Not all North Carolina health insurance plans are created equal. The size of the insurance company’s coverage network is an important consideration that can often be overlooked when selecting a plan. Each health insurance company that offers a plan through Obamacare has a different coverage network. This means that the doctors and hospitals that the insurance company has contracted with will vary. When buying a health insurance plan during open enrollment this year, be sure to check that doctors in your area will take your health insurance.
What Out-of-Network Means
Doctors who are in-network have an agreement with your insurance company to accept your plan’s contracted rates as payment in full for any medical services you receive. That contracted rate determines the portion of the bill that the insurance company will cover and what portion you will be responsible for paying.
When you see a doctor that is out of your coverage network, you will see higher medical costs than you see when you stay inside your network. Higher rates often occur because:
- Out-of-Network providers have not agreed to a rate for services with your insurer, so often those rates will be higher and you are responsible for paying the difference.
- Many plans have higher co-pays, deductibles, and co-insurance when you seek care out of your network. You will often pay the higher rate on top of the difference between your plan’s allowed amount for the service and the provider’s charge.
- In some cases, you will have to pay the entire cost of the medical bill because you plan does not cover out-of-network care at all.
A routine visit to your doctor that should cost you $10 in-network can quickly turn to $1,000 if you see a doctor outside of your network.
Why Coverage Networks Matter
If you select a plan that has good in-network coverage and choice of doctors in your hometown, most of your routine medical needs will be covered. However, what happens when you get hurt while on vacation at the beach? Or what if your child is diagnosed with a rare disease and you want to seek care from a specialist in a different county or even just a different state?
Having a larger coverage network means more choices when it comes to your health care and better coverage should you move within the state, go on vacation, or travel for work. A qualified North Carolina health insurance agent can help you determine which plans offer the coverage networks you want and need.
If you purchased a plan last year with a limited coverage network or are buying a North Carolina health insurance plan for the first time, Carolina Insurance Professionals can help! Fill out the contact form on the right to schedule an appointment for Open Enrollment this year. During your appointment, we will review your health care options to help you select the plan the best suites your needs!