Check Provider Networks Before You Buy

What is a Provider Network?

You may have heard that premiums, copays and deductibles are all important to take into consideration when selecting the best health insurance plan for you or your family. But did you know that you should also be thinking about your plan’s provider network? Before you compare health insurance plans, we’ll teach you what to look for!

Health plans use a select group of doctors, hospitals and health care professionals to provide a full range of covered health care services. Some plans’ provider networks have fewer doctors and hospitals than others. These smaller networks generally mean lower monthly premiums than plans with larger networks, but this also means that smaller networks limit your options for which doctors are covered under that plan.

You can keep costs low when using your plan by staying “in network,” or using the doctors and other health care providers that are in your plan’s network. If you visit a doctor outside of your network, you might have to pay more for your care. In some cases (such as HMO plans), you may have to pay the full cost when you go out of network. This is called an “out-of-pocket cost”. When you compare health insurance plans, check to see if your family’s usual doctors, specialists, hospitals and urgent care centers are in network. It can help you better control your expenses in the future.

Insider’s Tip: Use the BCBSIL Provider Finder®  online to see what doctors, hospitals and urgent care centers are in network for the plan you are considering to buy. Provider Finder is also the place to go to check for doctors or any specialists you need to see after you have coverage.

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Provider Networks: HMO vs PPO

While there are other options available, the two most common health plan networks are HMOs and PPOs.  An HMO may have lower monthly premiums, but your Primary Care Physician will direct your care within the network and a referral is required to see a specialist. In a PPO plan, you may pay a higher premium but have greater freedom to choose doctors and hospitals and do not need referrals.

 Because this can be a big factor in your medical visits, here are some questions to ask yourself as you select your health plan:

  • Is it important to me to have a lot of doctors and hospitals to choose from?
  • Is it worth paying a higher monthly premium to potentially have more provider choices?
  • Are the doctors, specialists, hospitals or urgent care centers that I usually go to in my selected plan’s network?

Still unsure? Consider these examples:

health insurance examples

Last update: 10/3/2017

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