What Is a Network Tier?
Some health plans use tiered provider networks that assign different cost-sharing levels to different providers. Using a Tier 1 (preferred) provider costs you less than using a Tier 2 provider, even if both are in-network.
Common Tier Structures
- Tier 1 — Preferred: Lowest copay/coinsurance. Typically large hospital systems or high-quality/high-value providers the insurer has negotiated lower rates with.
- Tier 2 — Standard: Higher copay/coinsurance than Tier 1, but still in-network coverage.
- Out-of-network: Highest cost or no coverage depending on plan type.
💡 Before choosing a specialist or hospital, check which network tier they're in — not just whether they're in-network. Tier 1 vs Tier 2 can mean the difference of $50–200 per visit.
How to Find Your Provider's Tier
- Use your insurer's online provider search tool — it usually shows tier information
- Call your insurer and ask specifically about the tier for a provider
- Call the provider and ask which tier they are in for your specific plan
Calculate Your Tier Costs
See exactly how this affects your costs with our free calculator.
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