Insurance Basics: Home

In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

In-Network and Out-of-Network Care
Cost Sharing

Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part.

Cost Sharing
Flexible Spending Plans

Flexible spending plans let you set aside money from your paycheck. You can use it to pay for care before meeting your deductible, and for copays and coinsurance afterward.

Negotiating Your Costs

Since providers are able to decide how much to charge for out-of-network care, sometimes that charge might be higher than you expected.

Receiving Care from an Accountable Care Organization

An Accountable Care Organization (ACO) is a group of doctors or hospitals who have agreed to work together to coordinate and improve their patients´ care

Looking Up Costs for Behavioral Health Services

To look up the estimated costs for behavioral health services (including mental health and alcohol and/or drug services), go to our home page, fairhealthconsumer.org, and click on Medical and Hospital Costs.

Menu