What Is a Provider Network?

Premiums, copays and deductibles are all things you need to consider when choosing the best health plan for you or your family. Did you know you should also think about the plan’s provider network? Here's why:

• Health plans save you money by negotiating discounts on health care charges with doctors, hospitals and other health care providers. When a provider agrees to take patients with a health plan, they agree to accept a lower fee for their care.
• The provider networks of some plans may have fewer doctors and hospitals than others. The plan offers lower costs to the member because they pay less to providers who see plan members. That means fewer providers agree to be in the plan’s network. A smaller network offers fewer choices of doctors you can use when you need care.
• By using doctors and other health care providers in your plan’s network, you can lower your out-of-pocket costs. If you visit a doctor outside your plan’s network, you may pay more for your care. In some cases (for example, if you have an HMO plan), you may have to pay the full cost when you go out of network. If your family would like to use certain doctors, specialists, hospitals or urgent care centers, make sure they are in the network of any health plan you consider.

Provider Networks: HMO vs. PPO

While there are many types of health plans, the two most common are HMO and PPO.

• An HMO may have lower monthly premiums.
• With an HMO, you'll choose a primary care provider (PCP) to direct your care within the network. You'll need a referral from your PCP to see a specialist.
• With a PPO plan, you may pay a higher premium, but have more freedom to choose doctors and hospitals without a referral.

Because this can be a big factor in your medical visits, here are some questions to consider as you choose your health plan:

• Is it important to have a lot of doctors and hospitals I can choose from?
• Is it worth paying a higher monthly premium to have more provider choices?
• Are the providers I often go to in my chosen plan’s network?

Insider’s tip: Search online to see if doctors, hospitals and urgent care centers are in network for the plan you are considering. Once you're a member, you can get a more personalized search based on your coverage.

Ready to choose your plan? Make sure you’re ready for Open Enrollment.