Can I go to any doctor or hospital, or am I limited?

It depends on your plan.

Most plans use a “network,” which is a list of doctors and hospitals that agree to lower prices. If you use in-network providers, you usually pay less. If you go out-of-network, you may pay more, or sometimes your plan won’t pay at all.

Here are common plan types and how they work:

  • HMO (Health Maintenance Organization): Use in-network doctors and hospitals. You usually choose a main doctor (PCP) and need a referral to see a specialist.
  • PPO (Preferred Provider Organization): More freedom to see doctors, including out-of-network providers, but you’ll pay more for that flexibility.
  • EPO (Exclusive Provider Organization): In-network only (like HMO), but often no referrals are required for specialists.

Before you enroll, check if your favorite doctor and nearby hospital are in the network. Also look at urgent care centers and labs you might use. A quick search can save you money and stress later on.

If keeping your current doctor is important, write down their name and practice, then compare plans to make sure they’re in-network. That way you won’t be surprised by higher bills.

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