QUESTION

Most of my doctors are in-network but not all. Can I get care out-of-network?

Individuals with no coverage | Comparing Plans: Benefits and Costs
ANSWER

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 that care. You may have a separate deductible to meet for out-of-network care, and/or be required to pay higher co-payments or coinsurance for the care you receive. It’s important to note that the limit on out-of-pocket costs that plans must meet 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 2018, $7,350 for individuals, $14,700 for families) and may not have any limit at all. (81 Fed. Reg. 94058, Dec. 22, 2016).

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