In-network vs out-of-network
The same visit can cost very different amounts depending on whether the doctor is in your plan’s network.
Last checked October 15, 2026 · Written by licensed advisors · Sources are numbered and listed under Notes and sources
The short answer
In-network doctors, hospitals and pharmacies have a contract with your insurer to charge set prices. Out-of-network providers don’t, so you usually pay much more, and on many plans you pay all of it.12
Why it matters for your bill
Your deductible and out-of-pocket maximum usually apply to in-network care. Out-of-network care may not count toward them at all. An out-of-network provider can also bill you for the difference between their price and what your plan pays.34
- Contract prices
- Usually counts toward your deductible and out-of-pocket maximum
- No bill for the difference
- You usually pay much more, often all of it
- May not count toward your deductible or maximum
- The provider can bill you the difference
Protection from surprise bills
Since 2022, the No Surprises Act protects you from surprise out-of-network bills for most emergency care, and for certain care from out-of-network providers at an in-network hospital or surgery center. In those cases you pay your in-network share.5
How to stay in network
Check every doctor, hospital and prescription against the plan’s provider directory before you enroll, and again before planned care. Networks can change from year to year.1
What to do: Send us your list of doctors and prescriptions. We check them against each plan before you choose.
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Obamacare Hotline and/or Medicare Po Polsku are private companies not affiliated with any local, state, or federal government agency. This guide is general information, not tax or legal advice.