How do benefits differ between in-network and out-of-network?


In-network benefits are the facilities, health care providers and suppliers that your insurance company has contracted with to provide services. Your health plan’s in-network benefits are cheaper than if you receive care out-of-network. Since out-of-network health care providers are not included in your insurance plan, you will be responsible for paying for most or all of the medical expenses.

For example, a Preferred Provider Organization (PPO) plan offers a limited set of in-network providers, and when you use them, a greater share of your medical bills will be covered. If you use an out-of-network provider, you will still receive some insurance coverage, but you may have exposure to much higher costs. Meanwhile, in a Health Maintenance Organization (HMO) plan, one physician or nurse practitioner is designated to serve as your primary care doctor, and that person provides most of your medical care, including referring you to specialists and other health care professionals as needed. Insurance coverage is not available if you elect to see a specialist without a referral from your primary care doctor, increasing the likelihood you will need to pay for all of the medical expenses.