What is a Health Plan Network?

HMO and PPO health insurance managed care plans have created health plan networks in an effort to combat the rising costs of health insurance. By sticking within a specified group of health care providers or facilities, you will generally enjoy reduced out-of-pocket expenses, copayments, and other associated costs.

The majority of Californians are enrolled in managed care plans such as HMOs, PPOs, or POS plans. They are generally affordable, often available through employers, and convenient for many people. However, it’s crucial that you understand the details of your managed care health insurance network in order to maximize the benefits of your managed care plan.

Health plan networks may include a variety of health care providers. Doctors and specialists, pharmacies, clinics, urgent care facilities, and hospitals may all be a part of your PPO or HMO health insurance plan’s network. Your plan negotiates with each provider within the network to receive discounted services for its members.

Seeking care within your network of health coverage providers will generally provide you with the most financial benefits. If you are a member of an HMO, your plan may cover only in-network care providers. If you are a member of a PPO plan, both in-network and out-of-network care will usually be covered, but you will most likely receive a financial incentive to use health care providers within the plan’s network.

Your insurance plan will provide you with a list of network providers when you sign up with your plan, making it easy for you to choose the best providers for your health care situation. If you already have a preferred doctor, or you have a specialist who isn’t on the list, you may consider using a PPO plan instead. A PPO provides more flexibility and coverage for out-of-network providers, while HMOs tend to provide coverage for care within the health plan network only.

 

 

Source: Los Angeles Health Insurance

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