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
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Updated on October 15, 2026
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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, an in-network plan 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, but a preferred provider can’t charge you the difference in rates for covered services. 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. Your insurer will pay only what it allows for out-of-network care, and the provider can bill you for the rest. This is called balanced billing. This usually means you’ll pay much more for covered services. 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 doctors’ 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 may charge you the full price for a visit because they don’t have any deals with your health insurance company. Some insurers will pay the in-network rate for covered services, but others will not contribute at all. Even if your plan pays part of the costs, the provider can bill you for the difference.

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, although some plans have a separate out-of-pocket limit.

Insurers must now offer an online price-comparison tool for covered services under the Transparency in Coverage Rule. 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 nonemergency care from out-of-network providers at in-network hospitals, hospital outpatient departments, and ambulatory surgery centers. You generally can’t be charged more than your in-network cost sharing.

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 nonemergencies.

Federal law prohibits plans from charging higher cost sharing for emergency care when 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. Medicare does not cover care outside the United States.

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

Do All Plans Offer Out-of-Network Benefits?

Preferred provider organizations (PPOs) are generally more flexible and offer out-of-network benefits. 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.

Exclusive provider organizations (EPOs) cover only in-network care, except in emergencies. Unlike an HMO, you don’t usually need a referral to see an in-network specialist.

Point of service (POS) plans usually pay for out-of-network care, but you pay more than when you see an in-network provider. You also need a referral to see a specialist.

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 typically need a primary care doctor to give you a referral for specialists.


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. Centers for Medicare and Medicaid Services. February 2026.
  2. No Surprises: Health Insurance Terms You Should Know. Centers for Medicare and Medicaid Services.
  3. Out-of-Network (Out of Plan). HealthInsurance.org.
  4. How Can I Find Out if My Doctor Is in a Health Plan’s Network? KFF. September 29, 2025.
  5. Consumers: How to Get the Most Out of Transparency in Coverage. Centers for Medicare and Medicaid Services. August 14, 2025.
  6. The No Surprises Act Protects People From Unexpected Medical Bills. Centers for Medicare and Medicaid Services. October 5, 2026.
  7. Medicine and Health. U.S. Department of State. August 11, 2025.
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