What in network really means
A network is the list of doctors, hospitals, labs and clinics that a plan has agreements with. Seeing someone on the list usually costs you less. Seeing someone off the list may cost much more, or the plan may pay nothing at all. Some plans work this way strictly. Others pay part of the bill for out-of-network care.
A PPO, which stands for preferred provider organization, is a plan with a network it prefers you use. Whether it pays for care outside that network, and how much, depends on the plan. Always ask.
When a doctor leaves a network
It happens for many reasons. A contract ends, a practice is sold, or a doctor and a plan cannot agree. It is not always something either side planned for you. If it happens, call your plan right away, ask what your options are, and ask for the answer in writing.
How to check before you switch
Do not rely on a plan's online list alone, because lists can be out of date. Call your doctor's office and give them the exact name of the plan and its network, not only the insurance company's name. Ask whether they are in the network today. Then confirm with the plan.
Check the whole path of your care. That includes the specialist you see, the hospital you would go to, the lab, the imaging center and the pharmacy. One missing piece can change your bill. Our blog has a short guide to the steps.
Keeping what you have can be the right call
If your current plan still has your doctors, staying put may be wise even when the monthly payment has grown. COBRA, if you have it, keeps the same plan and the same network. Switching plans means new rules and a new network. Weigh what you would give up.
Looking at a private plan with your doctor in mind
Tell your advisor which doctors matter most before we compare anything. A private plan can be applied for any time of year, and we can help you check the network. We cannot promise that a doctor will stay in a network, because contracts change. The plans we offer are private plans, not ACA Marketplace plans, and they have exclusions and limitations. An advisor explains the details.
Our plans are for people under 65. Tell us early which doctors matter most, so we can check the network before you apply.
Medications follow the same rule
A plan keeps a drug list, sometimes called a formulary, of the medications it covers. Check your prescriptions the same way you check your doctors. A medicine can be covered by one plan and not by another.