When it comes to choosing health insurance in North Carolina, one of the most popular options among individuals and families is a PPO (Preferred Provider Organization) plan. PPO plans offer flexibility, larger provider networks, and the freedom to see specialists without referrals, making them ideal for those who want more control over their healthcare.
In this article, we review the best PPO health insurance plans in North Carolina for 2025, focusing on ACA Marketplace availability, private options, cost, coverage, and provider access—so you can choose the plan that fits your health and budget.
What is a PPO Plan?
A PPO (Preferred Provider Organization) plan allows members to:
- See any doctor or specialist without a referral
- Get care in-network or out-of-network (with higher costs out-of-network)
- Have access to a broader network of hospitals and specialists
- Often pay higher premiums than HMO or EPO plans, but benefit from flexibility
Who Should Choose a PPO Plan?
PPO plans are ideal for:
- Individuals who want out-of-network access
- Those with chronic health conditions who need multiple specialists
- People who travel frequently or split time between states
- Families looking for more provider flexibility
Best PPO Health Insurance Providers in North Carolina (2025)
1. Blue Cross and Blue Shield of North Carolina (Blue Cross NC)
Plan Type: Blue Advantage PPO (Available on and off ACA Marketplace)
Highlights:
- Largest PPO network in the state
- Access to Duke Health, UNC Health, Novant, and Atrium Health
- Optional adult dental and vision coverage
- ACA-compliant Bronze, Silver, and Gold PPO tiers
- Includes Blue Connect portal for digital care access
Best For: Families and individuals wanting a statewide PPO with strong hospital access.
2. UnitedHealthcare (UHC) – PPO Plans
Plan Type: UHC Choice Plus PPO (Primarily offered off-exchange and employer markets)
Highlights:
- National network – great for frequent travelers
- No referrals needed for specialists
- Includes virtual care, wellness discounts, and pharmacy integration
- Often offered through employer-sponsored group plans in NC
Best For: Professionals or businesses looking for premium PPO coverage with national access.
3. Aetna PPO – Off-Marketplace Plans
Plan Type: Aetna Open Choice PPO (Available via brokers or employers)
Highlights:
- Access to WakeMed, Atrium Health, and many private hospitals
- Strong wellness support and prescription drug coverage
- No referrals needed; generous out-of-network benefits
- Online member portal + mobile app for 24/7 care
Best For: Individuals wanting digital tools + strong provider choice.
4. Cigna PPO (via Employers and Private Market)
Plan Type: Cigna Open Access Plus PPO
Highlights:
- Broad national network and partnerships
- Telehealth with MDLIVE included
- Strong focus on behavioral health and preventive care
- Typically available off-exchange via employers or direct purchase
Best For: Employees or private buyers wanting robust mental health and flexibility.
5. Humana PPO (Medicare Advantage Only in NC)
Plan Type: Humana PPO Medicare Advantage Plans
Highlights:
- Large PPO network for seniors
- Dental, vision, OTC, and hearing benefits included
- No referrals needed to see specialists
- Available in many NC counties for Medicare-eligible individuals
Best For: Seniors seeking PPO flexibility within Medicare Advantage.
PPO vs HMO in North Carolina
| Feature | PPO Plan | HMO Plan |
| Referrals Needed? | No | Yes |
| Out-of-Network Access | Yes (higher cost) | No (emergency only) |
| Cost | Higher premiums, more flexibility | Lower premiums, restricted network |
| Ideal For | Chronic conditions, frequent travelers | Local, budget-conscious, fewer medical needs |
How to Enroll in a PPO Plan in NC
You can explore and enroll in a PPO plan through:
- HealthCare.gov (for ACA-compliant Blue Cross NC PPO plans)
- Insurance brokers for off-exchange options like UHC, Aetna, Cigna
- Employer-sponsored plans (most PPOs available here)
- Medicare.gov for seniors shopping for PPO Medicare Advantage
Open Enrollment for ACA Plans:
📅 November 1, 2024 – January 15, 2025
While PPO plans are often more expensive than HMO or EPO options, they provide maximum freedom and provider choice, which is especially valuable for those with specialist needs or multi-state care requirements. In North Carolina, Blue Cross NC remains the best option for ACA Marketplace PPO plans, while UnitedHealthcare, Aetna, and Cigna offer strong off-market and employer PPO options.
Before enrolling:
- Compare monthly premiums, deductibles, and copays
- Check if your preferred doctors and hospitals are in-network
- Consider your health needs and travel lifestyle