“In-network” is one of the most important terms to understand when using health insurance. It refers to doctors, hospitals, pharmacies, and other providers that have a contract with your health plan.
What Does “In-Network” Mean?
An in-network provider is a doctor, hospital, pharmacy, or other healthcare provider that has a contract with your health insurance plan. These providers are part of the plan’s network and have agreed to the terms and rates established by the insurer.
HealthCare.gov defines a health insurance network as the facilities, providers, and suppliers that an insurer or health plan has contracted with to provide healthcare services.
When you receive covered care from an in-network provider, your plan will generally provide better cost-sharing terms than when you use a provider outside the network. However, the exact amount you pay depends on your specific plan.
Why Does Being In-Network Matter?
Using an in-network provider can affect how much you pay for covered healthcare services. Many health plans give members lower out-of-pocket costs when they receive care from providers within the plan’s network.
For example, your plan might have a lower copayment or coinsurance rate for an in-network doctor. A provider outside the network may have different cost-sharing rules or may not be covered at all, depending on the type of plan.
This distinction can be especially important when scheduling specialist visits, medical procedures, hospital services, laboratory tests, or other forms of care that may involve several different providers.
In-Network vs. Out-of-Network
The main difference is the relationship between the healthcare provider and your insurance plan. An in-network provider has a contract with the plan, while an out-of-network provider does not.
| Feature | In-Network | Out-of-Network |
|---|---|---|
| Provider contract | Has a contract with the plan | Does not have a contract with the plan |
| Cost-sharing | Usually lower | Often higher |
| Coverage | Generally covered according to plan terms | Depends on the plan |
Some plans, such as PPOs, may cover certain out-of-network services at a higher cost. Other plans, including many HMOs and EPOs, may generally limit coverage to in-network providers except for situations such as emergencies.
Always Check Your Provider’s Network Status
“In-network” means that a healthcare provider has a contract with your health insurance plan. Staying within your plan’s network can generally help you access the plan’s preferred cost-sharing rates, but coverage and costs vary by plan. Checking your provider directory before receiving care can help you understand your expected costs.
How to Check if a Provider Is In-Network
Before making an appointment, check whether the doctor, hospital, pharmacy, or other provider participates in your specific health plan. A provider may participate in one insurance plan or network but not another, even if both plans are offered by the same insurer.
One of the easiest ways to check is to use the provider directory on your health plan’s website. You can also contact your insurer using the phone number on your insurance card. HealthCare.gov recommends checking the plan’s provider directory and confirming coverage with the insurer or provider.
It is also useful to confirm the network status of specialists, hospitals, laboratories, and other providers involved in planned care. Network information can change, so checking before receiving services can help avoid unexpected costs.
Keep in mind that your plan’s deductible, copayments, coinsurance, and out-of-pocket maximum can also affect what you ultimately pay. For covered in-network services, these cost-sharing amounts generally apply according to your plan’s specific rules.