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 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 2024, $9,450 for individuals, $18,900 for families) and may not have any limit at all. (45 C.F.R. § 156.130; CCIIO, Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2024 Benefit Year.)

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