If you see a provider that is not included in your plan’s contracted network of providers (i.e., “out-of-network”), depending on your plan that care may or may not be covered. Either way, you are likely to pay more for out-of-network services. Also, the Affordable Care Act's limit on your annual out-of-pocket costs applies only to services received in-network. Any care you get outside your plan’s network will not apply to the limit set in law (in 2023, $9,100 for individuals, $18,200 for families) and may not have any limit at all. (FAQs About Affordable Care Act Implementation Part 46, June 4, 2021; CCIIO, Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2023 Benefit Year).
On Private Health Insurance Coverage & The Health Insurance Marketplace