What Is a Health Insurance Network?
A health insurance network is the group of doctors, hospitals, labs, and other healthcare providers that have contracted with your insurer to provide services at negotiated (discounted) rates.
Using in-network providers is almost always significantly cheaper than using out-of-network providers โ sometimes the difference is thousands of dollars.
Types of Health Insurance Networks
HMO โ Health Maintenance Organization
- Must use in-network providers (except emergencies)
- Requires a primary care physician (PCP) who coordinates your care
- Need referrals to see specialists
- Usually lowest premiums
PPO โ Preferred Provider Organization
- Can use out-of-network providers (at higher cost)
- No PCP requirement
- No referrals needed
- Higher premiums than HMO
EPO โ Exclusive Provider Organization
- Must use in-network providers (like HMO)
- No PCP or referral requirement (like PPO)
- Middle ground in terms of premiums
POS โ Point of Service
- Can use out-of-network with referral
- Requires PCP
- Hybrid of HMO and PPO
๐ก Before choosing a plan, always verify that your preferred doctors, specialists, and local hospital are in the plan's network. Networks change every year during open enrollment.
Compare Plan Networks
Use our plan comparison tool to evaluate which plan's network works best for you.
Compare Plan Networks โFrequently Asked Questions
Can I switch networks during the year?
No โ you can only change your health plan (and therefore your network) during open enrollment or after a qualifying life event. Check network carefully before choosing a plan.
What if my doctor leaves my network mid-year?
If your doctor leaves your insurer's network during the year, you may be entitled to a continuity of care period to finish ongoing treatment at in-network rates. Contact your insurer immediately to discuss your options.
Are online healthcare visits (telehealth) in-network?
Most major insurers have added telehealth providers to their networks, especially since 2020. However, the specific telehealth platform matters โ your insurer's own telehealth portal is usually in-network, while third-party services may not be. Check before using.