a handful of local specialist that no one had ever heard of, and none of them were where their son’s primary care physician practiced.
What followed was weeks of phone calls, referrals, and frustration. Hours spent on hold. Empty promises from customer service reps who said they’d “look into it.” In the end, they paid out of pocket just to get their child the care he needed.
That’s the moment they realized that health insurance isn’t designed around what you need. It’s built around what the insurance company needs.
This year, as Open Enrollment begins again, they’re determined to find a plan that actually works for their family. They’ve heard that private Preferred Provider Organizations (PPO) health plans are finally returning to Texas. They want to know if switching could finally give them the freedom and peace of mind they’ve been missing.
The Changing Situation for Texas Families
If you’ve been frustrated like Sarah and Mike have over the last few years, you’re not alone. Every health plan on the Federal Health Insurance Marketplace in Texas has been classified as a Health Maintenance Organization. The dreaded HMO.
These plans limit your access to in-network doctors and hospitals to "keep costs under control". You’re required to stay inside a small and shrinking network. If you need to see a specialist, you need a referral first.
In places like Dallas, Fort Worth, and Austin, this has created a real problem. Many major hospitals and well-known specialists simply don’t take ACA plans. Families like Sarah and Mike who want to see highly trusted health care providers end up with two choices.
- Pay out of pocket
- Settle for what’s in-network
The good news is that Texans are finally getting more options. For 2026, new private PPO plans are appearing outside of the ACA Exchange. These plans bring back options, simpler coverage, and more control over how and where you receive care.
Key Differences Between ACA HMO and Private PPO Plans
After last year’s frustration, Sarah and Mike started digging deeper into what really separates an ACA HMO health plan from a private PPO plan. Here are the three things every Texas family should consider before choosing their 2026 plan.
1. Network Flexibility and Provider Access
ACA HMO health care coverage can lock you into a limited list of doctors and hospitals. Especially if you are in the major metro areas of Texas like Dallas, Fort Worth, Houston, or San Antonio.
If your provider isn’t in-network, you’re stuck paying cash out of pocket. That’s exactly what happened when their son’s pediatrician referred him to a specialist at one of the top children’s hospitals in Dallas. Their plan said no.
Private PPO plans work differently. You have the flexibility to see any doctor, hospital, or specialist you choose regardless of network constraints. If you want to visit a facility out of state, that’s fine too. PPO plans give you the freedom to decide who provides your care instead of an insurance company making that decision for you.
For Texas families who value flexibility and trust their current doctors, that difference matters more than anything.
Key takeaway: If keeping your preferred doctors or accessing specialized care is important, a PPO plan is likely the better fit for your family.
2. Total Cost of Coverage (Not Just the Monthly Premium)
When most Texans compare plans, the first thing they look at is the monthly premium. It’s easy to do, but it’s not the full story.
ACA HMO plans can look cheaper upfront but often have higher deductibles and co-pays, higher out-of-pocket maximums, and smaller networks. The true test is what happens when you actually use your plan. That’s when the real costs show up.
Private PPO Health Insurance may have a higher premium, but they often come with lower total costs over the year if you actually use your coverage options. When you add up premiums, deductibles, and out-of-pocket expenses, many families find that PPO plans protect their wallets better in a bad health year.
After running the numbers, this Dallas family realized their total cost of risk was lower with a PPO health plan. The combined total of what they could pay in premiums and out of pocket medical bills was significantly less with a private PPO than with their current ACA plan.
Key takeaway: Don’t compare plans by monthly premium alone. Look at the full financial picture, especially what happens when someone in your family needs real care.
3. How Your Family Actually Uses Health Insurance
The way your family uses healthcare should guide the plan you choose.
If you rarely see a doctor and qualify for major subsidies, an HMO health insurance plan will fit just fine. But if your family visits specialists, travels often, or values convenience, a private PPO plan offers a better experience. You’ll spend less time fighting with networks and referrals, and more time actually getting care even if the out of network benefits cost a bit more.
For Sarah and Mike, it wasn’t about the lowest price. It was about knowing that when something went wrong, their insurance would work the way it should.
Key takeaway: Pick a plan that matches how you actually use healthcare, not just how much you pay each month.
Why Private PPO Plans Are Making a Comeback
Texans who use individual health insurance have been asking for flexibility for years. Fortunately, insurance companies are finally listening.
Private family health insurance is making a comeback with PPO plans for those who qualify. These plans are fully underwritten and work much like the ones Texans had before the ACA restricted most individual options to HMOs.
For families who don’t qualify for heavy ACA subsidies or want access to broader care, these private PPO plans can be a practical, cost-effective replacement. They simplify the process, expand provider options, and make it easier to get the care you need without extra steps or hidden limitations.
For the Sarah and Mike, this means their son can see the specialist they trust at one of Dallas’s top children’s hospitals without jumping through hoops or paying surprise bills. That peace of mind alone is worth the switch.
How to Choose the Right Option for Your Family
If you’re reviewing health plans for 2026, take the time to look beyond the surface ACA Exchange plans. Exploring your coverage options needs to include looking at everything available to you today.
Here are three key questions to consider when considering what to do for the upcoming year.
- Are your preferred doctors and hospitals in-network?
- What will your total out-of-pocket risk be this year?
- Do you want the freedom to choose where and how you get care?
If you’re not sure how to compare, that’s where we come in.
At Insurance For Texans, we specialize in helping Texas families compare ACA Marketplace and private PPO options side by side. We look at the real costs, real networks, and your real needs. We do this so you can make a confident decision without feeling overwhelmed.
The Bottom Line
Many Texans are in the same position as Sarah and Mike. Frustrated, uncertain, and ready for something better. The good news is, you have options now.
Private PPO plans bring back the freedom to choose your doctors, get care where you need it, and protect your family without the endless headaches of a limited network.
Whether you stay on the ACA Exchange or explore private coverage, the right plan is the one that truly works for your family’s needs.
Click the button below to compare ACA and Private PPO plans for your Texas family and find the coverage that gives you confidence, freedom, and peace of mind for 2026.