What is a provider network?
Health insurance companies contract, or enter into agreements, with healthcare providers – doctors, specialists, and hospitals – to provide their members with quality care at a discounted rate. These providers are called “in-network providers.” Providers that don’t contract with the health insurance company are called “out-of-network” providers. Because the health insurance company has negotiated a discounted rate with in-network providers, you can often save money by receiving care from an in-network provider.
For more information on provider networks, please click here.
Different health insurance plans will have different provider networks. If you want to see a specific provider, you should check to see if that provider is in your plan’s network. Remember, while a broader network might give you more options when it comes to providers, having more options means you will likely pay more in monthly premiums.
Depending on the type of plan you buy, your care may be covered only if you see an in-network provider. Your plan may also require you to pay more or get a referral if you choose to receive care from a provider that is not part of your plan’s network. Click on the plan types below to learn more about each one :
Preferred Provider Organization (PPO)
A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and other healthcare providers outside of the network without a referral for an additional cost.
Point of Service Plans (POS)
A type of plan where you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. POS plans require you to get a referral from your primary care provider in order to see a specialist.
Health Maintenance Organizations (HMO)
A type of health insurance plan that usually limits coverage to care from healthcare providers who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Exclusive Provider Organizations (EPOs)
A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Health Savings Accounts (HSAs)
A health insurance plan that is available to individuals with high-deductible health plans (HDHPs). An HSA is a personal medical savings account. You—rather than your employer or insurance company—manage the money in your HSA. The money deposited into your HSA is not taxed.
What are the different types of plans and provider networks?
See the helpful videos below:
- PPO Johnny: A Man Who Wants the Widest Choice of Doctors for His Family
- So What is a Provider Network?
- What is an HMO and How Does it Work?
- What Is EPO Medical Insurance? : Personal & Health Insurance Tips
- HSA Bank – What is a Health Savings Account? (HSA)
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