What types of plans usually have out-of-network coverage?

Plans that typically include out-of-network (OON) benefits:

• PPO (Preferred Provider Organization) the most common plan type with OON coverage
• POS (Point of Service) usually includes OON coverage with a referral
• HDHP (High-Deductible Health Plan) often includes OON benefits, and may be paired with an HSA
• EPO (Exclusive Provider Organization) typically does not cover OON care, but exceptions exist

Plans that typically do NOT include OON benefits:

• HMO (Health Maintenance Organization) generally no OON coverage, though some HMOs will pre-authorize OON care if no in-network specialist is available locally
• Traditional Medicare (Parts A & B)
• Medicaid
• Workers’ Compensation insurance

If you are unsure whether your plan qualifies, contact your insurer before filing.