Question: I went to a doctor who is not in my health plan’s network. What now?
Answer: PPO plans cover some of your out-of-network medical expense. HMO and EPO plans cover only emergency non-network expenses. Generally plans that provide an out-of-network option cover such care at a lower rate, for example a Silver Plan covers 80% of in-network costs after deductible versus only 50% of non-network costs after deductible. In addition, the out-of-network deductible is twice as much as the in-network deductible, $5,000 vs $2,500 for Silver plan. Finally, the annual out-of-pocket maximum for the Silver Plan in-network id $6,800, meaning you are covered 100% after your out-of-pocket expenses on covered items reaches $6,800 in a calendar year. The annual out-of-pocket maximum for the Silver Plan out-of-network is $9,800 and it’s separate from the in-network maximum.