In-Network vs. Out-of-Network Providers

What is a Health Insurance Network?

A health insurance network is a group of doctors and medical care providers across multiple specialties that have a contract to provide health care services to members of a health insurance plan.

What is In-Network?

When you see a doctor who is in-network, you are using a provider who participates in one of CareFirst’s provider networks. Some health insurance plans only cover care in-network, while other health plans cover both in-network and out-of-network care. If your health plan covers out-of-network care, staying in-network often still reduces the amount you pay for health care.

What is Out-of-Network?

Out-of-network means that a doctor or physician does not have a contract with your health insurance plan provider. This can sometimes result in higher prices. Some health plans, such as an HMO plan, will not cover care from out-of-network providers at all, except in an emergency.

Why does in-network vs out-of-network matter?

The coverage your plan offers for in-network and out-of-network health care providers, and the network your provider is in, both impact how much you pay for care.

If you have an HMO plan, you are only covered for in-network care, except in medical emergencies, when you may receive coverage out-of-network. With a PPO plan, you may have coverage for out-of-network care whenever you choose, but your out-of-pocket cost for out-of-network health care may be higher than for care in-network. Understanding the network coverage your plan has can help you choose which doctors and other health care providers to see, to get the best value for your money.