Based on my search this year, that isn't necessarily true. Here in Denver, all of the insurers that were offering PPO plans in years past have left the individual market (not just the ACA exchange), save one: Anthem BCBS.

Availability appears to vary widely, both from state to state and within states. If I lived in western Colorado instead of on the Front Range, I'd have a couple of PPO insurer options. If I still lived in Minnesota (where my previous health insurance policy was written), I'd have dozens of options from at least four different insurance companies.

I really miss my insurance policy from BCBS of MN.

Don't miss it too much, my BCBS of MN policy just went up 45% year-over-year. It's pretty good coverage, but it's still nearly $10k/year just for the premium for my wife and I.

Still, I was also one of those pre-existing conditions that simply could not buy any insurance before the ACA.

I spent many hours looking for this and couldn't find any individual PPO plans that cover Austin, Texas. If you know of one, please send it my way.

I am in Cedar Park and was offered the Scott & White PPO when I was on healthcare.gov. I didn't go with it due to the state limitation.

I researched Scott & White, and it looked like you had to go to their doctors, which for me defeated the purpose of getting an PPO over an HMO (i.e., I can choose where I go, I don't need a primary care physician). Scott & White's offices weren't close to me, and their clinics got bad reviews.

I have been to S&W and you are right to be concerned - I have had care and billing issues. That's why BCBS with HMO to me was preferable to S&W PPO even though I hadn't read through their "PPO" plan to the level of detail that you did.

Don't you then face a penalty anyway for not having an ACA compatible plan?

I think he's saying, you can buy a plan from outside the official marketplace. You still want to get a plan that qualifies as a real health insurance plan for the purposes of the penalty. It's probably pretty hard to NOT do that when buying a plan, however.