What’s the Difference Between In-Network and Out-of-Network?
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What's the Difference Between In-Network and Out-of-Network?

What's the Difference Between In-Network and Out-of-Network?
Everyday Health
By
Published on June 25, 2025
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If you have a health insurance plan, you’ve probably come across the terms “in-network” and “out-of-network.” Simply put, in-network means the doctors or hospitals you visit contract with your insurance, so you typically pay less. With out-of-network care, the providers don’t have an agreement with your insurance company, which likely leaves you with a higher bill.


What Does In-Network Mean?

In-network means your insurance company has a contract with certain doctors, health professionals, pharmacies, or medical facilities. When you visit these specific providers or receive these services, you receive a discounted rate.

That’s because your insurance company has negotiated a lower rate for these providers or services, and they pass those savings along to you.


In-network doesn’t necessarily mean “free,” though. Your insurance company will probably share the lower bill with you in some form. Depending on your plan, you may have to pay:

  • A copay: A small fee for the health service
  • Your deductible: A set amount you pay before your insurance kicks in
  • Coinsurance: A percentage of the bill that you share with your insurance after you reach your deductible
In most cases, the agreed-upon amounts for a copay, deductible, or coinsurance are only for providers and services that are in-network.


What Does Out-of-Network Mean?

Out-of-network providers don’t have a contract with your insurer, so your insurance company will be charged the full price for the services you receive. This usually means you’ll pay much more. Sometimes, your costs may not be covered at all, unless it’s an emergency.


When you go out-of-network, your copays, deductibles, and coinsurance might all be much higher.

How Do I Know if a Doctor Is In-Network or Out-of Network?

You should always verify that your preferred doctors, pharmacies, and hospitals are in-network. Here’s how.

  • Check your health insurance’s website. Many companies provide a list of in-network providers.
  • Call your insurance company. Ask a representative if your provider is in-network.
  • Contact your provider. Call or check their website. Many hospitals and doctor’s offices will list the insurance plans they accept.


How Much More Will I Pay for Out-of-Network Doctors?

It depends on your provider and your plan. An out-of-network doctor can charge you the full price for a visit because they don’t have any deals with your health insurance company. Some insurers will help you with these extra costs, but others will not contribute at all.

According to one eHealth survey, people who used out-of-network doctors spent nearly $900 more, on average, for their care than those who stayed in-network. But these costs can be even higher.

 Though there’s a federal cap on what patients can spend out of pocket, this applies only to in-network care. That means the amount you owe for out-of-network care can be unlimited.


If your insurer does cover some out-of-network costs, they will likely provide you with an estimate of the amount you can expect to pay. You may have different out-of-network copays, coinsurance, deductibles, and out-of-pocket maximums. Most of the time, these charges are higher than if you stayed in-network.

What Happens if I Go Out-of-Network for Emergency Care or While Traveling?

In emergency situations, you may have to go to the nearest medical facility quickly, whether it’s in-network or out-of-network. The No Surprises Act covers you if this happens. The law says that you are protected from surprise bills in emergency situations or if you unintentionally see an out-of-network provider at an in-network facility.

If you go out-of-network while traveling, you may still have to pay extra out-of-network costs. Some plans will offer access to in-network providers outside your state for non-emergencies.

Emergency care is typically covered if you’re traveling within the United States. But some plans may not offer emergency coverage outside the United States. You will have to check with your insurer.

If you’re concerned about medical costs while you’re away from home, you may want to purchase supplemental travel insurance.

Do HMO and PPO Plans Both Offer Out-of-Network Benefits?

Preferred provider organizations (PPOs) are generally more flexible and offer out-of-network benefits. For an additional fee, you can use providers outside of your network without the need for a referral. But you will still pay less if you use in-network providers.

On the other hand, health maintenance organizations (HMOs) typically limit you to in-network care, except if it’s an emergency. With HMOs, you usually must use in-network providers. Additionally, you usually need a primary care doctor to give you a referral for specialists.


The Takeaway

  • In-network doctors and hospitals work with your insurance company to give you a discounted rate.
  • Out-of-network care can be more expensive since your provider doesn’t have a deal with your insurer.
  • Emergencies in the U.S. are covered whether you use an in-network or out-of-network provider.
  • If you have any questions about what’s covered, you should check with your insurance company.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. What You Should Know About Provider Networks. HealthCare.gov. February 2024.
  2. In-Network vs. Out-of-Network Healthcare Providers: What’s the Difference? MetLife. August 21, 2023.
  3. Out-of-Network (Out of Plan). Healthinsurance.org.
  4. Copays, Deductibles, and Coinsurance. Cigna Healthcare.
  5. Cost of out-of-network doctors and hospitals. Aetna.
  6. Baum J. Using Out-of-Network Doctors Could Cost You Money. eHealth. March 15, 2024.
  7. What Does In-Network vs. Out-of-Network Mean? AdventHealth. January 7, 2025.
  8. Using Health Insurance While Traveling. Fair Health. June 24, 2021.
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Sarah Goodell, MA

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