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
Provider Networks

Your plan may contract with doctors, dentists and other healthcare practitioners; hospitals; labs; radiology facilities; pharmacies and other types of providers. These are the providers in your “network”.

Getting Care from a Medical Home

A medical home is a type of doctor´s practice that uses a team to focus on the “whole person”. It is sometimes called a patient-centered medical home (PCMH).

When Out-of-Network Care Can be Covered In Network

Receiving care from a provider in your health plan´s network usually costs you much less than going to an out-of-network provider.

When Can You Enroll In a Health Plan?

Health insurance is important. It protects you against what can be the very high costs of healthcare. But, to get health insurance, you need to enroll, or sign up. And, in most cases, you can’t enroll in a health plan any time you want. You have to do it during certain times.

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